Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims

The Relationship Between Secondary Traumatic Stress and Compassion Satisfaction: A Systematic Literature Review

This systematic literature review examines the relationship between secondary traumatic stress (STS) and compassion satisfaction (CS) to identify the state of the science and directions for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to guide the identification and evaluation of studies. Eight academic databases were systematically searched between July and December of 2022 to identify articles and dissertations published in English or Hebrew between 2000 and 2022. Studies were considered for inclusion if they examined the relationship between STS and CS and met an established quality threshold. If studies used a mixed methods approach, only quantitative results were included in the review. The search strategy yielded 537 studies with 33 included in the final review. Findings of this review suggest experiences of high levels of STS can coexist with high levels of CS indicating that people can gain satisfaction from their work and experience STS. Most studies examined the relationship between STS and CS using bivariate analyses with variability found in the direction of the relationship. This variability was also found in multivariate studies included in this review. These findings suggest the need for interventions to address both STS and CS with attention paid to the potential negative impact of emotional contagion and the vulnerability of younger female practitioners. Future research should pay attention to the rigor of the analysis of STS and CS and the exploration of mediating or moderating mechanisms between these constructs.

Listening to other people's traumatic experiences: What makes it hard and what could protect professionals from developing related distress? A qualitative investigation

Listening to people talk about their trauma experiences involves indirect exposure to trauma (IET) and can trigger emotional distress. Existing studies about the risk factors for post-IET distress have methodological limitations and reported inconsistent results, making their findings difficult to meaningfully synthesise. Also, most of them did not focus explicitly on trauma narratives and did not explore qualitatively the opinions and experiences of professionals who work closely with trauma survivors. The present study involved 36 professionals who worked with trauma survivors and used a qualitative design to investigate: (a) the perceived impact of the survivors' accounts, (b) the factors they deemed as important to be psychologically prepared for trauma accounts, and (c) their strategies for coping with IET. The semi-structured interviews conducted yielded rich data that was analysed thematically and organised in 13 subordinate themes, and 4 master themes. Listening to trauma narratives was thought to lead to emotional distress when it challenges the listener's 'basic assumptions' of safety and justice, when the listener has reduced sense of control and operates outside their 'window of tolerance', when empathic responses are too strong, and psychological preparedness for trauma-narratives is perceived as insufficient. Recommendations for future research and implications for practice are discussed.

[Risk Factors for Secondary Traumatic Stress (STS) and Post-Traumatic Stress Disorder (PTSD) in Interpreters with Personal Trauma Experience]

BACKGROUND

Interpreters play a crucial role in the care of refugees. However, little attention has been paid to the mental health of interpreters. Despite increased levels of secondary traumatic stress (STS) and increased prevalence of post-traumatic stress disorder (PTSD) among interpreters in the refugee context, there has been little research on risk factors for STS and PTSD in this population. The aim of this study was to investigate potential risk factors for STS and PTSD symptom severity.

METHODS

A Germany-wide online survey was conducted among interpreters for refugees in 2019. Only those who stated that they had experienced at least one traumatic event were included in the study. The final sample comprises N=83 interpreters. The examination of the potential risk factors (primary traumatic events, traumatic content, and personal refugee background) as well as the interaction between primary traumatic events and traumatic content was carried out using moderated multiple regression.

RESULTS

There was exclusively found a positive association between the number of primary traumatic events for both STS (p=0.003) and PTSD symptom severity (p=0.042).

DISCUSSION/CONCLUSION

In the present study, the number of primary traumatic events experienced was identified as a potential risk factor for STS and PTSD. The institutionalization of preventive measures such as regular supervision, follow-up talks, and interpreter-specific training could make an important contribution to protecting the mental health of interpreters. Further research is needed to gain a better understanding of risk factors for STS and PTSD in interpreters.

"Pouring From an Empty Cup": Manifestations, Drivers, and Protective Factors of Occupational Stress Among Healthcare Providers of Trauma-Informed Care

In the United States alone, 10 million people are affected by family and domestic violence (DV). DV survivors experience many forms of victimization, including physical, psychological, and sexual abuse resulting in trauma. The DV workforce, including healthcare providers, social workers, advocates, and other providers, utilize trauma-informed care in a variety of settings to help DV survivors heal and recover from their traumatic experiences. Given the intensity of DV work and occupational stressors associated with navigating complex survivor cases and systems of care, health and mental health professionals can experience burnout, compassion fatigue, and secondary traumatic stress. The purpose of this qualitative study was to explore how professionals in the DV workforce, including healthcare and mental health professionals, experience and mitigate occupational stress. Twenty in-depth interviews were conducted with DV professionals, who worked in medical settings like urban hospitals as well as DV shelters and rape crisis centers in Boston, MA. A semistructured interview guide was developed, and pilot tested and addressed the following topics including experiences of occupational stress, and mitigators of occupational stress. The interviews were audio recorded, transcribed, and analyzed using a thematic analysis approach. Codes were organized into themes and subthemes, which were reviewed and refined during research team discussions. Risk factors of occupational stress included caseload quantity and intensity, workplace isolation, and length of time in the field. Protective factors spanned individual, interpersonal, and organizational level factors. Participants described various strategies for mitigating occupational stress, including training, supervision, and self-care. Findings from this study have the potential to inform policies and practices among healthcare organizations that support professionals in the DV workforce who work with DV survivors.

Implementing supportive supervision in acute humanitarian emergencies: Lessons learned from Afghanistan and Ukraine

Mental Health and Psychosocial Support (MHPSS) practitioners working in humanitarian contexts are at significant risk of mental health conditions, ultimately hindering the quality and sustainability of their work. Supportive supervision has shown to be effective in improving the wellbeing of MHPSS staff and volunteers and enhancing the effectiveness of MHPSS service delivery. Despite these proven benefits, there is a lack of standardised guidelines to inform supportive supervision within humanitarian contexts. To address this gap, the Trinity Centre for Global Health and the International Federation of the Red Cross Red Crescent Societies' Reference Centre for Psychocosial Support co-developed the 'Integrated Model for Supervision' (IMS) Handbook and supporting tools and led IMS trainings with four humanitarian organisations in Ukraine, Afghanistan, Jordan, and Nigeria from June-August 2021. The subsequent acute humanitarian emergencies that occurred in Afghanistan and Ukraine provided the opportunity to (i) examine the implementation of the IMS in the acute stages of two humanitarian crises and (ii) identify the challenges and lessons learned from this process. This study employed a case study design using semi-structured qualitative interviews with five MHPSS personnel (female: 4; male: 1) who had received training in the IMS and were directly involved in the implementation of supportive supervision using IMS guidelines in either Ukraine or Afghanistan. Results showed that participants identified the key steps needed for the implementation of supportive supervision and reported two significant barriers to implementation including the stress of a humanitarian crisis leading to competing responsibilities and priorities, staff shortages and time constraints as well as the challenge of creating a new supervision structure when none had existed previously. Overall, participants felt that the IMS resulted in improved knowledge, confidence, perceived support, team cohesion, staff wellbeing and was a helpful blueprint to guide the implementation of supportive supervision in humanitarian contexts.

