Traumatic Stress Symptoms Research Articles

30 Monkeypox-Induced Secondary Traumatic Stress: An Exploratory Analysis of Young Sexual and Gender Minority Adults Living in Illinois

OBJECTIVES/GOALS: The rapid spread of Monkeypox (MPV) across the US may trigger stress reactions that increase the risk of developing secondary trauma among those most at risk of exposure. The present study aimed to investigate the degree to which vicarious MPV exposure (i.e., knowing people who acquired MPV), was associated with symptoms of secondary traumatization. METHODS/STUDY POPULATION: An online survey was administered to 253 participants enrolled in Keeping it LITE, a prospective U.S. cohort study of ethnically diverse, sexually active, sexual, and gender minority persons aged 19–39 in September 2022. Multiple linear regression was used to examine the association between proximity to MPV and secondary traumatic stress (STS) symptoms. RESULTS/ANTICIPATED RESULTS: Study findings demonstrated that MPV morbidity was low (1%); however, 37% of participants reported knowing at least one person diagnosed with MPV. For most individuals, this person was a friend (28%). 16% of participants were found to have at least one indicator of MPV-related STS. Our multiple linear regression results demonstrated a positive association between an individual’s indirect exposure to MPV via their interpersonal relationships and STS symptoms. DISCUSSION/SIGNIFICANCE: Findings suggest that the more adults’interpersonal relationships are saturated with people who have acquired MPV, the more likely they are to develop symptoms of secondary traumatization. These findings provide initial evidence that secondary exposure to MPV via one’s social network may undermine adults’mental health.

Psychometric properties of the traditional Chinese version of the COVID Stress Scales in Hong Kong.

The COVID Stress Scales (CSS) assess six domains of COVID-19-related stress, including (a) COVID danger, (b) COVID socioeconomic consequences, (c) COVID xenophobia, (d) COVID contamination, (e) COVID traumatic stress symptoms, and (f) COVID compulsive checking. Although the CSS have been validated in various cultural contexts, their psychometric properties in Hong Kong have not been examined. This study endeavors to validate the traditional Chinese version of the 36-item CSS (CSS-36) and the 18-item CSS (CSS-18) in Hong Kong. Participants were 521 Hong Kong undergraduate students (61% female) aged from 18 to 26 years (M = 20.65, SD = 1.56). An online questionnaire was used for data collection. The results of confirmatory factor analyses supported a six-factor structure for both the CSS-36 and the CSS-18. Multiple-group confirmatory factor analyses established the gender invariance of the six-factor model for both the CSS-36 and the CSS-18. The CSS-36 and the CSS-18 exhibited good internal consistency reliability and concurrent validity with fear of COVID-19 and negative emotional states. The findings offer evidence for the psychometric properties of the traditional Chinese version of the CSS-36 and the CSS-18 in the Hong Kong context.

Post-traumatic stress disorder in doctors: Origins, approach and Eye Movement Desensitisation and Reprocessing therapy

Navigating a high-stakes clinical environment, medical doctors tend to consider trauma and adverse workplace events as 'part of their job'. This often leads to delays in help-seeking in doctors who develop acute traumatic stress symptoms (ATSS), post-traumatic stress disorder (PTSD) and their comorbidities. This article outlines the prevalence of acute traumatic stress and PTSD in this population and summarises the emerging evidence base for Eye Movement Desensitisation and Reprocessing (EMDR) early-intervention protocols of this population. Doctors have higher prevalence rates of ATSS and PTSD than the general public. Eye Movement Desensitisation and Reprocessing therapy's early-intervention protocols for recent, prolonged and ongoing traumatic stress have the potential to be a widely acceptable, timely and cost-effective intervention for doctors and other healthcare workers (HCWs), as highlighted in the emerging evidence base, which has grown considerably in response to the impact of the COVID pandemic on HCWs' mental health. These evidence-based interventions could potentially be routinely offered to doctors and other HCWs within 1month of an adverse workplace experience to reduce ATSS, PTSD and other comorbidities.

