Secondary traumatic stress among mental health professionals working with war refugees in Pakistan: A qualitative exploration of lived experiences

Background: Secondary Traumatic Stress (STS) is a significant concern among mental health professionals working with traumatised populations, such as war refugees. However, limited research has explored the predictors of STS in different cultural contexts, particularly in Pakistan and Lithuania. Objective: This study aimed to investigate the protective and risk factors for STS among mental health professionals working with war refugees in Pakistan and Lithuania. Specifically, the study examined the roles of social support, marital status, agreeableness, and negative emotionality in predicting STS. Methods: A total of 120 mental health professionals from Lithuania and 111 from Pakistan participated in this cross-cultural study. Participants completed an online survey assessing demographic variables, STS symptoms, and the predictors of interest. The Secondary Traumatic Stress Scale (STSS), Big Five Inventory (BFI-2), and a social support scale were used to assess STS, agreeableness, and social support, respectively. Data was analysed using descriptive statistics, regression analyses, and ANOVA. Results: Significant differences were found in the prevalence of STS between the two countries, with 65.2% of Pakistani participants reporting STS symptoms compared to 20% in Lithuania. In Pakistan, social support, marital status, and agreeableness emerged as protective factors, while negative emotionality and divorced marital status were identified as risk factors. In contrast, in Lithuania, only social support was found to significantly predict STS, with negative emotionality serving as a risk factor. Conclusions: The findings underscore the importance of contextual factors in shaping the experience of STS among mental health professionals. While social support appears to act as a protective factor in both countries, other factors like marital status and personality traits (agreeableness) play varying roles depending on the cultural context. These insights provide valuable implications for developing targeted interventions to support mental health professionals working in refugee contexts, particularly in countries with differing socio-political landscapes.

With ongoing conflicts worldwide, the refugee crisis has escalated into a global humanitarian crisis, straining mental health professionals supporting war refugees. Growing demands and the emotional toll of witnessing trauma of the survivors of war highlight the need for research to better equip these professionals. This study examines influence of age on burnout and secondary traumatic stress (STS) among 103 mental health professionals working with war refugees in Pakistan, focusing on the moderating roles of detachment and work hours. In this cross-sectional study, 103 mental health professionals completed the Professional Quality of Life Scale, Experiences Questionnaire, and Secondary Traumatic Stress Scale. Regression, moderation, and mediation analyses were conducted using SPSS PROCESS macro. Increased work hours intensified the burnout-STS relationship, while detachment served as a protective factor by moderating this relationship rather than directly predicting STS. Additionally, burnout mediated the relationship between age and STS, with older professionals reporting lower burnout and, in turn, lower STS symptoms. These findings highlight the importance of addressing burnout in efforts to reduce STS among refugee-serving professionals and suggest that fostering detachment and managing work hours may provide protective benefits.

Recent progress in understanding the lifelong effects of early childhood adversities has clarified the need for an organized strategy to identify and intervene with children, adolescents, and families who may be at risk for maladaptive responses. Trauma-informed care (TIC) in child health care operationalizes the biological evidence of toxic stress with the insights of attachment and resilience to enhance health care delivery to mitigate the effects of trauma. The resulting pediatric health care delivery strategy promotes and restores resilience in children and adolescents, partners with families to support relational health, and reduces secondary trauma among pediatric health care clinicians. This policy statement summarizes what policy makers, legislators, and health care organizations need to consider in terms of infrastructure, resources, and financial support to facilitate the integration of TIC principles into all pediatric points of care. The accompanying clinical report describes the elements of TIC in the direct care of children, adolescents, and families and covers the spectrum from prevention to treatment. The recommendations in this statement and the clinical report build on other American Academy of Pediatrics policies that address the needs of special populations (such as children and adolescents in foster or kinship care, in immigrant and refugee families, or in poor or homeless families) and are congruent with American Academy of Pediatrics policies and technical reports concerning the role of pediatric clinicians in the promotion of lifelong health.Over the past 2 decades, basic science has explained how cumulative adverse childhood experiences in the relative absence of safe, stable, nurturing relationships (SSNRs)1 alter neurohormonal stress responses, gene expression, telomere length, brain development, and immunity, enabling researchers to elucidate how the body biologically embeds childhood trauma. Recent studies of toxic stress support assertions that the origins of lifelong health are in early childhood and that chronic stress in childhood strongly predicts adult health status.2,3 In the context of expanding evidence, pediatricians and others involved in community-based early childhood systems need strategies to mitigate the damaging effects of early childhood trauma and to promote resilience in children and families. Trauma-informed