Does Where You Work and What You Do Matter? Testing the Role of Organizational Context and Job Type for Future Study of Occupation-Based Secondary Trauma Intervention Development

Organizational context (e.g., criminal justice, community-based, and healthcare) and job type (e.g., police, social workers, and healthcare providers) may impact the extent of occupation-based secondary trauma (OBST). Survey data collected from a multiphase community-based participatory research project were analyzed from a variety of professionals, who were likely to "encounter the consequences of traumatic events as part of their professional responsibilities" (n = 391, women = 55%, White = 92%). Results document high trauma exposure (adverse childhood experiences [ACEs] and workplace) and OBST-related outcomes (Maslach Burnout Inventory, Secondary Traumatic Stress Scale, post-traumatic stress disorder symptom checklist for DSM-5) for the entire sample with important differences across organizational context and job type. Using multivariate regression, the strongest determinants of suffering, however, were not related to a provider's specific profession but to their number of years on the job and their ACEs (e.g., adjusted R2 = 0.23, b = 2.01, p < .001). Likewise, the most protective factors were not profession specific but rather the provider's age and perceived effectiveness of OBST-related training (e.g., b = 2.26, p < .001). These findings inform intervention development and have implications for rural and other often under-resourced areas, where the same OBST-related intervention could potentially serve many different types of providers and organizations.

Improving Emotional Safety, Coping, and Resilience Among Women Conducting Research on Sexual and Domestic Violence and Abuse

Secondary trauma arises through indirect exposure to trauma through engaging with first-hand accounts and narratives of traumatic events. While a significant amount of research has explored secondary trauma experienced by professionals who work with survivors of trauma, such as clinicians and front-line service providers, there is little research exploring the experiences of secondary trauma among violence researchers who routinely engage with traumatic first-hand accounts through their work. This study qualitatively explored violence researcher's professional experiences of secondary trauma and their perceptions of what enables and constrains their own coping and resilience. Participants were recruited using purposive sampling methods. Semi-structured interviews were conducted online with seven female violence researchers from the United Kingdom. Questions explored participant's experiences of secondary trauma symptoms related to their research, perceptions of their own coping and resilience, and experiences of organizational support that have enabled or constrained their resilience. Data were analyzed thematically using a coding framework applied reflexively across interview transcripts. All participants reported experiencing symptoms of secondary trauma from their work including cognitive disturbances; altered beliefs of themselves, others or the world; and challenges connecting with others. Participants' assessment of their own expertise in violence research did not generally impact their perception of their own resilience. Organizational support for violence researchers was rarely provided and participants felt generally unsupported-left to manage any resultant distress alone. Research organizations and universities should implement trauma-informed policies which positively transform workplace culture, provide peer support spaces, and conduct effective training in order to mitigate psychological harm and promote resilience among violence researchers. Support should be tailored to the requirements of violence researchers, and institutions should develop policies that are specifically attentive to the needs of researchers who also have lived experience of violence and abuse.

A model of hope as a protective measure to lower burnout and secondary traumatic stress among employees working in developmental and intellectual disabilities services

BACKGROUND

Burnout and secondary traumatic stress (STS) are problems for the workforce supporting people with developmental disabilities. This study investigated hope as a potential protective resource for burnout and STS among the developmental disability services workforce.

METHOD

One hundred and fifty-two non-supervisor caseworkers from a state agency, developmental disabilities division were recruited to participate in an anonymous web-based survey.

RESULTS

The analyses showed that hope was negatively associated with the three dimensions of STS (intrusion, avoidance, and arousal) and burnout. Controlling for tenure in the workforce and STS, the results of the hierarchical regression analyses showed that hope accounted for a significant incremental variance to burnout.

CONCLUSION

These findings provide support for emerging literature showing hope as a protective resource to workforce burnout.

Outside the Clinic Door: How Neighborhood Sociodemographic Disadvantage is Associated with Community Therapist Secondary Traumatic Stress and Emotional Exhaustion

Therapists serving families with high rates of trauma exposure in community mental health clinics face the potential risk of experiencing secondary traumatic stress and emotional exhaustion, both of which pose barriers for the implementation and sustainment of evidence-based practices. Previous research documents negative effects of living in socioeconomic disadvantaged neighborhoods on child development but has not examined the effects of working in these neighborhoods on therapist well-being. The current study merges publicly available data, administrative claims data on mental health services, and therapy survey data to 1) identify associations between neighborhood sociodemographic disadvantage and two community therapist well-being constructs, specifically secondary traumatic stress and emotional exhaustion; and 2) examine potential clinic- and therapist-level explanatory factors in the associations between neighborhood sociodemographic disadvantage and therapist well-being. A cumulative risk index approach was applied to calculate neighborhood sociodemographic disadvantage. Greater neighborhood sociodemographic disadvantage was significantly associated with higher levels of therapist secondary traumatic stress (B=.09, p<.05) but not emotional exhaustion. Because therapists in higher risk neighborhoods face higher secondary traumatic stress levels, additional research is needed to better understand how these therapists can be best supported; thus, supporting families receiving treatment and implementation of evidence-based practices.

Navigating the Shadows of Others' Traumas: An In-Depth Examination of Secondary Traumatic Stress and Psychological Distress among Rescue Professionals

Rescue workers, who often find themselves on the frontlines of traumatic events, face an increased risk of experiencing secondary traumatic stress (STS) and psychological distress (PD). The nature of their work, alongside professional factors, can influence the way these psychological aspects manifest and their level of severity. This study aimed to explore the relationship between STS and PD in rescue workers. Additionally, it sought to understand how factors such as age, years of experience, duration of work, training received and direct exposure to trauma explain significant variations in reporting to STS. To conduct this research, a cross-sectional study design was implemented involving a sample of 80 rescue workers from the Punjab province in Pakistan. Data was collected over eight weeks using the secondary traumatic stress scale (STSS-17) and the general health questionnaire (GHQ-12) as primary assessment tools. Participants' data was analyzed through Pearson correlation analysis, t-tests, and ANOVA. A strong positive correlation between STS and PD among rescue workers was established. Age significantly explains variation in scores, with older workers displaying reduced STS and PD symptoms. Rescue workers working for longer hours reported elevated STS compared to those working shorter shifts. Workers with more extended professional experience showcased lower STS, highlighting the potential resilience acquired over time. The study also underscored the importance of training duration: longer, well-structured training was associated with decreased STS and PD. Interestingly, longer exposure to trauma was found to be related to lower STS scores, albeit this warrants further investigation. This study underscores the intertwined nature of STS and PD among rescue workers and the various modulating factors. The study paves the way for more comprehensive research, expanding geographically and demographically.

Testing the effectiveness and acceptability of online supportive supervision for mental health practitioners in humanitarian settings: a study protocol for the caring for carers project

BACKGROUND

Local humanitarian workers in low and middle-income countries must often contend with potentially morally injurious situations, often with limited resources. This creates barriers to providing sustainable mental health and psychosocial support (MHPSS) to displaced individuals. Clinical supervision is an often neglected part of ensuring high-quality, sustainable care. The Caring for Carers (C4C) project aims to test the effectiveness and acceptability of online group-based supportive supervision on the well-being of MHPSS practitioners, as well as service-user-reported service satisfaction and quality when working with displaced communities in Türkiye, Syria, and Bangladesh. This protocol paper describes the aim, design, and methodology of the C4C project.