The mediating role of cognitive processing in the relationship between social support and secondary traumatic stress symptoms in healthcare professionals

Aim of the studyThe aim of this study was to establish how cognitive processing of trauma may mediate the interaction between social support and secondary traumatic stress (STS) symptoms in healthcare professionals.Subject or material and methodsWe collected data from 419 Polish paramedics and nurses. The age of study participants ranged from 19 to 65 years (M = 39.60, SD = 11.03). We used a custom-developed survey and the Secondary Traumatic Stress Inventory, Social Support Scale and Cognitive Processing of Trauma Scale. Pearson’s correlation coefficients were applied to analyze the relationships between variables. A mediation analysis was used to check a mediating role of cognitive trauma processing.ResultsThe results showed significant links between STS symptoms and social support, as well as cognitive processing of trauma.DiscussionCognitive coping strategies, play the intermediary role in the relationship between social support and STS symptoms, however, this role varies depending on the source of support and preferred cognitive coping strategies.ConclusionsParamedics and nurses have higher risk in developing STS. Our findings show that cognitive trauma processing and social support may play an important role in secondary traumatic stress symptoms. It is crucial to develop and implement programs for the prevention and treatment of STS symptoms, which would take into account the studied variables.

Screening for and Responding to Suicidality Among Youth Presenting to a Children's Advocacy Center (CAC).

Youth presenting to a Children's Advocacy Center (CAC) for a forensic interview are at increased risk for suicidality, but no data exist for suicidality or suicide screening and response at the time of the forensic interview. The current study applied a suicide and traumatic stress screening and response protocol, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), with youth (11-18 years) presenting for a forensic interview to one of 16 participating CAC locations, 2018-2020.46.2% of youth screened for traumatic stress and suicidality (N = 1651) endorsed thoughts of suicide or self-harm in the past two weeks, and 13.6% were assessed as high risk for suicide. High symptoms of traumatic stress increased the risk of suicidal thinking as well as of high risk suicidality. CAC workers, both clinicians and non-clinicians, facilitated screening and provided prevention response. Suicide screening and response at the CAC at the time of the forensic interview appears important and feasible.

Supplemental Material for Confirmatory Factor Analysis of the Race-Based Traumatic Stress Symptom Scale in a Sample of Asian American Adults

Supplemental Material for Confirmatory Factor Analysis of the Race-Based Traumatic Stress Symptom Scale in a Sample of Asian American Adults

The impact of necrotizing soft tissue infections on the lives of survivors: a qualitative study

PurposeNecrotizing soft tissue infections (NSTI) are potentially lethal infections marked by local tissue destruction and systemic sepsis, which require aggressive treatment. Survivors often face a long recovery trajectory. This study was initiated to increase understanding of the long-term impact of NSTI on health related quality of life (HRQoL), and how care may be improved.MethodsThematic analysis was applied to qualitative data from 25 NSTI-survivors obtained through two focus groups (n = 14) and semi-structured interviews (n = 11).ResultsThe median age of the participants was 49 years, 14 were female. The median time since diagnosis was 5 years. Initial misdiagnosis was common, causing delay to treatment. Survivors experienced long-term physical consequences (scarring, cognitive impairment, fatigue, sleeping problems, recurrent infections), psychological consequences (traumatic stress symptoms, fear of relapse, adjusting to an altered appearance, sexual issues) and social and relational consequences (changes in social contacts, a lack of understanding). The disease also had a major psychological impact on family members, as well as major financial impact in some. There was a strong desire to reflect on ‘mistakes’ in case of initial misdiagnosis. To improve care, patient and family centered care, smooth transitions after discharge, and the availability of understandable information were deemed important.ConclusionThis study reveals that NSTI have a large impact on physical and psychosocial wellbeing of survivors and their relatives. Except for a few differences (misdiagnosis, fear for re-infection and actual re-infection), the patient experience of patients with NSTI is largely similar to those of burn survivors. Thus, questionnaires to assess HRQoL in burn survivors may be used in future NSTI studies.