care (TIC) offers an organizing principle for pediatric practice that improves awareness of the spectrum of trauma-related symptoms, promotes an emotionally safe environment of care, and provides specific interventions to mitigate the effects of trauma exposure.4,5 This policy statement presents recommendations for policy makers, legislators, and health care organizations for implementation of TIC into pediatric health systems. The accompanying clinical report6 presents best-practice guidance for TIC in the direct care of children and adolescents.TIC is defined by the National Child Traumatic Stress Network as medical care in which all parties involved assess, recognize, and respond to the effects of traumatic stress on children, caregivers, and health care providers. TIC also includes attention to secondary traumatic stress (STS), the emotional strain that results when an individual, whether a health care worker or parent, hears about or witnesses the traumatic experiences, past or present, of children.Every pediatric encounter presents opportunities to promote family resilience and relational health.7 Informed by research in infant mental health and neurodevelopment, early relational health refers to the establishment of foundational relationships during the first 3 years of life that are central to successful physiologic, emotional, and moral development of the young child.8 Relational health, in a more general sense, is applicable to all age groups, is dyadic, and includes the capacity of both the child and caregiver to enter into a safe, secure, nurturing relationship allowing both to thrive.1,9,10 Strong foundational relationships support resilience and buffer stress in children, so they can be considered primary prevention of stress-related disturbance. Trauma-informed practices also support relational health and family resilience as important protective factors for those who have been exposed to persistent adversity or potentially traumatic events (see Fig 1).Human neuroendocrine–immune networks respond to internal and external sensors that identify danger and safety by activating in dangerous circumstances and deactivating when danger has subsided.11 Toxic stress responses occur with prolonged activation of the neuroendocrine–immune system and dysregulation of homeostasis (or allostasis if multiple systems are involved)12 in the absence of buffering by SSNRs. Toxic stress responses can result in lifelong impairments in physical, mental, and relational health.13The concept of toxic stress adds an important physiologic basis to the study of attachment and our understanding of trauma. Trauma is defined as an event, series of events, or circumstances experienced by a person as physically or emotionally harmful that can have long-lasting adverse effects on the person’s functioning and well-being (emotional, physical, or spiritual).14 Attachment theory describes the deep and enduring relationship between a child and adult caregiver that ideally provides a secure base from which the child can develop and explore the world.15Resilience is the dynamic process of adaptation to or despite significant adversity by using protective factors and learned skills to manage stressful circumstances.16 Resilience may allow a person to experience tolerable rather than toxic stress in response to adversity. Some characteristics of resilient children include strong executive functions (self-control of attention and impulses) and a strong personal identity, often related to a cultural or faith tradition.17 However, most important to both resilience and relational health is the capacity for young children to form at least one stable, caring, and supportive relationship.9,18Almost half of American children, or 34 million younger than 18 years, have faced at least one potentially traumatic early childhood experience.19 More than 1 in 7 adults report exposure during childhood to 4 or more adverse childhood experiences such as abuse, neglect, or other household adversity,20 including intimate partner violence or parental incarceration. Certain populations are at higher risk for trauma exposure, both physical and emotional. In surveys, poverty or financial stress is the most commonly reported childhood adversity, second only to loss of a parent.21,22 Exposure to divorce, child maltreatment, sexual abuse, intimate partner violence, bullying, parental mental illness, parental substance use problems, and community violence are also common.21 Specific populations at high risk for trauma include children and adolescents who identify as LGBTQ, have developmental or behavioral problems,23–25 are in foster or kinship care, are incarcerated, are living in deep poverty, or are immigrants. Potentially traumatic environmental and community-level conditions include economic stress, school or community violence, adverse experiences during and after immigration, natural disasters, pandemics, and mass-casualty events such as shootings or bombings.Racism is a common cross-cutting risk factor. Racial, ethnic, or religious bigotry magnifies the risk inherent to other special populations.26 Experiences ranging from hate crimes, police profiling, bullying, or microaggressions to covert discrimination are traumatic events and may be internalized as trauma by those who are victims, indirectly or directly, of the events.27,28 Historical trauma refers to the collective, transgenerational emotional and psychological injury of specific ethnic, racial, or cultural groups and their descendants who have experienced major events of oppression such as genocide, forced displacement, or slavery.29,30 Originally applied to children of the Holocaust, the concept is now applied to American Indian and Alaskan native people, African American people, Mexican American people, Japanese American people, and other groups of people who have experienced mass trauma.30 Investigators link historical “soul wounding” to current health and behavioral disorders including substance use disorder, domestic violence, and suicide, particularly in