METHOD

A quasi-experimental, mixed-method, community-based participatory research study will be conducted to test the effectiveness of online group-based supportive clinical supervision provided to 50 Syrian and 50 Bangladeshi MHPSS practitioners working with Syrian and Rohingya displaced communities. Monthly data will be collected from the practitioners and their beneficiaries during the active control (six months) and supervision period (16 months over two terms). Outcomes are psychological distress (Kessler-6), burnout (the Copenhagen Burnout Inventory), compassion fatigue, compassion satisfaction, and secondary traumatic stress (Professional Quality of Life Scale), perceived injustice, clinical self-efficacy (Counseling Activity Self-Efficacy Scale), service satisfaction, and quality (Client Satisfaction Questionnaire and an 18-item measure developed in this project). A realist evaluation framework will be used to elucidate the contextual factors, mechanisms, and outcomes of the supervision intervention.

DISCUSSION

There is a scarcity of evidence on the role of clinical supervision in improving the well-being of MHPSS practitioners and the quality of service they provide to displaced people. By combining qualitative and quantitative data collection, the C4C project will address the long-standing question of the effectiveness and acceptability of clinical supervision in humanitarian settings.

A Socioecological Approach to Understanding Secondary Trauma in Professionals Working with Survivors of Sex Trafficking: A Hierarchical Regression Analysis

Individuals who are trafficked for sex have high rates of trauma exposure prior to and while being trafficked; therefore, professionals who work with this population are potentially exposed to high levels of trauma details increasing their risk of developing secondary traumatic stress (STS). This study investigated the STS symptoms of professionals working with survivors of sex trafficking utilizing a socioecological framework to guide the design and analysis. An online survey was completed by 583 respondents from a broad range of organizational settings who completed measures tapping into STS symptoms, lifetime trauma exposures, history of being sex-trafficked, dose of direct and indirect trauma exposure at work, use of emotional and instrumental support to cope, state report cards on sex trafficking policies, and organizational-level practices toward being STS informed. STS scores among professionals working with survivors of sex trafficking were high, with those in child welfare settings reporting the highest levels of STS. Hierarchical regression analysis indicates higher STS was associated with variables at all levels of the socioecological model except the macrosystem, with fewer years of experience, a history of being sex trafficked, higher dose of indirect exposure, less use of emotional support, and lower organizational STS scores predictive of higher distress. Together, study findings indicate that STS is a significant concern in the anti-trafficking workforce and that a socioecological framework is useful for understanding STS impacts, highlighting the value of multiple response strategies across levels. This analysis suggests that organizational-level strategies to ameliorate/buffer impacts of occupation-related trauma exposure among these professionals can be especially impactful.

Japanese public health nurses classified based on empathy and secondary traumatic stress: variable-centered and person-centered approaches

BACKGROUND

Healthcare providers frequently help traumatized people and are regularly exposed to indirect trauma from their work, resulting in negative psychological responses, such as secondary traumatic stress. Empathy has been associated with patient's quality of care and secondary traumatic stress among healthcare providers. However, the relationship between dispositional empathy and secondary traumatic stress has not been fully elucidated. This study used person- and variable-centered approaches to explore the nature of this relationship.

METHODS

A total of 1,006 Japanese public health nurses working in the Tohoku region and Saitama prefecture completed questionnaires that included scales assessing dispositional empathy, secondary traumatic stress, and burnout. First, we examined predictors of secondary traumatic stress using multiple linear regression analysis. Then, we conducted a latent profile analysis to classify participants into unique groups based on four subscales of dispositional empathy (i.e., empathic concern, perspective taking, personal distress, fantasy) and secondary traumatic stress. Finally, we compared the mean values of the study variables across these groups.

RESULTS

The multiple regression indicated that in those working in Saitama prefecture, lifetime traumatic experiences, work-related distress, and personal distress were positively related to secondary traumatic stress, but perceived support was negatively related to secondary traumatic stress. Latent profile analysis extracted four unique subgroups. Group 1 displayed the highest secondary traumatic stress levels. Group 2 was characterized by the highest level of empathic concern, personal distress, and fantasy and the lowest perspective taking. Group 3 had a moderate secondary traumatic stress level. Group 4 had the lowest secondary traumatic stress and personal distress scores. In these four groups, the burnout scale (exhaustion, cynicism, and professional efficacy) showed a pattern similar to the secondary traumatic stress scale.

CONCLUSIONS

Our person-centered approach showed that this sample of public health nurses could be classified into four unique groups based on their empathy and secondary traumatic stress scores. Although this group of public health nurses was not large, one group displayed high personal distress levels and high secondary traumatic stress levels. Further research is needed to determine effective interventions for this group.

TF-CBT Training Augmented with a Self-Care Focus: Understanding Facilitators and Barriers to Treatment Implementation

Clinicians working with youth exposed to trauma may be at increased risk for experiencing elevated levels of stress and symptoms of secondary traumatic stress, which can negatively impact clinician wellbeing and ultimately contribute to reduced access to quality care for clients. An innovative Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training incorporating self-care practices (i.e., Practice What You Preach; PWYP) was developed to help facilitate the implementation of TF-CBT and to enhance clinicians' coping and decrease stress. The primary purpose of this study was to determine whether the PWYP-augmented training met three Objectives: (1) increase clinicians' feelings of TF-CBT competency; (2) improve clinicians' coping abilities/reduce clinicians' stress; and (3) increase clinicians' insight into the benefits and/or challenges clients may experience in treatment. An exploratory aim was also developed to identify additional facilitators and barriers of TF-CBT implementation. The written reflections of 86 community-based clinicians who participated in the PWYP-augmented TF-CBT training were examined using qualitative methods. The majority of clinicians indicated increased feelings of competency and improved coping abilities and/or stress levels; almost half mentioned increased insight into clients' experiences. The most frequently mentioned additional facilitators were related to elements of the TF-CBT treatment model. Anxiety/self-doubt was the barrier most frequently mentioned, though all clinicians who mentioned this barrier indicated it lessened or resolved over the course of the training. Incorporating self-care strategies into trainings may serve as a facilitator for TF-CBT implementation by enhancing the competency and well-being of clinicians. The additional insights into barriers and facilitators can be used to further improve the PWYP initiative and future training and implementation efforts.

A nervous wait: Instagram's sensitive-content screens cause anticipatory anxiety but do not mitigate reactions to negative content

Online platforms like Instagram cover potentially distressing imagery with a sensitive-content screen (blurred imagery plus a content warning). Previous research suggests people typically choose to "uncover" and view screened content. In three studies, we investigated whether the presence of screens mitigates the negative emotional impact of viewing content. In Study 1, participants viewed positive and neutral images, and screens (with an option to view the negative images beneath) for a 5-minute period. In Study 2, half the participants saw a grey mask in place of the typical sensitive-content screen. In addition, each image appeared for a fixed period (5 s) and participants had no option to uncover it. Study 3 was like Study 2 except half the participants saw negative images preceded by a sensitive-content screen and half saw negative images without screens. Overall, participants reported a significant increase in state anxiety and negative affect from pre-to post task when they were exposed to sensitive-content screens, whether or not they were also exposed to the negative imagery beneath. Our data suggest sensitive-content screens cause negative responses - state anxiety and negative affect - that do not translate to an emotional benefit when people view negative content.

Long-Term Consequences of War Captivity in Military Veterans

Numerous studies on the health and functioning of veterans and former prisoners of war have shown that the experience of war captivity is one of the most difficult human experiences. Captivity is often characterized by extremely difficult and inhumane conditions, as well as exposure to various forms of both psychological and physical abuse. Such traumatic experiences can lead to serious psychological consequences that can last for years, even decades after release from captivity. The aim of this paper is to present a brief overview of research that points to the specifics of wartime captivity and the long-term psychological consequences in veterans of former camp detainees, as well as the consequences suffered by their families and factors that, apart from the intensity of the trauma, contribute to the emergence and persistence of psychological disorders. From the presented research, it can be concluded that former prisoners of the camp represent an extremely vulnerable group of the social community and require long-term appropriate treatment, while the needs of veterans' families should not be neglected, with the necessity of including spouses and children in psychological and psychosocial treatments.