Mental health burden for NHS healthcare staff during the COVID-19 pandemic: First results of a longitudinal survey

BackgroundThe current investigation aimed to assess the mental health burden on healthcare workers during the early stages of the COVID-19 pandemic. MethodsA link to an online survey was sent to an estimate of 18,100 employees of Sheffield Teaching Hospitals NHS Foundation Trust (STH) who had access to email. The survey was completed between 2nd and June 12, 2020.1390 healthcare workers (medical, nursing, administrative and other professions) participated in the first survey. Data from a general population sample (n = 2025) was used for comparison. Severity of somatic symptoms was measured by the PHQ-15. Severity and probable diagnosis of depression, anxiety, and PTSD were measured by the PHQ-9, GAD-7, and ITQ. Linear and logistic regressions were performed to determine if population group predicted the severity of mental health outcomes, and probable diagnosis of depression, anxiety, and PTSD. Additionally, ANCOVAs were performed to compare mental health outcomes between occupational roles in HCWs. Analysis was performed using SPSS. FindingsHealthcare workers are more likely to experience greater severity of somatic symptoms, as well as severity and probable diagnosis of depression and anxiety, compared to the general population, but not increased traumatic stress symptoms. Scientific and technical, nursing and admin staff were more likely to experience worse mental health outcomes, compared to medical staff. InterpretationThe COVID-19 pandemic has led to increased mental health burden in some, but not all healthcare workers during the first acute phase of the pandemic. The findings from the current investigation provide valuable insights into which healthcare workers are particularly vulnerable to developing adverse mental health outcomes during and after a pandemic.

Paediatric Medical Traumatic Stress in Children with Cancer and their Parents: Difference in Stress Levels Due to Illness and Treatment Factors.

Pediatric medical traumatic stress (PMTS) is a set of children's and their parents' psychological and physiological responses to pain, injuries, serious illnesses, and other experiences with the medical environment.Pediatric cancer patients have the highest prevalence of PMTS as the illness its treatment involve a set of stressors that trigger many negative psychological reactions. The current study examined the difference in levels of traumatic stress in children with cancer and their parents due to medical factors (type of cancer, outcome, duration, and intensity of treatment, time since diagnosis, relapse, and hospitalization in ICU). The study involved 183 parents of 133 children and 62 children and adolescents who were treated between 2009 and 2019 at the Clinical Department of Pediatric Hematology and Oncology of University Children's Hospital in Ljubljana. We collected the data using The Intensity of Treatment Rating Scale 2.0 [IRT-2], PTSD Checklist for Children/Parent [PCL-C/PR], The PTSD Checklist for DSM-5 [PCL-5] and The Child PTSD Symptoms Scale for DSM-5 [CPSS-5]. Traumatic stress symptoms are frequently present in both children and their parents, regardless of the cancer type, treatment duration, and treatment outcome. Children with relapse, children with more intensive treatment, and parents of the latter are at higher risk for PMTS occurrence. Additionally, we found a decreasing trend of traumatic responses after five or more years post-cancer diagnosis. [Table: see text].

The Role of Pre-Treatment Traumatic Stress Symptoms in Adolescent Substance Use Treatment Outcomes

Background: Prominent theories suggest that individuals with co-occurring traumatic stress symptoms (TSS) and substance use (SU) may be less responsive to SU treatment compared to those with SU only. However, empirical findings in adult samples are mixed, and there has been limited work among adolescents. This study assesses the association between TSS and SU treatment outcomes among trauma-exposed adolescents, using statistical methods to reduce potential confounding from important factors such as baseline SU severity. Method: 2,963 adolescents with lifetime history of victimization received evidence-based SU treatment in outpatient community settings. At baseline, 3- and 6-months, youth were assessed using the Global Appraisal of Individual Needs Traumatic Stress Scale and the Substance Frequency Scale. Propensity score weighting was used to mitigate potential confounding due to baseline differences in sociodemographic characteristics and SU across youth with varying levels of TSS. Results: Propensity score weighting successfully balanced baseline differences in sociodemographic factors and baseline SU across youth. Among all youth, mean SU was lower at both 3- and 6- month follow-up relative to baseline, indicating declining use. After adjusting for potential confounders, we observed no statistically significant relationship between TSS and SU at either 3- or 6-month follow-up. Conclusions: Based on this investigation, conducted among a large sample of trauma-exposed youth receiving evidence-based outpatient SU treatment, baseline TSS do not appear to be negatively associated with SU treatment outcomes. However, future research should examine whether youth with TSS achieve better outcomes through integrative treatment for both SU and TSS.