Indigenous communities.29,31 Children separated from families during immigration and/or detained in group facilities overseen by the Office of Refugee Resettlement are a recent special population at severe risk for long-term sequelae resulting from forced family separation.32,33In November 2019, the Centers for Disease Control and Prevention reviewed the emerging literature linking early childhood adversity with adult illnesses20,34 and analyzed survey data from 25 states over 2 years.3,35 Researchers concluded that reducing exposure to early childhood trauma and mitigating posttrauma effects would generally and significantly reduce adult morbidity and mortality. Using logistic regression modeling, they estimated potential reductions in incidence from low for obesity (1.7%) to high for heavy drinking, chronic obstructive pulmonary disease, and depression (23.9%, 27.0%, and 44.1%, respectively). Recommendations included creating healthy communities, supporting SSNRs, and developing programs that apply primary (reducing exposure to childhood adversity) and secondary prevention (mitigating the effects of exposure) on the basis of principles of TIC.The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) presents a list of trauma-related disorders ranging from mild (adjustment disorder) to severe (posttraumatic stress disorder [PTSD]).36 Two additional categories, reactive attachment disorder and disinhibited social engagement disorder, are specific to young children (please see the DSM-5 for complete diagnostic criteria). This nosology can be expanded to describe other presentations common in pediatric health care settings: developmental trauma disorder (DTD), pediatric medical traumatic stress (PMTS), and STS, the last being most relevant for health care workers, family members, and caregivers.The diagnosis of PTSD, as outlined in the current DSM-5, does not adequately describe the variable presentations of trauma manifestations in children across developmental stages.37 Children with complex trauma histories often exhibit heterogeneous developmental symptoms as well as difficulties with intimate relationships and with regulation of attention and impulse control.38 DTD is a proposed new diagnostic category that incorporates these differences and attempts to better describe the disturbances that occur in multiple developmental domains.39 The omission of DTD in the DSM-5 has been controversial,40 and the search for a better nosology of trauma, including DTD, is ongoing.41PMTS refers to the distress that patients and family members experience during hospitalization for a perceived life-threatening diagnosis or while living with or caring for individuals with life-altering chronic conditions.42 PMTS is underrecognized and rarely addressed despite its high prevalence.43,44 Up to 80% of ill or injured children and their families may have traumatic stress reactions after a life-threatening illness, injury, or procedure.45 In some surveys, up to 20% of parents of children admitted to a PICU develop PTSD within a few months.45 The suffering of family members and caregivers is often not addressed because of existing structural and reimbursement obstacles for multigenerational care.Although research on PMTS (and on pediatric postintensive care syndrome)46,47 is ongoing, researchers in 1 study found that approximately 10% of children developed PTSD 3 to 5 months after major surgery, and 28% developed posttraumatic stress symptoms (PTSS) resulting in functional disability by parent report.48 PTSS can also occur after a severe injury or diagnosis of an illness such as cancer. In another family study, more than 10% of children had persistent functional impairment from PTSS at 6 weeks and 1 year after a potentially life-threatening injury or diagnosis, and 15% of mothers and 8% of fathers met criteria for PTSD at 1 year.49As described earlier, STS may occur in parents, other family members, and health care workers such as physicians, nurses, other hospital staff, first responders, and therapists. STS may have many of the same long-term effects on health that affect children exposed to trauma.50 Some health care workers may also develop disabling posttrauma symptoms that can interfere with quality of life both at work and home. Health care workers may have their own trauma histories that contribute to their reactions when exposed to the suffering of others. Nonclinical staff may also experience STS triggered by their own trauma histories, especially if the health care facility is located in an area with high adversity and nonclinical staff live in the vicinity.Preliminary evidence exists of a synergistic effect among STS, depression, and burnout in affected health care workers.51 STS in combination with burnout has been associated with a significant increase in the frequency of medical errors.52,53 Depression, anxiety, and suicide are greater risks for physicians than for the general population. In the United States, the rate of suicide among female physicians is 130% higher than among women who are not physicians; the rate for male physicians is 40% higher than for men who are not physicians.51 Burnout includes a spectrum of pathologic conditions that develop in the context of occupational stress and is almost twice as prevalent among physicians. The risk among nurses for burnout, depression, and STS is even higher. More than half of nurses reported suboptimal mental or physical health,54 approximately 35% reported a high degree of emotional exhaustion,55 and 18% reported depression in national surveys. Reports of posttraumatic stress among health care workers related to the coronavirus disease 2019 pandemic prompted worldwide concern for increased awareness and trauma-informed support for the mental health of all involved.56Core principles that can be helpful for policy development, outlined by the National Council on Behavioral Health (2019)57 are outlined in the following sections. Implementation of TIC at a practice level is described in detail in the accompanying clinical report.6The