Psychological well being professionals typically work with individuals who have been traumatised ultimately, both by being direct victims of abuse, violence, severe harm and threats of dying, or by witnessing these occasions. Listening to sufferers sharing these tales can put the skilled liable to themselves experiencing what is named ‘secondary traumatic stress’. Is that this extra more likely to occur if the skilled additionally has a historical past of trauma?
Phrases used on this subject might be complicated:
- Secondary traumatic stress is an acute response with signs slightly like post-traumatic stress dysfunction (PTSD) and skilled when professionals get psychologically overwhelmed of their need to help others (Orru et al, 2021)
- Vicarious trauma refers back to the means our view of the world is altered when working with traumatised folks over time. We wrestle to proceed to care, present empathy and understanding (Pearlman and Mac Ian, 1995)
- Compassion fatigue is a mixture of secondary traumatic stress and burnout, leaving the skilled mentally and bodily exhausted (Figley, 1999)
- Burnout is the results of persistent stress within the office slightly than working with traumatised sufferers (Edu-Valsania et al, 2022).
This evaluate units out each to establish the prevalence of a private trauma historical past and secondary traumatic stress in psychological well being professionals and to look at whether or not there may be an affiliation between them.
Psychological well being professionals are liable to secondary traumatic stress. Is that this extra probably if in addition they have a private historical past of trauma?
Strategies
The databases Medline, Embase, Net of Science and CINHAL have been searched as much as 17th August 2023.
Inclusion Standards:
- Articles that assessed private trauma OR secondary trauma (which included secondary traumatic stress, vicarious trauma or compassion fatigue)
AND one or each of the next:
- The correlation between trauma historical past and secondary trauma (any of three as above).
- The prevalence of both private trauma historical past and/or secondary trauma (any of three as above).
Plus
- The pattern consisted of psychological well being professionals together with those that had skilled their very own trauma (and college students on placement).
- Utilised legitimate measures to evaluate prevalence.
Research reporting on burnout solely have been excluded. Information on the prevalence and affiliation between private trauma historical past and secondary trauma have been extracted independently by two reviewers. Threat of Bias was assessed utilizing an tailored model of the Newcastle-Ottawa Scale (Wells et al, 2013). On account of examine heterogeneity a meta-analysis was not attainable.
Outcomes
Search outcomes
Out of the 4,779 research situated in searches, 23 research have been lastly included, all of which have been cross-sectional, i.e. amassing knowledge at one time level solely.
Research high quality
General, a majority of the research have been described as of ‘truthful’ high quality, with solely 5/23 scoring greater than 6 on the 8 level modified Newcastle-Ottawa Scale. The pattern measurement was judged as passable in solely 4 research.
Measuring private trauma historical past
There was appreciable variation in how the research requested about life expertise of trauma. Two terribly solely included a sure/no choice. Some requested if the participant had ever had a prognosis of PTSD, some used a easy ranking of non-public historical past of trauma (0-10 with ‘0’ for no trauma to ‘10’ for excessive private trauma historical past). Others requested far more detailed questions or utilised instruments that authors had both developed themselves or tailored from others.
Measuring secondary trauma
The time period ‘secondary traumatic stress’ was utilized in 11 research, ‘compassion fatigue’ in 5 and ‘vicarious trauma’ in 3 research. One used PTSD and a couple of separated secondary traumatic stress and vicarious trauma. A wide range of totally different measures have been used, however totally different variations or subscales of the Skilled-High quality of Life Scale (Professional-QOL) (authentic: Linley and Joseph, 2007) have been sometimes employed.
Prevalence of non-public trauma historical past
For the 19 research that reported on private trauma historical past, 13 used percentages to current their findings – starting from 21.2% to 83.3%. So, between a fifth and over four-fifths of psychological well being professionals had skilled a historical past of non-public trauma. The authors word that is considerably larger than the reported findings for the final inhabitants within the 3 predominant examine areas (United States of America, Australia and United Kingdom).
Prevalence of secondary traumatic stress
17 research reported vital ranges of secondary traumatic stress. For the 6 that reported this in percentages, this ranged from 19-70%, between a fifth and over two thirds of psychological well being professionals reported experiencing secondary traumatic stress.
Affiliation between secondary traumatic stress and trauma historical past
Fourteen of the research discovered a constructive affiliation between secondary traumatic stress and a psychological well being skilled’s expertise of their very own trauma historical past, 4 discovered no affiliation and 5 didn’t report on this.
The bulk of research on this evaluate discovered a constructive affiliation between secondary traumatic stress and a psychological well being skilled’s expertise of their very own trauma historical past.
Conclusions
The authors concluded that:
each private trauma historical past and secondary traumatic stress are frequent in psychological well being professionals,
and
private trauma historical past is related to post-traumatic stress.
They imagine this discovering is necessary for these concerned in coaching, supervision and administration of psychological well being professionals, as presence of a trauma historical past can put employees at larger danger of growing traumatic stress.
This evaluate means that the presence of a trauma historical past can put employees at a better danger of growing secondary traumatic stress.
Strengths and limitations
There was just one earlier systematic evaluate of this subject. Leung and colleagues (2022) used totally different inclusion standards, (together with burnout) and a really broad definition of ‘psychological well being professionals’ together with volunteers and even non-clinical employees. A single reviewer carried out assessments of suitability for inclusion and there was no high quality evaluation of included research.