Are reframing strategies more effective than empathy in processing trauma reports? A pilot study

Listening to trauma reports can lead to the development of symptoms associated with secondary traumatization. This is particularly relevant for psychotherapists in practice, where psychologists need to estabilish effective strategies for processing and coping with such emotionally challenging events. This explorative study investigated adaptive reframing strategies for future therapists listening to trauma stories compared to feeling empathy for the client. In a mixed design, 42 postgraduate psychology students were randomly instructed to objectively distance themselves, reappraise, or feel empathetic while watching a video of a presumed trauma patient reporting a single violent act. An overall ANOVA did not reveal a difference between the reframing groups and the empathy group (between subjects manipulated) in their skin conductance level and heart rate variability during the video, as well as their change in state depression and state anxiety over the three measurements (before the video, after the video, and 2 days later). Nevertheless, an explorative t-test showed a significantly weaker rise in state depression and state anxiety from before the video to after the video in the reframing groups compared to the empathy group. This supports the suggestion that reframing strategies can be discussed as a protective factor against health issues such as secondary traumatization in therapists and should be examined in further studies in more detail.

Psychological Effects of Professional Exposure to Trauma and Human Suffering: Systematic Review and Meta-Analysis

Over the past decades, a growing interest has emerged toward understanding the impact that the exposure to human suffering produces in mental health professionals, leading to the identification of three constructs: vicarious traumatization (VT), compassion fatigue (CF), and secondary trauma (ST). However, little is known about how these conditions affect psychologists. A systematic review and a meta-analysis were conducted to examine the evidence about the effects of occupational exposure to trauma and suffering in studies that included psychologists among their samples. Fifty-two studies were included comprising 10,233 participants. Overall, the results showed that most professionals did not experience relevant distress due to their work, yet some of them developed clinically significant symptoms (i.e., PTSD). However, solid conclusions could not be drawn due to the numerous methodological difficulties found in this research field (i.e., group heterogeneity, lack of comparison groups, and conceptual overlap). Thus, it is necessary to further investigate this topic with scientific rigor to understand these stressors and develop evidence-based interventions.

Psychological distress among teaching staff during the COVID-19 pandemic: A transdiagnostic perspective on profiles of risk and resilience

Teaching staff are especially vulnerable to COVID-19-related stress, due to the significant demands they have experienced. Yet, many have shown resilience-good mental health despite stress exposure. The current study used a person-centered approach to identify distinct profiles according to individual differences in psychosocial risk and protective factors. Latent Profile Analysis and ANOVAs were employed among 350 Israeli teaching staff during the fourth wave of COVID-19. Two distinct profiles, "risk" (55%) and "resilience" (45%) were identified. While groups showed no differences in COVID-19-related stress outcomes, they consistently differed in their psychological reaction to COVID-19 (psychopathology, compassion fatigue, and compassion satisfaction).

Secondary Institutional Betrayal: Implications for Observing Mistreatment of Sexual Assault Survivors Secondhand

Institutional betrayal has been used to describe the experiences of sexual assault survivors who are harmed by institutions which they rely on for safety or survival. This concept has primarily been studied in the context of survivors' direct relationships with institutions they are members of (e.g., universities, churches, military) and how the said institutions either failed to protect them or were unsupportive following their disclosure. Institutional betrayal can exacerbate negative mental and physical health outcomes for survivors, highlighting a need to hold institutions accountable for harm they cause. A limitation to this conceptualization is that many adults in the general public are not proximally connected to institutions (as they have historically been defined), and the majority of survivors do not formally report. Drawing on semi-structured interviews conducted with young women survivors (n = 12), the present study aims to address this gap by abstracting the conceptualization to a more macro level, proposing the term secondary institutional betrayal. Secondary institutional betrayal refers to survivors' feelings of mistrust and disillusionment toward institutions they are distally connected to which are not directly involved in their own assault (e.g., the media, U.S. government, U.S. criminal legal system, their university), yet still have influence over their personal safety and survival. This sense of betrayal stems from secondhand observations, through the news media, of how other survivors are treated by these institutions. Many survivors in the present study reported their secondhand observations of institutional betrayal would likely deter them from reporting future assaults. Establishing research in this area is important to understand how survivors in the general public are impacted by news stories which highlight institutional betrayal, particularly in the context of ongoing social movements (e.g., #MeToo) which amplify public discourse about sexual assault.

Transforming Empathy-Based Stress to Compassion: Skillful Means to Preventing Teacher Burnout

Objectives

Teachers play a critical role in preparing our children and adolescents for a successful future. However, despite the large number of students impacted by trauma and adversity, teachers are often not well prepared to provide trauma-sensitive support. Furthermore, while working to support students exposed to trauma and adversity, teachers may experience empathy-based stress exacerbating already high levels of stress among them. This narrative review explores the issue of empathy-based stress within the context of the prosocial classroom model which proposes that teachers' social and emotional competence and well-being are key to their ability to create and maintain supportive learning environments critical to student academic and behavioral outcomes.

Methods

Recent findings in neuroscience and education research are applied to support teachers' development of these competencies.

Results

We propose that shifting from empathy-based stress to compassionate responding may be one such competency to help teachers' respond effectively to their students' needs while protecting their own wellbeing.

Conclusion

We review research that supports this proposition and explore implications for teacher professional learning, educational policy, and further research.

The role of cognitive flexibility in moderating the effect of school-related stress exposure

Educators are exposed to various stressful events as part of their ongoing work, including violence, sexual assaults, suicidal behavior, and loss or illness of students or their family members. Previous studies revealed an increased risk of developing PTSD symptoms in healthcare and supportive professionals exposed to repeated stress as part of their work. Cognitive flexibility might be a protective factor against the negative effect of such stress. The current study aimed to examine the interactive effects of school-related stress exposure and cognitive flexibility on the tendency to develop Post Traumatic Stress Disorder (PTSD) symptoms and the coping abilities of educators. One hundred and fifty educators (86.5% female; M_age = 43.08, M_{teaching_experience} = 12.90) volunteered to participate in this study. They completed questionnaires measuring levels of stress exposure, cognitive flexibility, coping ability, and PTSD symptoms. Analyses revealed that cognitive flexibility moderated the relationship between school-related stress exposure and both PTSD symptoms severity and maladaptive coping. Specifically, whereas educators with low cognitive flexibility exhibited positive associations between continuous stress exposure and both levels of PTSD symptoms and maladaptive coping, no such association was found among educators with high cognitive flexibility. The results highlight the importance of cognitive flexibility as a protective factor against the harmful effects of possible stress exposure in school environments. Awareness of the crucial role of cognitive flexibility as a protective factor for educators can be a breakthrough in improving educators' well-being and adaptive functioning.

Prevalence and factors associated with compassion fatigue, compassion satisfaction, burnout in health professionals

BACKGROUND

Constant exposure of health professionals to the pain and suffering of patients can adversely affect their emotional wellbeing.