health care organization, workspace, and every encounter should be characterized by compassion, cultural humility, equity, collaboration, and safety for families and employees. An emotionally safe workplace includes acknowledgment of and particular attention to racial and gender discrimination, including implicit bias both in rendering care and workplace human relations. A review of health care settings from the viewpoints of patients, families, and staff can uncover practices, processes, or details in the environment that are potentially traumatizing.Hospital and health system leadership can annually review policies and procedures to ensure a safe work environment and setting to provide TIC, to reduce STS and burnout, and to promote sensitivity to the needs of trauma survivors.58 The alignment of financial and human capital resources to support an optimal health environment in all levels and locations of care is extremely important. Surveys designed to assess system readiness for implementation are available and can be adapted for pediatric health care settings.Surveillance and standardized screening to assess staff and patients for trauma exposure, symptoms, and strengths are important components of trauma-informed pediatric care. Universal screening, when implemented within the larger context of trauma-informed approaches and endorsed and supported by administrative leadership, reduces stigma and allows standardized responses such as time off or referral to an employee assistance program. Families and youth may be queried at the point of care, such as at the time of hospital admission. Formal screening should always be for the benefit of children and adolescents, avoid retraumatization, and identify protective as well as risk factors.59 More specific information about screening is included in the accompanying clinical report.6Involvement of families and youth in the development of TIC policies and practices, particularly regarding cultural, historical, and gender issues, is essential to building an environment of support and mutuality.14 Both formal and informal structures, such as Family Advisory Councils and family-centered rounds,60 create a cultural expectation of collaboration and enable the health care team to understand the strengths and vulnerabilities of individual families and of the populations served. When appropriate, tribal elders, traditional healers, and other faith community leaders can be included in developing individual care plans or institutional quality-improvement efforts. A whole-person, whole-family, whole-community perspective promotes improved awareness of how cultural backgrounds affect the perception of trauma, safety, and privacy.61,62TIC, from a public health perspective, includes primary, secondary, and tertiary prevention strategies. Primary prevention is a comprehensive approach that addresses social determinants of health (such as structural racism, poverty, and violence) that are often root causes of community trauma.63 Promotion of relational health and other resilience factors (such as strong executive function and self-efficacy) may be considered primary prevention.64 Following the fourth edition of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, promotion of early childhood relational health is a core purpose of both pediatric primary care and early childhood education.65The National Child Traumatic Stress Network includes the promotion of child and family resilience, enhancement of protective factors, awareness of parent or caregiver trauma, and involvement of families in program development and evaluation as secondary prevention.66 Trauma-informed therapies (eg, trauma-focused cognitive behavioral therapy) for symptomatic children and youth are considered tertiary prevention. These therapies are especially important for high-risk populations as identified earlier.67–70 Attachment-based dyadic therapies, such as parent–child interaction therapy, may serve to prevent development of persistent traumatic stress symptoms in high-risk families71 and may be considered both secondary and tertiary prevention.Recruitment and pre-employment practices may help discern the capacity for empathy among prospective employees.72 Training and education of all administrators, clinicians, and staff, both clinical and nonclinical, can promote the appreciation of the lifelong effects of trauma on child and adolescent development and family resilience and the implementation of trauma-aware practices. Continuous quality-improvement programs translate new knowledge and skills about childhood trauma into supervision, training, and patient care.Prevention of STS requires specific training of all staff to raise awareness, promote resilience, and explore the interaction among STS, burnout, depression, substance use, and professional quality of life. Supportive supervision and peer mentoring offer opportunities for all employees to reflect on their own trauma histories and to promote compassion, nonjudgmental attitudes and collaboration.73Trauma-informed health care systems establish and support collaborative, interdisciplinary relationships among community and public health agencies that serve children and adolescents to coordinate care for children, adolescents, and families exposed to trauma. Schools,74 juvenile justice programs,75 mental health professionals,76 home visiting services, child welfare systems,76 and foster care agencies77 are natural partners for pediatric health organizations in promoting community resilience. Many have established TIC programs. Community early intervention programs can help prevent and mitigate adversity and often have the advantage of caring for young children in their natural environment as home visitors.78–80Federal agencies such as the Centers for Disease Control and Prevention can continue and expand research to improve understanding of the developmental effects of trauma and the efficacy of specific interventions for historically resilient populations. Urgently needed are successful strategies to interrupt the