Post-traumatic stress symptoms and burnout in healthcare professionals working in neonatal intensive care units: Results from the STRONG study.

Newborns' deaths and life-threatening conditions represent extremely stressful events for parents and professionals working in NICUs, facilitating the onset of secondary traumatic stress symptoms. The STRONG study aims to better understand the psychological impact on Italian NICUs staff of bereavement care. The STRONG (STress afteR lOss in NeonatoloGy) study is a cross-sectional study based on a web survey consisted of four sections: sociodemographic, CommuniCARE-Newborn questionnaire, the Maslach Burnout Inventory and the Impact of Event Scale-Revised. 227 NICU workers (42.7% nurses, 23.3% midwives, 22.2% physicians, 11.8% other HCPs) answered the survey. The hardest tasks were "communicating baby's death" and "informing on autopsy results"; 44.7% of HCPs did not receive formal training in communicating bad news, 44.2% 'learned from the field' by watching other colleagues; 41.2% declared that they do not have any communication strategy. More than 90% of professionals thought that training on bereavement care is necessary. The majority of HCPs showed some degree of post-traumatic stress symptoms: 34% medium and 35.3% severe. Professionals with training in bereavement care and/or in communication had less probability to develop stress symptoms. A multivariate analysis showed that higher levels of burnout were associated with 4 or more monthly losses and medium or severe stress symptoms. Having a well-defined communication strategy for breaking bad news was independently associated with a better personal accomplishment. Dealing with newborns' deaths is a highly stressful task; professionals should receive proper support such as debriefing, psychological support and training in order to prevent post-traumatic stress symptoms and reduce professional burnout.

Voluntary Search-and-Rescue Workers’ Experiences After Witnessing Trauma in the Earthquake Field

Turkey has an earthquake-prone geography, and as in Turkey, when professional resources are not sufficiently available in a community hit by a disaster, volunteer search-and-rescue workers’ help is crucial for quickly meeting disaster-area needs. However, few studies focus on volunteer search-and-rescuer’s post-traumatic reactions although trauma literature has grown regarding professional search-and-rescue teams’ post-traumatic responses. Based on this gap in the literature, this study was conducted. This qualitative study provides an in-depth understanding of secondary trauma and vicarious post-traumatic growth among 13 search-and-rescue team workers involved in disaster relief activities following the 2020 Izmir earthquake in Turkey. Data were collected through semi-structured interviews, and an interpretive phenomenological approach was used. The findings revealed that the participants suffered secondary traumatic stress symptoms, namely, hyperarousal, intrusive images, and thoughts but experienced vicarious post-traumatic growth in discovering personal strength, relating to others, appreciating life, and striving to do their job better. This study’s findings can be a source for developing psychosocial post-disaster support services and interventions for volunteers and be used to improve pre-field preparation training content for voluntary search-and-rescue teams. The findings also underlined the fact that focusing on facilitating vicarious post-traumatic growth is as crucial as overcoming voluntary search-and-rescue workers’ post-traumatic stress.

"I Carry the Trauma and Can Vividly Remember": Mental Health Impacts of the COVID-19 Pandemic on Frontline Health Care Workers in South Africa.

We know from research that pandemics and disease outbreaks expose HCWs to an increased risk of short and long-term psychosocial and occupational impacts. We conducted qualitative research among 44 frontline health care workers (FHCWs) practicing in seven South African hospitals and clinics. FHCWs were interviewed on their experiences of working during the first-wave of the COVID-19 pandemic and its perceived impact on their wellness. In this study, FHCWs included the non-medical and medical professionals in direct contact with COVID-19 patients, providing health care and treatment services during the COVID-19 pandemic. Most of the FHCWs reported stressful and traumatic experiences relating to being exposed to a deadly virus and working in an emotionally taxing environment. They reported depression, anxiety, traumatic stress symptoms, demoralization, sleep difficulties, poor functioning, increased irritability and fear of being infected or dying from COVID-19. The mental health impacts of COVID-19 on HCWs were also associated with increased poor physical wellbeing, including fatigue, burnout, headache, and chest-pains. FHCWs reported professional commitment and their faith as critical intrinsic motivators that fostered adaptive coping while working on the frontline during the first-wave of the COVID-19 pandemic. Many alluded to gaps in workplace psychosocial support which they perceived as crucial for coping mentally. The findings point to a need to prioritize interventions to promote mental wellness among FHCWs to ensure the delivery of quality healthcare to patients during pandemics or deadly disease outbreaks.