AIM

The study aimed to investigate the prevalence and the factors affecting the levels of secondary traumatic stress/compassion fatigue (STS/CF), burnout (BO) and compassion satisfaction (CS) of health professionals working in adult and paediatric Intensive Care Units (ICU) as well as in departments treating patients with serious illness in five hospitals in Crete.

STUDY DESIGN

A descriptive cross-sectional survey with the use of the Professional Quality of Life Scale (ProQOL-CSF-R-IV) questionnaire.

METHODS

We enrolled medical, nursing and support staff working in the adult and paediatric ICU, emergency, oncology, haematology and neurosurgical departments, haemodialysis unit and operating theatre.

RESULTS

598 health professionals completed the questionnaire (response rate 73.2%). Significantly increased levels of STS/CF were observed in non - ICU as compared to ICU staff (p = .009) females compared to males (p < .001), those who have previously experienced a traumatic event (p < .004), nurses and support staff compared to doctors (p = .007 and p = .028 respectively), and people not working in a department by choice (p < .001). CS was higher for older professionals, personnel subjected to stress reduction techniques (p < .019) and professionals working with children or mixed adults and children population (p = .009). Rolling schedule and bad working conditions negatively affected CS (p = .02, p = .001). Increased BO levels were associated with younger age (p = .029) and showed a positive correlation with STS/CF (r = .356, p < .001).

CONCLUSIONS

STS/CF is common in health professionals regardless of their profession, working department or hospital level. Non-ICU staff displayed higher STS/CF levels. Working in a department by choice ameliorates CS, BO and STS/CF.

RELEVANCE TO CLINICAL PRACTICE

Health professionals need to be informed about the risks of projecting patients' suffering on themselves. Hospital managers and department heads are responsible to provide appropriate support.

[Psychological impact of involvement of medical and psychological emergency unit professionals in the medical and psychological care system of the COVID-19 epidemic]

Objectives

COVID-19 pandemic and its consequences have put into great difficulty health professionals, and the general population, fostering the emergence of various psychological and psychiatric disorders. Medical and psychological emergency units' mission is the medical and psychological emergency care of people impacted during a traumatic event. Given their expertise in crisis management, they set up an important medical and psychological support system adapted to the health crisis' characteristics. The unusual modalities of intervention, the specific clinic that these professionals faced in this context of great tension may have unsettled workers and generate a psychological impact. This study aims to assess the existence of such repercussions among medical and psychological emergency unit professionals involved in this new system.

Method

In all, 313 medical and psychological emergency unit professionals agreed to participate at the online survey. They filled surveys and visual analog scales assessing the difficulties encountered in the system, as well as their level of satisfaction, post-traumatic stress, burnout, level of anxiety and depression and coping strategies put in place.

Results

Results show few significant emotional difficulties. However higher scores are found among women, among professionals who felt a negative impact on their personal lives, as well as for those who thought they had been infected with COVID-19. The establishment of coping strategies such as active coping, planning, expressing feelings, positive reinterpretation and acceptance helped to decrease the level of emotional complexities and brought more compassionate satisfaction. We note that participants with more medical and psychological emergency unit experience tend to show less emotional hardship and more compassionate satisfaction. It appears that older as well as younger professionals have lower burnout scores, as do workers who conducted more interviews for the same person. Likewise, participants who were satisfied of the system organization and of the support - a majority in this study - report less emotional challenges and more compassionate satisfaction.

Conclusion

Psychological impact in this new system among medical and psychological emergency unit professionals is overall low. It appears that some coping strategies, perceived usefulness, satisfaction with the organization and the received support are associated with a lower level of emotional difficulties. A supportive framework and an operative organization of the medical and psychological emergency unit system in times of crisis has a protective effect on the participants.

The effect of the COVID-19 pandemic on front-line nurses' professional quality of life

BACKGROUND

Front-line nurses caring for patients with coronavirus disease 2019 (COVID-19) experience stressful and traumatic working conditions, which may affect their professional quality of life.

AIM

To identify the effect of COVID-19 on front-line nurses' professional quality of life, specifically on their levels of compassion satisfaction, burnout and secondary traumatic stress.

METHOD

A descriptive, cross-sectional comparative design was adopted. Data collection tools included self-reported sociodemographic and work-related characteristics and the self-report Professional Quality of Life Scale (ProQOL). Questionnaires (n=200) were distributed by email to two groups of nurses working in a government hospital in Saudi Arabia: front-line nurses who cared for patients with COVID-19 in isolation units; and front-line nurses who cared for patients without COVID-19 in inpatient units.

RESULTS

Completed questionnaires were received from 167 respondents, a response rate of 84%. Moderate levels of compassion satisfaction, burnout and secondary traumatic stress were found regardless of respondents' involvement in caring for patients with COVID-19. There was no statistically significant difference between the two groups in terms of compassion satisfaction, burnout and secondary traumatic stress.

CONCLUSION

The COVID-19 pandemic presents a new challenge for front-line nurses, necessitating appropriate interventions to avoid burnout and secondary traumatic stress.

The role of secondary traumatic stress breakthrough champions in reducing worker trauma and improving organizational health using a configurational analysis approach

Background

Emerging research has demonstrated that organizational efforts at becoming secondary traumatic stress (STS)-informed can improve the overall well-being of the workforce, especially when implementation activity by a champion team is high. Questions remain, however, regarding the mechanisms that enable these improvements.

Method

This study uses configurational analysis to determine necessary and sufficient conditions to produce reductions in STS symptoms in workers as well as organizational improvements toward being more STS-informed in a cohort survey of 6,033 professionals working with individuals exposed to trauma representing 52 organizations. The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA) was used to measure professional's perceptions of how well the unit addressed secondary trauma in the workplace, and the Secondary Traumatic Stress Scale (STSS) assessed traumatic stress symptoms in respondents. Champions' activity was scored using the categories suggested by Shea.

Results

For the STSS outcome, either a STSI-OA positive increase of 10 or more points or high levels of champion problem-solving were independently sufficient for an improvement in the outcome. The STSI-OA model had two pathways: high levels of peer engagement via the scaling up of innovations using PDSAs or the combination of facilitation of peer knowledge and skills together with working in a child welfare organization. Either pathway was sufficient by itself to yield the STSI-OA outcome.

Conclusions

Identifying and cultivating the champions' use of problem-solving and peer engagement strategies can transform the threat posed by indirect trauma exposure into an opportunity for shared experience and healing.

Plain Language Summary

Organizational champions are individuals or teams that strive to promote change within their workplace. These champions are integral to spreading innovative ideas and strategies and creating organization-wide changes ( Powell et al., 2015). However, little is known about the processes or specific strategies that make champions successful. One area in which champions are needed is in improving organizations' response to and understanding of secondary traumatic stress (STS), among those in helping professions that are indirectly exposed to trauma through the traumatic stories of those they work with. In fact, research has shown that organizational efforts to address STS improve the well-being of individual professionals within that organization ( Sprang et al., 2021). The present study sought to better understand what champion-related processes or conditions led to organizational change in addressing the effects of indirect exposure and improving symptoms related to STS. Results showed that organizational change in addressing STS and champions' problem-solving strategies resulted in reductions in individual professionals' STS symptoms. Furthermore, champions' use of peer engagement or sharing of knowledge among peers in child welfare settings led to improvements at an organizational level. These results show that organization-level change can have a direct impact on individual well-being and there are specific champion activities that can promote this change. Specifically, results demonstrate a need to identify and support champions' use of problem-solving and peer engagement strategies to turn the individual and organizational threat posed by indirect trauma into an opportunity for shared healing.