intergenerational transfer of family violence. Strategies are also crucial to blunt the impact of historical trauma in communities of color and in American Indian and Alaskan native populations in the United States.30 It is particularly important to identify the origins of and successfully mitigate community violence, including racism, misogyny, and religious, ethnic, and cultural bias.State-level resources can be directed to implementation, dissemination, and evaluation of trauma-informed community programs, such as interagency and multigenerational strategies for opioid dependency. One example of a state interagency, multigenerational treatment program is Ohio START (Sobriety, Treatment and Reducing Trauma).81 States could develop a communication infrastructure to facilitate data sharing, improve interdisciplinary/interagency cooperation, and engage community partners including foundations and academic institutions.Federal guidelines can require that state Medicaid programs ensure comprehensive coverage for all children and adolescents and pregnant mothers without regard for legal or immigration status and mandate that coverage include mental health and substance use disorder services. Financing that increases access to high-quality, comprehensive, coordinated, culturally competent health care for high-risk populations is a high priority. Federal and state regulations can require all insurers, including Medicaid and private health insurers, to include coverage for TIC elements, including surveillance, screening, diagnosis, counseling, case management, follow-up, community collaboration, mental health care, and home visiting.In large health systems, leadership can align its mission and financing with the core elements of trauma-informed systems.82 Supporting TIC includes payment for trauma-informed, integrated mental health services, care coordination, rigorous case management, and seamless referral networks for intensive treatment. Prevention of secondary trauma, including care of affected health care workers, should be built into the mission of the health system.Academic health centers train and educate the next generation of physicians, nurses, and ancillary health personnel and can promote the transformation to TIC in all health settings through education, research, and advocacy. Children’s hospitals and health systems can model mental health integration83 and trauma-informed practices throughout all service lines.84 Because children’s hospitals embrace population health management and community advocacy, they may serve as the anchor institution collaborating with community agencies to address social adversity at the neighborhood level while promoting TIC services.85 Together with community pediatric care systems, academic health centers and children’s hospitals can integrate core elements of education into workforce training for health care workers and community partners such as first responders, child welfare workers, teachers, and juvenile justice personnel.86,87Deborah L. Shropshire, MD, FAAP

High rates of secondary traumatic stress and burnout have been found across nursing populations. However, few studies have focused on neonatal staff. The objectives of this article are to explore the prevalence and severity of secondary traumatic stress (STS) and burnout in neonatal staff, and identify risk factors and protective factors for STS and burnout within this population with the aim of informing future staff support. A quantitative, cross-sectional study using a survey design was conducted; 246 neonatal staff reported measures of STS, burnout, self-compassion and satisfaction with ward climate. Neonatal staff reported high rates of moderate-severe STS and burnout. STS and burnout were negatively associated with self-compassion and satisfaction with ward climate, suggesting them to be protective factors against STS and burnout. STS was found to be a risk factor for burnout and vice versa. Interventions that increase understanding of STS and burnout, nurture self-compassion, provide support and enhance stress management could help mitigate the impact of STS and burnout amongst neonatal staff.

Since the 1980s, concern has increased about how a challenging work environment consisting of a traumatized population of victims of violence and crime affects those professionals (including social workers, mental health workers, psychologists, nurses, and psychiatrists) who try to help these individuals. Data indicate that these helping professionals tend to develop occupational stress symptoms when they assist victims in managing their trauma or posttraumatic stress disorder (PTSD) (Boscarino, Figley, & Adams, 2004; Bride, 2007; Bride, Jones, & MacMaster, 2007). Working with traumatized clients or patients not only threatens the emotional balance of helping professionals, it may also cause these caregivers to suffer overwhelming negative feelings (Collins & Long, 2003; Halloran & Linton, 2000; Herman, 1992). Specifically, secondary traumatic stress (STS) symptoms have been viewed as the inevitable consequence of supporting victims of violence and crime (Bride, 2004; Figley, 1983, 1999). The symptoms of STS, which parallel those that appear in people directly exposed to trauma, include intrusive imagery related to the clients' traumatic disclosures, avoidant responses, physiological arousal, emotional numbing, distressing emotions, physiological somatic problems, hypervigilance, and functional impairment (Brady, Guy, Poelstra, & Fletcher-Brokaw, 1999; Chrestman, 1999; Dutton & Rubenstein, 1995; Figley, 2002; Pearhnau & Maclan, 1995). Helping professionals get STS either from their knowledge about a traumatic event or from their efforts to support traumatized or suffering people (Brown & O'Brien, 1998; Epstein & Silvern, 1990; Figley, 1995; Iliffe & Steed, 2000). STS has been measured by the Compassion Fatigue Self-Test (Figley, 1995) and the Secondary Traumatic Stress Scale (Bride, Robinson, Yegidis, & Figley, 2004). One essential factor in making STS a priority is societal. Statistics