Depression, Anxiety, and Traumatic Stress Symptoms among Emergency Service Workers in Finland after a Post-Critical Incident Seminar—A Pilot Study

Emergency service workers encounter potentially traumatic incidents as part of their normal work duties. They are, therefore, at an increased risk of symptoms of poor mental health. In the past, post-critical incident seminars (PCIS) were offered to police officers in Finland who had suffered mental health consequences from a critical incident at work. Recently, the same seminar has been offered to emergency service workers in Finland. In this pilot study, the effects of PCIS on the symptoms of depression, anxiety, and traumatic stress are tentatively mapped using self-assessment inventories. Fifteen emergency service workers who attended a PCIS in April 2021 filled out the inventories at the beginning of the PCIS and one, three, and six months after the PCIS. All symptoms measured in this study (depression, anxiety, and traumatic stress) decreased after the PCIS, but the clearest decrease was observed in traumatic stress symptoms. Future similar research should use a control group and a larger sample, track mental health symptom scores over a longer period, and compare qualitative and quantitative data to contribute to a richer understanding of this issue.

Psychosocial Predictors of COVID-19 Vaccine Uptake among Pregnant Women: A Cross-Sectional Study in Greece.

An understanding of the factors associated with the COVID-19 vaccine uptake in pregnant women is paramount to persuade women to get vaccinated against COVID-19. We estimated the vaccination rate of pregnant women against COVID-19 and evaluated psychosocial factors associated with vaccine uptake among them. We conducted a cross-sectional study with a convenience sample. In particular, we investigated socio-demographic data of pregnant women (e.g., age, marital status, and educational level), COVID-19 related variables (e.g., previous COVID-19 diagnosis and worry about the side effects of COVID-19 vaccines), and stress due to COVID-19 (e.g., danger and contamination fears, fears about economic consequences, xenophobia, compulsive checking and reassurance seeking, and traumatic stress symptoms about COVID-19) as possible predictors of COVID-19 vaccine uptake. Among pregnant women, 58.6% had received a COVID-19 vaccine. The most important reasons that pregnant women were not vaccinated were doubts about the safety and effectiveness of the COVID-19 vaccines (31.4%), fear that COVID-19 vaccines could be harmful to the fetus (29.4%), and fear of adverse side effects of COVID-19 vaccines (29.4%). Increased danger and contamination fears, increased fears about economic consequences, and higher levels of trust in COVID-19 vaccines were related with vaccine uptake. On the other hand, increased compulsive checking and reassurance seeking and increased worry about the adverse side effects of COVID-19 vaccines reduced the likelihood of pregnant women being vaccinated. An understanding of the psychosocial factors associated with increased COVID-19 vaccine uptake in pregnant women could be helpful for policy makers and healthcare professionals in their efforts to persuade women to get vaccinated against COVID-19. There is a need for targeted educational campaigns to increase knowledge about COVID-19 vaccines and reduce vaccine hesitancy in pregnancy.

Campus Racial Climate, Psychological Well-being, and Race-Based Traumatic Stress Symptoms Among Monoracial Black and Biracial Black Students Following Heightened Exposure to Police Brutality.

The spring of 2020 was characterized by highly visible acts of police brutality and a heightened attention to systemic racism that created a macro-stressor for Black-identifying individuals. The current study aimed to capture college students' perceptions of campus racial climate, subjective well-being, and race-based trauma symptoms during this time. Results indicated that racial identity was associated with students' mental well-being, perceptions of campus racial climate, and experiences of traumatic stress symptoms. Monoracial Black and biracial Black students differed from non-Black students in their perceptions of campus racial climate and their traumatic stress symptoms. Monoracial Black and biracial Black students differed from one another on reports of subjective well-being. A unique pattern of correlations among the study variables emerged for each group. Our findings document the race-based trauma symptoms experienced by monoracial Black and biracial Black students in the spring of 2020 and provide a foundation for future research to examine factors that uniquely contribute to the well-being of monoracial Black and biracial Black students.