Identifying child protection workers at risk for secondary traumatization: A latent class analysis of the Professional Quality of Life Scale-5

Secondary traumatization (ST) is a topical area among trauma-exposed employees, where many are at risk of occupational mental health problems due to their work with trauma survivors. Challenges related to the accurate operationalization of ST symptoms persist, and there is no valid method for identifying employees at risk of clinically significant symptom levels. This study aimed to test the applicability of latent class analysis (LCA) to identify employees at risk for clinically relevant ST symptoms. LCA was used to identify patterns of ST symptom endorsement using the Professional Quality of Life Scale-5 (ProQoL) in a national sample of Danish child protection workers (CPW; N = 545). Predictors and associated levels of distress and functional impairment across the symptom presentations were tested using regression analysis, and three classes were identified. A total of 3.8% (n = 21) of participants were at high risk of endorsing symptoms of ST that were associated with significant levels of distress and increased functional impairment. The LCA approach outperformed existing scoring procedures in differentiating between employees with varying levels of distress, impairment, and well-being. A minority of Danish CPWs are at risk for levels of ST that may be considered clinically significant for their associations with anxiety and social and cognitive impairment. Although the ProQoL is not a diagnostic tool, per se, a revised scoring procedure may render the measure useful when screening for employees who are at risk for levels of distress and impairment that require intervention.

The experience of secondary traumatic stress among community violence interventionists in Chicago

Community violence intervention strategies are rising in prominence as promising alternatives to traditional criminal justice responses to gun violence. Although such approaches may offer policy advantages and yield societal benefits, the costs to the practitioners of this work-owing to the intimate proximity to violence required by the job-have generally been overlooked. Using a first of its kind survey of nearly the entire population of community-based violence interventionists in Chicago, Illinois (United States), this study assesses the extent to which violence intervention workers experience Secondary Traumatic Stress (STS). Responses to a series of 17 items on a Secondary Traumatic Stress Scale revealed alarmingly high levels of STS among violence interventionists: 94% of workers reported at least one STS indicator in the past 7 days and a full 50% reported experiencing 9 out of the 17 STS items. Our analysis further showed that the STS responses of interventionists were impacted by on-the-job traumatic experiences, particularly the death of a client. These results offer an important first systematic analysis of the trauma and mental health risks associated with community violence intervention practice and suggest that policymakers and practitioners should monitor and address worker risk of traumatic stress within this important public health profession.

Vicarious Trauma Scale: Psychometric Properties in a Sample of Social Workers from Spain

As a result of secondary exposure to traumatic material, social workers may experience vicarious trauma. However, the analysis of this variable among social workers is scarce. The Vicarious Trauma Scale (VTS) is a brief instrument designed to measure the stress consequence of shared trauma. This study aims to examine the psychometrics of the VTS in a sample of 448 social workers from Spain. The results from the exploratory and confirmatory factor analyses (EFA and CFA) indicated that the VTS has satisfactory psychometric properties. Different indices of internal consistency supported the reliability of the VTS. Both EFA and CFA revealed the existence of two factors, corresponding to the cognitive and affective consequences of secondary exposure to trauma. Finally, the correlations of the VTS with other relevant and well-known job variables (workload, work-family conflict, detachment, supervisor support, burnout, and engagement) followed the expected pattern, and the VTS differentiated the social workers by their trauma caseload. Therefore, the VTS can be considered an adequate screening method of social workers' vicarious trauma, and its application recommended to examine the possible risk and protective factors and consequences.

Trauma-Informed Supervision and Related Predictors of Burnout and Secondary Traumatic Stress Among Prelicensed Counsellors During the COVID-19 Pandemic

In the current study, we examined individual factors, organizational factors, COVID-19 anxiety, and trauma-informed supervision as predictors of prelicensed counsellor burnout and secondary traumatic stress (STS). In a sample of 282 prelicensed counsellors, we conducted two hierarchical regression analyses for counsellor burnout and STS. The variables of interest accounted for 38% of the variance in counsellor burnout and 32% of the variance in counsellor STS. In the model of counsellor burnout, statistically significant variables included age, caseload, setting, COVID-19 anxiety, and trauma-informed supervision. For STS, statistically significant predictor variables were age, caseload, COVID-19 anxiety, and trauma-informed supervision. Implications of the findings for prelicensed counsellors, supervisors, and counselling researchers are discussed.

Coping with Secondary Traumatic Stress

Exposure to the traumatic experiences of others can lead to secondary traumatization (STS), a condition comprising trauma-related symptoms. There is a lack of evidence on efficient ways to mitigate STS among professionals working with refugees, who are secondarily exposed to traumatic content. This study examines the latent structure of coping mechanisms and explores the predictive power of coping strategies for STS in a sample of professionals working with refugees. A total of 288 participants (age: M = 34.01, SD = 10.03; 57.3% female) working with refugees completed the COPE Inventory and Secondary Traumatic Stress Scale. Factor analysis of the COPE Inventory showed that coping mechanisms are grouped around four interrelated factors-Problem-focused, Socially supported emotion-focused, Avoidant, and Passive coping-which accounted for 46.7% of the variance. The regression model showed that Avoidant coping positively predicts negative alterations in cognition, mood, and reactivity (NACMR) and intrusions, and Passive coping was positively associated with NACMR and avoidance. Problem-focused coping was related to lower NACMR and avoidance, while Socially supported emotion-focused coping was not associated with any of the STS symptoms. In total, coping factors accounted for 10.8%, 6.3%, and 4.3% of the variance of NACMR, intrusions, and avoidance, respectively. The study provides a foundation for programs to mitigate STS among professionals working with refugees.

Secondary trauma, burnout and resilience among mental health professionals from India: A review of research

While globally there has been growing research interest in the negative psychological consequences faced by helping professionals, literature among Indian Mental Health Professionals (MHPs) is sparse, and predominantly focussed on health care workers. This systematic review aims to synthesize and summarize current Indian literature on burnout, secondary traumatic stress and resilience among Indian MHPs. The review explores 14 research studies published in peer-reviewed journals between January 2005 to January 2022. Studies in the areas of secondary traumatic stress, burnout, vicarious trauma, compassion fatigue, and resilience have been included in the review. The term resilience within this paper includes compassion satisfaction, vicarious post-traumatic growth, well-being, coping, and stress management. The mental health professionals considered were psychiatrists, psychiatric nurses, psychiatric social workers, clinical psychologists, psychotherapists and counsellors. Studies were reviewed for their methodological considerations, the mental health population being studied, and the primary outcomes. Data related to sociodemographic variables, psychological impacts, risk and protective factors that influence burnout, secondary trauma and resilience among mental health professionals in India have been reported. The review summarizes conceptual, methodological, and analytical gaps and generates recommendations that contribute to theoretical and practice-based improvements in this area of research and practice.

A comparison of interpreters' wellbeing and work-related characteristics in the care of refugees across different work settings

Background

Interpreters in the care of refugees work in various different settings. Qualitative studies suggest that interpreters are confronted with a variety of demands depending on the context in which they work, which may in turn influence their wellbeing. To date, no larger-scale study has investigated differences between work settings regarding interpreters’ work-related characteristics or wellbeing.

Objective

The aim of this study was to compare the work-related characteristics and possible changes in the wellbeing of interpreters between four main work settings (psychotherapy, counselling, medical setting, and authorities) in the care of refugees.