show that the United States continues to suffer from issues of violence and crime, although serious violent crime levels have declined in recent years (Bureau of Justice Statistics, 2006; Dye & Roth, 1990; Lindhorst, Nurius, & Macy, 2005; U.S. Department of Health and Human Services, 1996). Helping professionals in social service agencies, clinics, and hospitals have a higher probability of meeting traumatized populations, such as victims of violence and crime. For example, Bride (2007), who conducted an STS study of 282 social workers in a southern state, found that nearly all (97.8 percent) of the social workers he questioned indicated that their client population experienced trauma; most (88.9 percent) indicated that their work with clients addressed issues related to those client traumas. Bride's (2007) study revealed that 70.2 percent of the social workers had exhibited at least one STS symptom m the previous week, and 55.0 percent met the criteria for at least one of the core STS symptoms (intrusion, avoidance, and arousal). Another national STS study of 515 mental health workers (Ting, Jacobson, Sanders, Bride, & Harrington, 2005) found that over half (53.3 percent) acknowledged the effects of secondary trauma on their personal and professional lives. Both societal issues and the problem of turnover of helping professionals within the workplace raise concern that STS be addressed. Previous studies indicate that those helping professionals with STS symptoms tend to leave their jobs more frequently than those without STS (Beaton & Murphy, 1995). With the loss of experienced staff, social agencies, clinics, and hospitals will no longer be able to support or protect traumatized victims of violence and crime. Finally, because the symptoms of STS (intrusion, avoidance, and arousal) mimic those of PTSD, it would be reasonable for DSM-V to assess STS as it will PTSD. STS is almost identical to PTSD, except that STS applies to people who have been affected by the trauma of others (Figley, 2002). …

IntroductionTeachers’ mental health is an imperative aspect in ensuring their appropriate cognition, behaviors and perception. Studies have reported mixed results on work engagement and compassion fatigue among employees in different time and cultures. This study assesses and examines the correlation between Chinese teachers’ work engagement and compassion fatigue during the pandemic.MethodsAn online questionnaire was designed through a Chinese data collection platform (Credamo), and the sample of 3147 teachers in Zhejiang province (China) completed the survey online. The Utrecht Work Engagement Scale (UWES) was used to measure teachers’ work engagement (WE), while the Professional Quality of Life Scale version 5 (ProQoL-5) was used to measure teachers’ compassion fatigue (CF). SPSS 25, PROCESS Macro of SPSS, and JASP were used to analyze the data.ResultsThe results indicated a negative correlation between teachers’ work engagement and compassion fatigue in general, while particularly, vigor, dedication, and absorption negatively correlated with burnout (r = −0.370, r = −0.243, and r = −0.220 respectively), but positively correlating with secondary traumatic stress (r = 0.489, r = 0.343, and r = 0.319).DiscussionTeachers’ working experience positively correlates with their work engagement but negatively correlates with their compassion fatigue.ConclusionTeachers’ work engagement (ie, dedication) is important in reducing compassion fatigue and maintaining compassion satisfaction.

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.

BackgroundCompassion fatigue among health care professionals has gained interest over the past decade. Compassion fatigue, as well as burnout, has been associated with depersonalization and suboptimal patient care. Professional caregivers in general are exposed to the risk of compassion fatigue (CF), burnout (BO) and low levels of compassion satisfaction (CS). While CF has been studied in health care professionals, few publications address its incidence among family physicians, specifically. The objectives of this study were to assess the prevalence and severity of CF among family practitioners (FPs) in the Negev (Israel’s southern region), evaluating the correlations between CF, BO and CS and their relations with socio-demographic variables and work related characteristics.MethodsSelf-report anonymous Compassion Satisfaction and Fatigue Test questionnaires (CSFT) measuring CF, BO, and CS were distributed among 194 family physicians at Clalit Health Services clinics in the Negev between July 2007 and April 2008. Correlations between CF, BO and CS were assessed. Multivariable logistic regression models with backward elimination were constructed.Results128 (66%) physicians responded. 46.1% of respondents scored extremely high and high for CF, 21.1% scored low for CS and 9.4% scored high for BO. Strong correlations were found between BO and CF (r = 0.769, p < 0.001), and between BO and CS (r = −0.241, p = 0.006), but no correlation was found between CS and CF. The logistic regression model showed that the only factor associated with a significantly increased risk for CF was former immigration to Israel. Increased risk for BO was associated with female gender, history of personal trauma and lack of academic affiliation. Higher CS was associated with holding management positions and teaching residents.Conclusions and policy recommendationsFamily physicians in the Negev are at high risk for CF, with the potential for CF- associated patient dissatisfaction, compromised patient safety and increased medical error. We propose creation of a CF educational and early intervention treatment program for family physicians and other health care professionals. Such programs would train facilitators of physician well-being and resiliency building. We also recommend analyzing contributing variables and organizational factors related to higher CF. Policy recommendations include integrating such programs within required risk management continuing medical education.

