Meta‐Analysis of Risk Factors for Secondary Traumatic Stress in Therapeutic Work With Trauma Victims

Abstract

Revisions to the posttraumatic stress disorder (PTSD) diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) clarify that secondary exposure can lead to the development of impairing symptoms requiring treatment. Historically known as secondary traumatic stress (STS), this reaction occurs through repeatedly hearing the details of traumatic events experienced by others. Professionals who work therapeutically with trauma victims may be at particular risk for this exposure. This meta-analysis of 38 published studies examines 17 risk factors for STS among professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Small significant effect sizes were found for trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19). Small negative effect sizes were found for work support (r = -.17) and social support (r = -.26). Demographic variables appear to be less implicated although more work is needed that examines the role of gender in the context of particular personal traumas. Caseload frequency and personal trauma effect sizes were moderated by year of publication. Future work should examine the measurement of STS and associated impairment, understudied risk factors, and effective interventions.

Factors Associated with Secondary Traumatic Stress among Emergency Nurses: An Integrative Review

“…Variation among these findings implies that gender does not relate STS, but these findings must be interpreted cautiously for three reasons: majority of ED nurses are females [16], female nurses had higher level of stress than male nurses [36], and female nurses had higher level of compassion fatigue than male nurses [37]. These inconsistent findings caused Hensel et al to suggest the need for more research and further investigation to elucidate this relationship and the role of gender in STS [22].…”

“…Consequently, the ED nurses are at risk and tend to develop STS more than others due to nature being repetitively exposed to traumatized individuals [21]. Another factor may contribute to STS among the ED nurses is being involved in a high level empathetic relationship with the traumatized individuals [22]. Sharing empathy is a central concept and key component in the process of developing STS among nurses [21].…”

“…Moreover, the models explain the STS ignored addressing effects of secondary exposure on nurses, and rather, focused prevalence and contributing factors. [32], history of sexual assault [30], trauma training, social support, personal trauma history [22], and spirituality level [2]. While the organizational factors identified in the literature are: trauma case load [22], organizational support [33], clinical supervision, and relationship with colleagues [30].…”

“…[32], history of sexual assault [30], trauma training, social support, personal trauma history [22], and spirituality level [2]. While the organizational factors identified in the literature are: trauma case load [22], organizational support [33], clinical supervision, and relationship with colleagues [30]. The following sections will explore and discuss the literature found on a selected group of these factors in details and combine findings from both the quantitative and qualitative literature.…”

“…Relationship between perceived social support and STS has been established in several studies. Studies demonstrated that nurses and trauma workers who received high levels of social support found to have less STS symptoms [22]. The qualitative literature also identified that ED nurses viewed social support as preventive and beneficial tool for the management of STS [16].…”