Method

Interpreters in refugee care were recruited for a nationwide online survey in Germany with two measurement time points. Participants provided socio-demographic data and answered questions about the working conditions in their respective main work setting. In addition, psychological distress (Brief Symptom Inventory, BSI-18), work-related exhaustion (Copenhagen Burnout Inventory, CBI), and compassion satisfaction (Professional Quality of Life, ProQOL) were assessed.

Results

Overall, 158 interpreters were included at t1, of whom 63 were also included at t2. Significantly more traumatic content was interpreted in counselling settings and psychotherapy than in medical and authorities settings (H (3) = 26.09, p < .001). The highest proportion of interpreters with an interpreting degree worked in the authorities setting (Fisher’s exact test, p = .002). Significant differences between the four settings were found for psychological distress (Kruskal–Wallis-test, H (3) = 12.02, p = .01) and work-related exhaustion (Kruskal–Wallis-test, H (3) = 8.10, p = .04) but not for compassion satisfaction.

Conclusion

The presented results indicate differences regarding working conditions, psychological distress, and work-related exhaustion between different work settings of interpreters. Future studies may explore each setting in greater detail and include a larger sample size to reach a better understanding of the relationship between setting-specific challenges and interpreters’ wellbeing.

Trauma-informed attitudes in residential treatment settings: Staff, child and youth factors predicting adoption, maintenance and change over time

BACKGROUND

Little is known about the benefits of implementing trauma-informed care (TIC) training programs for child welfare workers serving in out-of-home treatment settings, or about how staff, child and youth characteristics affect adoption of favorable attitudes towards TIC.

OBJECTIVE

This study aimed to understand how attitudes towards TIC changed over time for child welfare workers receiving training and monthly supervision sessions.

PARTICIPANTS AND SETTING

Child welfare workers (n = 429) serving juveniles mandated to protection or offender units (ages = 3-20 years), across 11 child protection agencies in Quebec, Canada.

METHODS

Participants completed the ARTIC-35 at pre-training, 6 months post-training, and 1 year follow-up. Multilevel mixed effect regression models were fit to examine outcomes for all subscales.

RESULTS

Participants reported small improvements in attitudes towards TIC at post-training and 1 year follow-up for subscales related to problematic child/youth behavior (β = 0.23-0.32, p's < 0.001). Multilevel modeling revealed that age group (adolescent), unit gender (boys) and legal mandate (offender) predicted higher pre-training TIC ratings for staff in management versus frontline positions across three subscales related to problematic child/youth behavior (β = 0.77-0.93, p's < 0.05) and two subscales related to trauma work and support needs (β = 0.66/0.84, p's < 0.05).

CONCLUSIONS

Results extend previous research demonstrating an association between TIC training and improved attitudes towards TIC over time, and highlight specific contexts in which frontline staff may experience more difficulty applying TIC-based principles than colleagues in management positions.

Economic Precarity, Financial Strain, and Job-Related Stress Among Philadelphia's Public Mental Health Clinicians

OBJECTIVE

Efforts to improve mental health treatment delivery come at a time of rising inequality and cuts or insufficient increases to mental health funding. Public mental health clinicians face increased demands, experience economic stress, and treat underresourced patients disproportionately burdened by trauma. The authors sought to understand clinicians' current economic and psychological conditions and the relationship of these conditions to the delivery of an evidence-based intervention (EBI) designed to treat posttraumatic stress disorder among youths.

METHODS

In July 2020, 49 public mental health clinicians from 16 Philadelphia clinics who were trained in an EBI, trauma-focused cognitive-behavioral therapy (TF-CBT), were surveyed by e-mail. Respondents reported on their economic precarity, financial strain, burnout, secondary traumatic stress (i.e., the stress response associated with caring for people exposed to trauma), and TF-CBT use. Associations between clinicians' job-related stressors and their use of TF-CBT were examined with mixed models. Content coding was used to organize clinicians' open-ended responses to questions regarding financial strain related to the COVID-19 pandemic.

RESULTS

Clinicians' economic precarity, financial strain, and job-related stress were high; 37% of clinicians were independent contractors, 44% of whom wanted a salaried position. Of 37 clinicians with education debt, 38% reported owing ≥$100,000. In the past year, 29% of clinicians reported lack of personal mental health care because of cost, and 22% met the cutoff for experiencing secondary traumatic stress symptoms. Education debt was negatively associated with use of TF-CBT (p<0.001).

CONCLUSIONS

The stress of providing care in underresourced clinical settings may interfere with efforts to integrate scientific evidence into mental health care.

Distress Tolerance and Emotion Regulation as Potential Mediators Between Secondary Traumatic Stress and Maladaptive Coping

The extant literature has illustrated that protective service workers experience negative repercussions associated with their job (including the development of secondary traumatic stress; STS) and may utilize maladaptive coping mechanisms. Developing an improved understanding of factors that might explain the relationship between STS and the utilization of maladaptive coping mechanisms is warranted. This study sought to examine emotion regulation and distress tolerance as potential mediators between STS and the utilization of maladaptive coping mechanisms. Participants were 152 elder protective service workers and 105 child protective service workers who completed an online survey of self-report measures of emotion regulation, distress tolerance, STS, and coping behaviors. A parallel multiple mediator model was analyzed using structural equation modeling (SEM) to examine the hypothesis that distress tolerance and emotion regulation would mediate the relationship between STS and the utilization of maladaptive coping. Our hypothesis was partially supported as the effect of STS on maladaptive coping was mediated by emotion regulation but not by distress tolerance. The results from this study have both prevention and intervention implications. From a prevention perspective, efforts could be directed at teaching emotion regulation skills to those at risk for developing STS as a mechanism for decreasing the probability of denial, substance use, behavioral disengagement, and self-blame that may occur as a consequence of STS. From an intervention perspective, some of the negative sequelae of exposure to STS may be averted by teaching EPS and CPS workers who present with STS symptoms, emotion regulation skills.

Developing a Response to Secondary Trauma for American Indian and Rural Service Providers

How can victim service providers, the organizations they work for, and the communities they serve help respond to the issue of occupation-based secondary trauma? Over the last few years, federal agencies in the United States have spent millions in research and programming to answer this important scientific and policy question. The current study builds on this work by describing and evaluating a community-based participatory research project focused on finding manageable, effective, sustainable, and ethical ways to respond to occupation-based secondary trauma in two separate communities: a rural American Indian community, Blackfeet Tribal Nation, and a predominantly white county in Montana, Gallatin County, United States. Findings from evaluation questionnaires (n=178; 80.10% women; 64.60% American Indian; 29.14% White) representing a wide range of occupations document that: (1) the implementation of the project was successful; (2) toolkits created for the project were useful to both individual participants and organizations; (3) training outcomes improved significantly; and (4) findings were consistent across the two different community contexts. Contributions, lessons learned, and future directions are discussed.