The current authors have vastly improved on this by defining the phrases to explain ‘post-traumatic stress’, excluding burnout, and together with research focussed on scientific psychological well being professionals. As an alternative of a single reviewer, two reviewers assessed research independently and a 3rd was concerned after they have been unable to achieve an settlement. Research high quality was additionally assessed.
Nevertheless, the authors themselves remark they solely included research written in English, and participant ethnicity was not recorded in most of the research, limiting the generalisability of the findings. Reported correlations have been small and lots of research have been probably underpowered. These experiencing a private trauma historical past and/or secondary traumatic stress have been maybe extra more likely to take part in such analysis, and all the papers have been of cross-sectional design, which means this is able to have excluded those that left the office after growing secondary traumatic stress.
Given the appreciable variation between the research included by way of pattern measurement, typology of pros included, setting through which they labored, and measures employed for assessing trauma historical past and secondary traumatic stress (asking a sure/no query about having both of those experiences is actually inadequate). The choice to publish as a story evaluate is kind of comprehensible. Nevertheless, I do marvel if the authors may need thought-about, after their preliminary scoping evaluate, to slim their inclusion standards additional to incorporate solely larger high quality research? The vast variation within the reported percentages of non-public trauma historical past (in these 13 papers that included percentages) additionally makes the reported comparability with nationwide knowledge extremely unreliable.
There was appreciable variation between the research included by way of pattern measurement, professionals included, work settings and measures employed for assessing trauma historical past and secondary traumatic stress.
Implications for observe
I agree with the authors that “there’s a frequent acknowledgement within the office that these drawn to a profession on this subject of psychological well being are sometimes these of some data and expertise of inauspicious life occasions.” That is true not just for me, however for a lot of others I’ve identified, but it’s hardly ever, if ever, acknowledged in our coaching. Fairly the other, we have now till lately been discouraged from and stigmatised for admitting we would want help or are literally looking for it.
As this evaluate does reveal clearly by the breadth of its scope, the general high quality of analysis carried out on this space has been restricted. We’d like potential research, not solely to discern the power of the affiliation between private trauma historical past and secondary traumatic stress, but in addition to discover when these with such a historical past are most liable to growing it of their careers, and the best way to distinguish this from burnout, though this may occasionally co-exist. What makes us susceptible and what can we do to forestall it? What half do gender and ethnicity play?
To have the ability to perform such analysis requires far more widespread acknowledgement of the problem by those that prepare, supervise and handle psychological well being professionals. We have to educate about it and supply specialist supervision for these liable to it. That is necessary for understanding not solely the best way to retain our skilled employees in psychological well being companies, however enhancing the expertise and outcomes of sufferers and repair customers. We proceed to wrestle in psychological well being companies with not solely unkind and unprofessional behaviour from psychological well being professionals, however generally frankly abusive actions. I can totally perceive how service customers and sufferers may imagine {that a} give attention to secondary traumatic stress skilled by professionals is perhaps misplaced, when set towards the doubtless retraumatising impression of some psychological well being care (Hennessy et al, 2022), however a higher understanding may gain advantage not solely skilled wellbeing, however in the end sufferers and repair customers too.
A greater understanding of the extent and causes of secondary traumatic stress in psychological well being professionals may gain advantage not solely skilled wellbeing, however in the end sufferers and repair customers too.
Assertion of pursuits
I’ve no competing pursuits.
Hyperlinks
Major paper
Anita Henderson, Tom Jewell, Xia Huang, Alan Simpson. (2024) Private trauma historical past and secondary traumatic stress in psychological well being professionals: A scientific evaluate. (PDF) Journal of Psychiatric and Psychological Well being Nursing. 2024 Jun 30.
Different references
Edú-Valsania S, Laguía A, Moriano JA. (2022) Burnout: A evaluate of concept and measurement. (PDF) Worldwide Journal of Environmental Analysis and Public Well being. 2022 Feb 4;19(3):1780.
Figley, C. R. (1999) Compassion fatigue: In the direction of a brand new understanding of the prices of caring. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care points for clinicians, researchers, & educators (2nd ed., pp. 3–28). Lutherville, MD: Sidran Press.
Hennessy B, Hunter A, Grealish A. (2022) A qualitative synthesis of sufferers’ experiences of re‐traumatization in acute psychological well being inpatient settings. (PDF) Journal of Psychiatric and Psychological Well being Nursing. 2023 Jun;30(3):398-434.
Leung T, Schmidt F, Mushquash C. A private historical past of trauma and expertise of secondary traumatic stress, vicarious trauma, and burnout in psychological well being employees: A scientific literature evaluate. [PubMed Abstract] Psychological trauma: concept, analysis, observe, and coverage 2022 15, 213-221
Linley PA, Joseph S. (2007) Remedy work and therapists’ constructive and adverse effectively–being. Journal of Social and Scientific Psychology. 2007 Mar;26(3):385-403.
Orrù G, Marzetti F, Conversano C. et al (2021) Secondary traumatic stress and burnout in healthcare employees throughout COVID-19 outbreak. Worldwide Journal of Environmental analysis and public well being. (PDF) 2021 Jan18(1) 337
Pearlman LA, Mac Ian PS. (1995) Vicarious traumatization: An empirical examine of the results of trauma work on trauma therapists. (PDF) Skilled Psychology: Analysis and observe. 1995 Dec;26(6):558.
Wells G, Shea B, O’Connell S. et al (2013) The Newcastle-Ottawa scale (NOS) for assessing the standard of nonrandomised research in meta-analyses. Cochrane. http://www.ohri.ca/packages/clinical_epidemiology/oxford.as