Mental health professionals are at increased risk for developing secondary traumatic stress (STS), which can progress to posttraumatic stress disorder. Distress tolerance (DT) and rumination play important roles in posttraumatic stress disorder development and maintenance, yet few studies have examined these constructs in relation to STS. This study first compared mental health professionals and individuals in nonhelping professions regarding STS, DT, and rumination. Second, it explored whether rumination mediates the relationship between DT and STS. Participants included mental health professionals (N = 90) and individuals not at risk for STS through their work (N = 67). Self-report measures assessed DT, rumination, and STS. Independent-samples t tests were used for group comparisons, and mediation analyses were conducted using the SPSS PROCESS Macro. Mental health professionals showed lower STS and higher DT scores, but no significant differences were found in rumination. Lower DT was associated with higher STS and rumination. Rumination partially mediated the relationship between DT and STS. While mental health professionals experienced lower levels of STS and higher DT, this study highlights the role of transdiagnostic factors-such as DT and rumination-that are relevant across various mental health conditions. Low DT may lead to maladaptive cognitive strategies, like rumination, which in turn heighten STS. These findings emphasize the importance of understanding transdiagnostic constructs to develop targeted interventions and prevention efforts for both the general population and mental health professionals. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

O NE of the greatest population transfers in history took place at the time of the granting of independence to India and Pakistan. According to the India and Pakistan census reports of 1951, there were 7,150,000 Muslim refugees in Pakistan and 7,471,000 non-Muslim refugees in India by March 1, 1951.1 Even now, over five years after Partition, the influx of refugees has not ended. Indeed, as this was being written, 1,700 recent refugees from East Bengal were camping in the Howrah Station in Calcutta. task of taking care of the millions of displaced persons, of providing food, shelter, and means of rehabilitation, has been an enormous problem for the young governments of India and Pakistan; and the last five years have been a very painful period for the refugees, who have often had to adjust to radical changes in their standard of living, their occupations, and their way of life. As this vast process of shifting and amalgamation takes place, one wonders how it will ultimately affect the social structure of South Asia. Throughout India there are hundreds of refugee settlements which sprang up overnight in the first months of Independence. Many of these have since become permanent communities, and in each one some kind of social organization has necessarily taken shape. It would be interesting to know what kind of social structure has developed in these settlements. Has there been simply a reconstitution of the old town and village life, transplanted but unchanged-or has something new developed in the new setting? What has happened to the traditional Hindu caste system in these settlements? Has it tended to disappear in the shaking-up process of migration; or has it, through a self-protective reaction, been strengthened, reaffirmed? And what is the present role of the caste and regional panchayats, those regulative bodies which settle the disputes and infringements of taboo in Indian villages? Have the panchayats lost their hold in the transplantation? If so, what new organizations have taken their place? Has there, furthermore, been any development of class stratification in these settlements? Finally, what kind of relationships exist between the refugees and the local populations where they have settled? It would be difficult to find general answers to these questions, because of the great variety in these settlements. Some, like Faridabad and Nilokheri, have received extensive government support, have well-developed co-operative organizations, and appear to the visitor to be laid out with mathematical orderliness, like a huge army camp. Other communities, on the other hand, are small makeshift colonies with only a few hundred inhabitants, lacking planned enterprises or co-operatives. There are also various regional differences-for example, in the situations confronting the refugees in East Punjab and those in Bombay State. No special linguistic adjustment has been necessary in East Punjab. Most of the refugees there have come from West Punjab, where the language and culturepatterns are essentially the same. But in the case of the Sindhis, who sailed from Karachi to Bombay State, the refugees have had to adjust to an area with quite a different language and written script and with many other striking cultural differences. It would be difficult, therefore, to frame universally applicable generalizations about the social structure in India's new refugee settlements. In October-November 1952 the writer interviewed camp officials, panchayat leaders, and other refugees at Pimpri Colony, a settlement of Sindhi refugees located by the Bombay-Poona railroad, about twenty minutes by train from the city of Poona. purpose was to answer the questions listed above with regard, at least, to one refugee community.2 This is no substitute for I William Henderson, The Refugees in India and Pakistan, Journal of International Affairs, VII (1953), 57-65; India and Pakistan Year Book; and Who's Who, 37 (Bombay, 1951), pp. 15-17. See also C. N. Vakil, Economic Consequences of the Division of India (Bombay: Vora and Co., 1950). For a general discussion of India's refugee problem, see Horace Alexander, New Citizens of India (London: Oxford University Press, 1952). 2 Having previously received official permission to

BackgroundDue to long working hours, shifts, poor working conditions, and high risk of exposure to traumatic incidents at work, healthcare workers (HCWs) are at high risk of developing mental health and wellbeing issues. Family members and close friends of HCWs are often the primary support source for the HCWs. However, while supporting the HCWs, family members’ and friends’ mental health and wellbeing may be impacted negatively. According to the findings of previous literature, family members of other high-risk workers may experience secondary traumatic stress. To date, there has been no research focusing on secondary traumatic stress in family members and friends of HCWs.MethodsIn this cross-sectional, mixed-method study, we examined secondary traumatic stress and associated factors amongst 320 household members (family members and housemates) of HCWs in the UK using the Secondary Traumatic Stress Scale. We used multivariable linear regression to examine the predictors of secondary traumatic stress, specifically sex, age, job role of the HCW, and the relationship with the HCW. Then we used content analysis of responses to open-ended questions to explore the experiences of household members in-depth.Results33.8% of household members reported secondary traumatic stress within the severe range. Female spouses and partners of HCWs with clinical roles showed higher STS compared to male and other household members of HCWs with non-clinical roles. In our regression model, we found that being female, having a HCW household member with a clinical role, and being a spouse or a partner of a HCW were statistically significant predictors of high STS. Open-ended responses showed that household members reported that HCWs tended to be irritated, quieter/distant, anxious/stressed, in low moods, and exhausted after having a difficult day at work. These feelings and behaviours impacted the rest of the household members negatively.ConclusionThis is the first study which has examined secondary traumatic stress amongst household members of HCWs. While trying to support the HCW, household members were at high risk of developing secondary traumatic stress. There are research implications to understand HCWs’ and their household members’ experiences better, including extending current research and conducting further research exploring secondary traumatic stress in HCWs’ household members, and factors associated with it, which go beyond the demographics examined here. There are also organisational and clinical implications to protect and support both HCWs and their household members, such as improved working conditions for HCWs and carefully planned psychological support for both HCWs and their household members.