Secondary Traumatic Stress, Depression, and Anxiety Symptoms Among Service Providers Working with Syrian Refugees in Istanbul, Turkey

This paper examines the mental health of service providers working with Syrian refugees. Using the Professional Quality of Life framework, we hypothesize greater stress/less support from the work, person, client environment is associated with symptoms of STS, depression, and anxiety. We surveyed a sample of 104 service providers throughout Istanbul late 2018. Multivariable logistic regression examined associations between work (organizational support, caseload, supervision), person (perceived social support), client environment (trauma disclosure, percent Syrian refugees) on STS, depression, and anxiety. We found rates of moderate-to-severe STS to be 27.88%; depression 40.38%; and anxiety 29.81%. Our hypothesis was partially supported. Lower organizational support was associated with moderate-to-severe STS (aOR 0.91, 95% CI 0.84, 0.99) while lower social support with anxiety (aOR 0.89, 95% CI 0.81, 0.99). Caseload, supervision, trauma disclosure, percent refugees did not show significant associations. Organizations working with Syrian refugees may benefit from enhancing organizational support and promoting social support for staff.

Identifying best practice for the supervision of mental health and psychosocial support in humanitarian emergencies: a Delphi study

Background

Supportive supervision has been shown to improve worker resilience and wellbeing, which are particularly important in the context of humanitarian emergency settings. Despite its noted importance however, supervision remains an under-prioritised area in mental health and psychosocial support (MHPSS).

Method

The present study used a Delphi consensus-building methodology to examine levels of agreement among a diverse sample of MHPSS stakeholders (n = 48) on key ideas and concepts relating to supervision in humanitarian settings.

Results

The majority of statements presented showed a high degree of consensus, with some receiving almost universal agreement, such as the importance of using active listening skills in the supervisory context and the need for supervisors to have access to their own supervisory support. However, disagreement on several points remained. For example, participants disagreed about whether the qualities required to be an effective supervisor can be taught, or whether they are more innate and should be screened for when recruiting supervisors. Gender differences in responses were also analysed, with potential associations between gender and level of agreement emerging in relation to statements about power dynamics, remote supervision, and intervention quality enhancement.

Conclusions

The findings of the present study are discussed in terms of their implications for a forthcoming set of guidelines for supervision of MHPSS in humanitarian settings: The Integrated Model for Supervision (IMS).

Resilience Predicts Lower Anxiety and Depression and Greater Recovery after a Vicarious Trauma

This study validated the French version of the Brief Resilience Scale (BRS-F) and tested the protective role of resilience in the context of vicarious trauma (22 March 2016 terrorist attacks in Brussels) regarding anxiety and depression symptoms. Confirmatory factor analyses indicated a single-factor structure of the BRS-F. Investigation of convergent validity showed that the BRS-F was positively correlated with usual outcomes such as subjective happiness, acceptance, and sense of coherence, and negatively correlated with anxiety and depression symptoms. Lastly, the results of the study showed that resilience protected against the effect of vicarious trauma in two ways. First, at the time of exposure, the more resilient individuals reported lower levels of anxiety and depression symptoms. Second, after three months, the more resilient individuals recovered from these symptoms, whereas no significant effect was found for less resilient individuals. Theoretical and clinical implications of the findings are discussed.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study

AIM

We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health.

BACKGROUND

Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma.

METHODS

We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms.

RESULTS

We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support.

CONCLUSION

Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

Kompetenzerleben von Psychotherapeut_innen im Umgang mit Kindern und Jugendlichen mit Gewalterfahrungen und Traumafolgestörungen

Zusammenfassung. Theoretischer Hintergrund: Die psychotherapeutische Versorgung von Kindern und Jugendlichen mit psychischen Störungen nach Gewalterfahrungen ist ungenügend. Zu ihrer Verbesserung wird eine routinemäßige Exploration von Gewalterfahrungen und Traumafolgestörungen und eine evidenzbasierte Behandlung empfohlen. Behandelnde berichten jedoch Unsicherheiten und Befürchtungen dahingehend. Fragestellung: Beeinflusst das therapeutische Kompetenzerleben das konfrontative Vorgehen, den Einbezug von Bezugspersonen, die berufliche Belastung und das Interesse an Weiterbildungen? Methode: 323 Psychotherapeut_innen nahmen an der Online-Umfrage teil. Zur Beantwortung der Fragestellung wurde ein Strukturgleichungsmodell spezifiziert und geprüft. Ergebnisse: Ein höheres Kompetenzerleben ist mit einem konfrontativeren Vorgehen, einem häufigeren Einbezug von Bezugspersonen und einer geringeren beruflichen Belastung assoziiert, nicht jedoch mit einem geringeren Weiterbildungsinteresse. Organisatorische Aspekte werden als häufigste Gründe gegen Weiterbildungen genannt. Diskussion und Schlussfolgerung: Es ergeben sich praktische Implikationen für die inhaltliche und organisatorische Gestaltung von Weiterbildungen und Supervisionen.

Psychological impact of an acute intervention on medical-psychological emergency unit professionals: the example of hurricane Irma

BACKGROUND

Medical-psychological emergency units (Cellules d'Urgence Médico-Psychologiques, CUMP) are deployed following major events where there is a risk of psychological trauma, in order to provide acute and proper psychological care for the victims.

AIMS

To describe and evaluate the risk of a psychological impact on CUMP professionals after their participation in the aftermath of the hurricane Irma natural disaster. CUMP teams consist of medical and paramedical staff, who can have permanent or volunteer status. We reasoned that there might be a psychological and emotional impact on CUMP professionals, despite their own expertise in the field, after their intervention following hurricane Irma.

METHOD

A cross-sectional survey was conducted during a feedback meeting. Participating professionals completed a sociodemographic questionnaire and the Professional Quality of Life (ProQOL) scale (5th French version), which is composed of three subscales: compassion satisfaction, burnout and secondary traumatic stress (STS).

RESULTS

A total of 53 participants were included with 24 (45.3%) psychiatrists, 15 (28.3%) paramedical staff and 14 (26.4%) psychologists. The median age was 46 years (range 39-55.5) and 29 (54.7%) were women. We found that psychiatrists compared with other professions had higher secondary traumatic stress scores (P = 0.007) and that volunteer psychiatrists had higher burnout scores than permanent psychiatrists (P = 0.03).

CONCLUSIONS

These preliminary results suggest a psychological impact attributable to leadership status, which was reserved for psychiatrists. The results also underline the need for a supportive accompaniment for such teams by promoting formation improvement, psychological support and team cohesion.

Estrutura Interna da Versão Brasileira do Questionário de Estresse Traumático Secundário

Resumo O Estresse Traumático Secundário caracteriza-se por um conjunto de sintomas e condutas que se manifestam após a exposição indireta ao trauma. Profissionais que cuidam de pessoas traumatizadas estão susceptíveis ao transtorno. Este estudo examinou a estrutura interna da versão brasileira do Cuestionario de Estrés Traumático Secundario. Participaram 624 profissionais da saúde, acessados on-line. Para realização das análises fatoriais, a amostra foi dividida em dois grupos. Na análise exploratória, foram retidos 12 componentes, com cargas fatoriais entre 0,312 e 0,999. Os resultados da análise confirmatória revelaram que o modelo de doze fatores para 50 itens forneceu o melhor ajuste possível para os dados (RMSEA = 0,044; IC = 10%-90%; CFI = 0,949; TLI = 0,904) e índice de consistência interna geral do modelo foi de 0,91. Esses doze fatores foram distribuídos em quatro escalas (Antecedentes, Síndrome de Trauma Secundário, Personalidade e Consequências), com índices psicométricos relativamente baixos e uma nova organização dos itens das escalas do QETS, em contraste com a versão teórica original do instrumento. Sugere-se que novos estudos psicométricos analisem as escalas do questionário, separadamente, e investiguem outras categorias profissionais, especialmente na área dos serviços de emergências, além de estudos comparativos com amostras clínicas.