Latent structure of secondary traumatic stress, its precursors, and effects on people working with refugees

Current Status and Influencing Factors of Secondary Traumatic Stress in Emergency and Intensive Care nurses:A Cross-Sectional Analysis

Objective

Secondary traumatic stress (STS) is stress caused by helping or wanting to help someone who has suffered a traumatic event. STS has adverse effects on nurses and their work, such as reduced career achievement, an increased staff turnover rate, inability to complete work, avoidance of contact with patients, mental exhaustion, negative emotions which seriously affect the quality of their work and life. The study to investigate secondary traumatic stress in emergency and intensive care nurses and analyze factors that influence it.

Material and Methods

The study was a cross-sectional survey. Convenience sampling was used to select hospital emergency and intensive care department nurses (n=434) who met the inclusion and exclusion criteria from August to October 2021 to participate in this study. They provided demographic data and completed measures of secondary traumatic stress, emotional intelligence, anxiety and depression. Data analysis included independent samples t-tests, one-way analysis of variance, Pearson correlation analysis and multiple linear regression analysis.

Results

Almost one-third (30.7%) of participants were at moderate risk for Secondary Traumatic Stress Scale or above, with high average scores on measures of anxiety (GAD-7 average = 6.05 ± 4.13), and depression (PHQ-9 average = 6.35 ± 4.85). The results of multiple linear regression analysis showed that the average daily amount of sleep in the past week, the number of night shifts in the past month, emotional intelligence, anxiety, and depression influenced secondary traumatic stress, explaining 70.8% of the variance.

Conclusion

The STS of emergency and intensive care nurses in Changzhou is at a high level. Sleep time, number of night shifts and emotional intelligence are related to secondary traumatic stress and anxiety and depression significantly predicted the degree of secondary traumatic stress. Nurses need to master effective treatment methods for secondary traumatic stress, to improve their work efficiency and nursing quality and ensure nursing safety.

The effects of traumatic experiences during transit and pushback on the mental health of refugees, asylum seekers, and migrants

Background: There are 26 million people recognised as refugees worldwide. Many of them spent a prolonged period of time in transit - time after they leave their country of origin and before they reach the receiving country. Transit brings numerous protection and mental health risks refugees are exposed to.Objective: The aim of this study was to assess the stressful and traumatic experiences refugees are exposed to during transit, with a special focus on the experience of pushback - the denial of access to the territory to foreign nationals and forcible return to countries of origin or neighbouring countries without an assessment of their rights to international protection, as well as the impact of these experiences on refugees' mental health and well-being.Method: 201 refugees currently residing in Serbia completed the Stressful and Traumatic Experiences in Transit questionnaire - short version (SET-SF), questionnaire for assessing stressful and traumatic experiences during pushback (SET-SF PB), Refugee Health Screener (RHS-15), and Well-being index (WHO-5).Results: The results showed that refugees experience a large number of stressful and traumatic events (M = 10.27, SD = 4.85). In addition, half of the participants experience severe symptoms of depression (50.7%), while about a third of the participants experience severe symptoms of anxiety (37.8%) and post-traumatic stress disorder (PTSD) (32.3%). Refugees who experienced pushback showed overall higher levels of depression, anxiety, and PTSD. Traumatic experiences during transit and pushback were positively related to the severity of depression, anxiety, and PTSD. In addition, traumatic experiences during pushback showed an incremental contribution in predicting refugees' mental health difficulties over and above traumatic experiences in transit.Conclusions: This study provides valuable insights into the multiple risks refugees are exposed to and emphasise the need for the provision of adequate protection and support.

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.

A neglected aspect of refugee relief works: Secondary and vicarious traumatic stress

The literature demonstrates evidence that secondary traumatic stress (STS) and vicarious traumatic stress (VTS) may adversely affect the well-being of refugee relief workers and, thus, the quality of their services. The present review offers an exploration of (a) the theoretical background of STS and VTS, (b) their appearance among refugee relief workers, (c) intervention studies available, (d) common points among intervention studies and guidelines on STS and VTS released by local and international nongovernmental organizations (NGOs), and (e) the potential problems that can be associated with the insufficiency of standardized intervention programs as assessed in effectiveness studies. This review may help mental health professionals in countries that host large numbers of refugees and asylum seekers, such as Turkey, Lebanon, and Jordan, to design more effective intervention programs targeting STS and VTS.

Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey

BACKGROUND

Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey.

DISCUSSION

In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week.

CONCLUSIONS

The research team's experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes.