Psychological well being professionals usually work with individuals who have been traumatised in a roundabout way, both by means of 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 prone 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 area will be complicated:
- Secondary traumatic stress is an acute response with signs quite like post-traumatic stress dysfunction (PTSD) and skilled when professionals get psychologically overwhelmed of their want to help others (Orru et al, 2021)
- Vicarious trauma refers back to the approach our view of the world is altered when working with traumatised individuals over time. We battle to proceed to care, present empathy and understanding (Pearlman and Mac Ian, 1995)
- Compassion fatigue is a mix of secondary traumatic stress and burnout, leaving the skilled mentally and bodily exhausted (Figley, 1999)
- Burnout is the results of continual stress within the office quite 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 prone to secondary traumatic stress. Is that this extra possible if in addition they have a private historical past of trauma?
Strategies
The databases Medline, Embase, Internet of Science and CINHAL had 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 had been excluded. Information on the prevalence and affiliation between private trauma historical past and secondary trauma had been extracted independently by two reviewers. Danger of Bias was assessed utilizing an tailored model of the Newcastle-Ottawa Scale (Wells et al, 2013). As a result of examine heterogeneity a meta-analysis was not potential.
Outcomes
Search outcomes
Out of the 4,779 research situated in searches, 23 research had been lastly included, all of which had been cross-sectional, i.e. gathering knowledge at one time level solely.
Research high quality
Total, a majority of the research had been described as of ‘honest’ high quality, with solely 5/23 scoring greater than 6 on the 8 level modified Newcastle-Ottawa Scale. The pattern dimension 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 possibility. Some requested if the participant had ever had a analysis of PTSD, some used a easy ranking of private historical past of trauma (0-10 with ‘0’ for no trauma to ‘10’ for excessive private trauma historical past). Others requested rather 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 completely different measures had been used, however completely different variations or subscales of the Skilled-High quality of Life Scale (Professional-QOL) (unique: Linley and Joseph, 2007) had been usually employed.
Prevalence of private 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 private trauma. The authors notice that is considerably greater than the reported findings for the final inhabitants within the 3 important examine places (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 widespread in psychological well being professionals,
and
private trauma historical past is related to post-traumatic stress.
They imagine this discovering is essential for these concerned in coaching, supervision and administration of psychological well being professionals, as presence of a trauma historical past can put employees at greater threat of creating traumatic stress.
This evaluate means that the presence of a trauma historical past can put employees at the next threat of creating secondary traumatic stress.
Strengths and limitations
There was just one earlier systematic evaluate of this matter. Leung and colleagues (2022) used completely 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 a substitute of a single reviewer, two reviewers assessed research independently and a 3rd was concerned once they had been unable to succeed in 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 had been small and lots of research had been possible underpowered. These experiencing a private trauma historical past and/or secondary traumatic stress had been maybe extra more likely to take part in such analysis, and all the papers had been of cross-sectional design, that means this may have excluded those that left the office after creating secondary traumatic stress.
Given the appreciable variation between the research included by way of pattern dimension, typology of pros included, setting by 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 sort of comprehensible. Nevertheless, I do marvel if the authors might need thought-about, after their preliminary scoping evaluate, to slim their inclusion standards additional to incorporate solely greater high quality research? The huge variation within the reported percentages of private 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 dimension, 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 widespread acknowledgement within the office that these drawn to a profession on this area of psychological well being are sometimes these of some information 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 not often, if ever, acknowledged in our coaching. Fairly the alternative, we have now till lately been discouraged from and stigmatised for admitting we would want help or are literally searching for it.
As this evaluate does reveal clearly by means of 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 energy 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 prone to creating it of their careers, and easy methods 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 rather more widespread acknowledgement of the problem by those that practice, supervise and handle psychological well being professionals. We have to educate about it and supply specialist supervision for these prone to it. That is essential for understanding not solely easy methods to retain our skilled workers in psychological well being companies, however enhancing the expertise and outcomes of sufferers and repair customers. We proceed to battle in psychological well being companies with not solely unkind and unprofessional behaviour from psychological well being professionals, however typically frankly abusive actions. I can totally perceive how service customers and sufferers may imagine {that a} concentrate on secondary traumatic stress skilled by professionals is perhaps misplaced, when set towards the possibly retraumatising affect of some psychological well being care (Hennessy et al, 2022), however a better 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
Main 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 idea 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: idea, analysis, observe, and coverage 2022 15, 213-221
Linley PA, Joseph S. (2007) Remedy work and therapists’ constructive and damaging nicely–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
Picture credit
Psychological well being professionals usually work with individuals who have been traumatised in a roundabout way, both by means of 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 prone 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 area will be complicated:
- Secondary traumatic stress is an acute response with signs quite like post-traumatic stress dysfunction (PTSD) and skilled when professionals get psychologically overwhelmed of their want to help others (Orru et al, 2021)
- Vicarious trauma refers back to the approach our view of the world is altered when working with traumatised individuals over time. We battle to proceed to care, present empathy and understanding (Pearlman and Mac Ian, 1995)
- Compassion fatigue is a mix of secondary traumatic stress and burnout, leaving the skilled mentally and bodily exhausted (Figley, 1999)
- Burnout is the results of continual stress within the office quite 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 prone to secondary traumatic stress. Is that this extra possible if in addition they have a private historical past of trauma?
