Abstract

Introduction: Refugees fleeing persecution, torture, or sexual violence are at high risk of developing both acute and chronic psychological disorders. Systematic violence, as committed against the Yazidi minority in Northern Iraq by the terror organization known as the Islamic State (IS), can be seen as a particularly traumatic burden to the victims, but also to caregivers providing treatments and assistance to them. The intense exposure to traumatic content may cause secondary traumatization in respective caregivers. This study aims (1) to identify the prevalence of secondary traumatization in caregivers working with traumatized women and children from Northern Iraq; (2) to determine the specific distressing factors and resources of the caregivers; as well as (3) to analyze whether caregivers' personal history of trauma or flight, attachment styles, working arrangements as well as support offers qualify as risk or resilience factors for secondary traumatization.Materials and Methods: In this cross-sectional study, N = 84 caregivers (social workers, psychotherapists/physicians, and interpreters) in the context of a Humanitarian Admission Program (HAP) for women and children traumatized by the so called IS were investigated about their work-related burdens and resources. Secondary traumatization was assessed with the Questionnaire for Secondary Traumatization (FST). To identify relevant determinants for secondary traumatization multiple linear regression analyses were performed.Results: Secondary traumatization was present in 22.9% of the participating caregivers, with 8.6% showing a severe symptom load. A personal history of traumatic experiences, a personal history of flight, a higher number of hours per week working in direct contact with refugees as well as a preoccupied attachment style were detected as risk factors for secondary traumatization. A secure attachment style could be identified as a resilience factor for secondary traumatization.Discussion: Caregivers working with traumatized refugees are at high risk of developing secondary traumatization. Based on the findings of this study and theoretical considerations, a framework of classification for different types of trauma-associated psychological burdens of caregivers working with traumatized refugees is proposed. Implications for the training and supervision of professionals in refugee- and trauma-care are discussed.

Highlights

  • Refugees fleeing persecution, torture, or sexual violence are at high risk of developing both acute and chronic psychological disorders

  • The aims of this study are to [1] identify the prevalence of secondary traumatization in caregivers working with Islamic State (IS)-traumatized refugees, [2] to analyze the caregivers’ specific distressing factors and resources and [3] to determine risk and resilience factors of secondary traumatization in caregivers by testing the hypothesis that supervision, intervision, secure, and preoccupied attachment styles serve as resilience factors of secondary traumatization whereas an own trauma history, own experiences of flight, more hours per week of direct contact with refugees as well as fearful and dismissing attachment styles serve as risk factors for secondary traumatization

  • The role of the detected potential risk and resilience factors should be considered as hypothetical and needs to be confirmed by longitudinal data. This is the first study to explore secondary traumatic symptoms, burdens and resources in caregivers working with women and children who suffered from extreme IS-violence in the form of torture, slavery, and sexual violence by using inter alia an instrument designed and evaluated to detect secondary traumatization

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Summary

Introduction

Torture, or sexual violence are at high risk of developing both acute and chronic psychological disorders. In 2016, Germany registered the highest number of asylum applications in the last decade: 722.370 fist-time applications for asylum in Germany In both years, around half of refugees trace their origin to one of three countries: Syria, Afghanistan, or Iraq [2]. The prevalence rates of mental disorders in refugees worldwide varies widely among different studies, a large metaanalytic review recently identified prevalence rates of 30.6% for post-traumatic stress disorder (PTSD) and rates of 30.8% for depressive disorder among refugees [3, 4] In this context and in general, man-made traumas such as torture and especially sexual violence are a strong predictor for developing PTSD [5, 6] and comorbid depression [7]

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