Characterizing changes in behaviors associated with chemical exposures during the COVID-19 pandemic.

The COVID-19 pandemic-and its associated restrictions-have changed many behaviors that can influence environmental exposures including chemicals found in commercial products, packaging and those resulting from pollution. The pandemic also constitutes a stressful life event, leading to symptoms of acute traumatic stress. Data indicate that the combination of environmental exposure and psychological stress jointly contribute to adverse child health outcomes. Within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort, a national consortium initiated to understand the effects of environmental exposures on child health and development, our objective was to assess whether there were pandemic-related changes in behavior that may be associated with environmental exposures. A total of 1535 participants from nine cohorts completed a survey via RedCap from December 2020 through May 2021. The questionnaire identified behavioral changes associated with the COVID-19 pandemic in expected directions, providing evidence of construct validity. Behavior changes reported by at least a quarter of the respondents include eating less fast food and using fewer ultra-processed foods, hair products, and cosmetics. At least a quarter of respondents reported eating more home cooked meals and using more antibacterial soaps, liquid soaps, hand sanitizers, antibacterial and bleach cleaners. Most frequent predictors of behavior change included Hispanic ethnicity and older age (35 years and older). Respondents experiencing greater COVID-related stress altered their behaviors more than those not reporting stress. These findings highlight that behavior change associated with the pandemic, and pandemic-related psychological stress often co-occur. Thus, prevention strategies and campaigns that limit environmental exposures, support stress reduction, and facilitate behavioral change may lead to the largest health benefits in the context of a pandemic. Analyzing biomarker data in these participants will be helpful to determine if behavior changes reported associate with measured changes in exposure.

TRAUMATIC STRESS AND HEALTH ANXIETY IN INTENSIVECARE WORKERS DURING THE COVID-19 PANDEMIC

Aims: Intensive care professionals are the individuals who are most exposed to the psychological effects of the COVID-19 pandemic
 The aim of the present study was to evaluate and compare the, traumatic stress symptoms and health anxiety in intensive care unit (ICU) workers and non-ICU workers who have been playing an active role in caring for COVID-19 patients.
 Method: The sociodemographic characteristics of all the healthcare professionals working in the ICU and other units, were recorded. In addition, their history of COVID-19 infection, living with an elderly person, intensive care hospitalization history of relatives, and death status of relatives due to COVID-19 were recorded. The participants were divided into two groups, namely ICU workers and non-ICU workers. The Health Anxiety Inventory (HAI)and the Impact of Event Scale-Revised (IES-R) scales were applied to all the participants.
 Results: Of the 150 healthcare workers initially identified, 116 agreed to participate in this study. Sixty-nine (59.5%) of them were working in the ICU, while 47 (40.5%) were in non-ICU. 
 The mean IES-R score of all participants was 40.19 ± 15.73. When the IES-R scores and ICU results with non-ICUs were compared, the healthcare workers who work in ICU had significantly higher total IES-R scores (42.83 ± 14.65, p

The association between facets of mindfulness and COVID-19 related distress: A cross-sectional study

ObjectivesTrait mindfulness could function as a protective factor against distress. The current study investigated the relationship of the five distinct facets of mindfulness and COVID-19 related distress. MethodsAn online self-report study was conducted in a Dutch sample (N = 811; Mage = 49 ± 17; 54.5 % female) in February 2021. Dispositional mindfulness was assessed with the Five Facet Mindfulness Questionnaire, and the COVID Stress Scale was used to assess COVID-19 related distress. ResultsMultivariate regression analyses showed that describing and non-judging were inversely related to COVID-19 related distress. Specifically, describing was related to fewer socioeconomic worries, while describing and non-judging were negatively associated with traumatic stress symptoms. Non-judging was negatively associated with COVID-19-related compulsive checking. ConclusionsThe results indicate that individuals high in mindfulness traits describing and non-judging, experience less distress during the pandemic. Teaching mindfulness skills and practice could be helpful in global situations like pandemics.

A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic.

This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.