Strategies
The databases Medline, Embase, Internet of Science and CINHAL had 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 had been excluded. Information on the prevalence and affiliation between private trauma historical past and secondary trauma had been extracted independently by two reviewers. Danger of Bias was assessed utilizing an tailored model of the Newcastle-Ottawa Scale (Wells et al, 2013). As a result of examine heterogeneity a meta-analysis was not potential.
Outcomes
Search outcomes
Out of the 4,779 research situated in searches, 23 research had been lastly included, all of which had been cross-sectional, i.e. gathering knowledge at one time level solely.
Research high quality
Total, a majority of the research had been described as of ‘honest’ high quality, with solely 5/23 scoring greater than 6 on the 8 level modified Newcastle-Ottawa Scale. The pattern dimension 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 possibility. Some requested if the participant had ever had a analysis of PTSD, some used a easy ranking of private historical past of trauma (0-10 with ‘0’ for no trauma to ‘10’ for excessive private trauma historical past). Others requested rather 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 completely different measures had been used, however completely different variations or subscales of the Skilled-High quality of Life Scale (Professional-QOL) (unique: Linley and Joseph, 2007) had been usually employed.
Prevalence of private 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 private trauma. The authors notice that is considerably greater than the reported findings for the final inhabitants within the 3 important examine places (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 widespread in psychological well being professionals,
and
private trauma historical past is related to post-traumatic stress.
They imagine this discovering is essential for these concerned in coaching, supervision and administration of psychological well being professionals, as presence of a trauma historical past can put employees at greater threat of creating traumatic stress.
This evaluate means that the presence of a trauma historical past can put employees at the next threat of creating secondary traumatic stress.
Strengths and limitations
There was just one earlier systematic evaluate of this matter. Leung and colleagues (2022) used completely 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 a substitute of a single reviewer, two reviewers assessed research independently and a 3rd was concerned once they had been unable to succeed in 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 had been small and lots of research had been possible underpowered. These experiencing a private trauma historical past and/or secondary traumatic stress had been maybe extra more likely to take part in such analysis, and all the papers had been of cross-sectional design, that means this may have excluded those that left the office after creating secondary traumatic stress.
Given the appreciable variation between the research included by way of pattern dimension, typology of pros included, setting by 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 sort of comprehensible. Nevertheless, I do marvel if the authors might need thought-about, after their preliminary scoping evaluate, to slim their inclusion standards additional to incorporate solely greater high quality research? The huge variation within the reported percentages of private 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 dimension, 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 widespread acknowledgement within the office that these drawn to a profession on this area of psychological well being are sometimes these of some information 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 not often, if ever, acknowledged in our coaching. Fairly the alternative, we have now till lately been discouraged from and stigmatised for admitting we would want help or are literally searching for it.
As this evaluate does reveal clearly by means of 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 energy 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 prone to creating it of their careers, and easy methods 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 rather more widespread acknowledgement of the problem by those that practice, supervise and handle psychological well being professionals. We have to educate about it and supply specialist supervision for these prone to it. That is essential for understanding not solely easy methods to retain our skilled workers in psychological well being companies, however enhancing the expertise and outcomes of sufferers and repair customers. We proceed to battle in psychological well being companies with not solely unkind and unprofessional behaviour from psychological well being professionals, however typically frankly abusive actions. I can totally perceive how service customers and sufferers may imagine {that a} concentrate on secondary traumatic stress skilled by professionals is perhaps misplaced, when set towards the possibly retraumatising affect of some psychological well being care (Hennessy et al, 2022), however a better 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
Main 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 idea 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: idea, analysis, observe, and coverage 2022 15, 213-221
Linley PA, Joseph S. (2007) Remedy work and therapists’ constructive and damaging nicely–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