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Being a mental health worker in Rwanda is very difficult as many endure traumatic stress as a result of working with trauma survivors and other psychiatric patients. This phenomenon has been described as Secondary Traumatic Stress (STS). This study aimed to explore the mental health workers' experiences of STS when working with mental health clients in Kigali, Rwanda. Using a qualitative approach with an exploratory design, mental health workers from four mental health services in Kigali City were invited to participate in the study. A total of 30 participants were interviewed and included nurse managers, medical doctors, social workers, trauma counsellors, psychologists and psychiatric nurses. Four categories emerged from the data, namely; feelings while experiencing STS; factors contributing to STS; strategies used to cope with STS; and support systems which limit STS. Mental health workers in Rwanda could experience immediate and long-term STS responses which might affect them emotionally and physically. Although there are a few positive aspects to working with traumatised clients in Rwanda, the effects of STS impact negatively on the professional functioning and interpersonal relationships of mental health workers in that country. Mental health institutions should consider implementing protective strategies such as structured supervision and peer support groups to mitigate STS. Mental health professionals working with traumatised clients need to tend to their own self-care by examining within themselves any unresolved trauma issues of their own.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Mental health clinicians who work with clients who have experienced severe trauma are at greater risk of developing compassion fatigue. Limited prior research investigated the relationship between self-compassion and compassion fatigue. The purpose of this quantitative correlational study was to assess the relationships of self-compassion and duration of professional service to compassion fatigue among licensed mental health clinicians who worked with clients that have experienced trauma in southern California. Two research questions asked whether self-compassion and duration of professional service were significantly related to compassion fatigue. The researcher collected primary data for the variables of interest via an online survey using two validated instruments, SCS-SF and ProQOL-Version 5. The study was conducted with a convenience sample of (n = 67) licensed mental health clinicians who resided in southern California. The results of non-parametric Kendall’s tau-b correlations revealed a significant inverse correlation between self-compassion and compassion fatigue, τb = -0.273, p = .002. The correlation between duration of professional service and compassion fatigue was nonsignificant, τb = -0.104, p = .299. These results are vital and relevant to the field as they justify further research, training and professional development in this area, leading to the development of clinical interventions that are needed to mitigate compassion fatigue symptoms among this population.

Compassion Satisfaction, Burnout, and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties

Emergency medicine specialists’ mental and physical health may be threatened if they experience burnout, sleep disorders, and secondary traumatic stress (STS). We aimed to investigate whether Emergency Medical Services (EMs) professionals’ mental and physical health status, depression, and anxiety are associated with burnout, STS, and sleep disorders. We hypothesized that burnout, STS, and the severity of sleep disorders would raise the risk of impaired mental, and physical health, depression, and anxiety in emergency medical clinicians. A cross-sectional multicentric study was conducted. In total,178 EMs specialists completed validated surveys to assess mental health complaints (Mental Health Inventory, MHI-5 screening test), physical health complaints (Ware scale), depression, and anxiety (Depression, Anxiety and Stress Scale-DASS), burnout (Maslach Burnout Inventory-general survey, MBI-GS), sleep disorders (Insomnia Severity Index, ISI), and STS (STS scale). This study aimed to analyze the influence that work-related factors can have on EMs specialists’ mental and physical health, depression, and anxiety. Specifically, mental health was predicted by exhaustion (β = 0.16), cynicism (β = 0.21), insomnia severity (β = 0.13), and STS (β = 0.35); physical health was predicted by exhaustion (β = 0.33) and insomnia severity (β = 0.18); depression was predicted by cynicism (β = 0.21) and STS (β = 0.46); and anxiety was predicted by STS (β = 0.63) and inefficacy (β = 0.20). Work-related stress symptoms such as burnout, STS, and sleep disorders were found to predict emergency medicine clinicians’ mental and physical health, as well to increase the risk of depression and anxiety. It is of most importance to develop practices to prevent such symptoms and to promote mental health and well-being among the emergency medicine personnel.