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Exposure to Client Trauma, Secondary Traumatic Stress, and the Health of Clinical Social Workers: A Mediation Analysis

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Abstract

While it is widely acknowledged that providing services to traumatized populations may negatively impact the mental health of clinicians, little is known about the impact of exposure to traumatized clients and secondary traumatic stress on the physical health status of clinicians. As such, the twofold purpose of this study was to: (1) document the prevalence of STS in a national (US) sample of clinical social workers, and (2) to examine the relationships between exposure to client trauma, STS, and perceived health of clinical social workers. Specifically, we sought to determine if STS mediates the relationship between exposure to client traumas and perceived health. Results indicate clinicians experience intrusion symptoms most frequently, and a significant portion report arousal and avoidance symptoms. Mediation analyses revealed that exposure to traumatized client populations indirectly influenced clinical social workers’ physical health perceptions by way of secondary traumatic stress. Findings call for increased attention toward prevention and amelioration of secondary traumatic stress symptomology among direct service providers, given both its prevalence and potential impact on physical health. Directions for future research are discussed.

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References

  • Adams, R. E., Figley, C. R., & Boscarino, J. A. (2008). The compassion fatigue scale: Its use with social workers following urban disaster. Research on Social Work Practice, 18(3), 238–250. doi: 10.1177/1049731507310190.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn., revised), Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Andersen, J. P., Hughes, T. L., Zou, C., & Wilsnack, S. C. (2014). Lifetime victimization and physical health outcomes among lesbian and heterosexual women. PLoS ONE, 9(7), e101939. doi: 10.1371/journal.pone.0101939.

    Article  PubMed  PubMed Central  Google Scholar 

  • Aversa, L. H., Lemmer, J., Nunnink, S., McLay, R. N., & Baker, D. G. (2014). Impact of childhood maltreatment on physical health-related quality of life in U.S. active duty military personnel and combat veterans. Child Abuse & Neglect, 38(8), 1382–1388. doi: 10.1016/j.chiabu.2014.03.004.

    Article  Google Scholar 

  • Badger, K., Royse, D., & Craig, C. (2008). Hospital social workers and indirect trauma exposure: An exploratory study of contributing factors. Health & Social Work, 33, 63–71.

    Article  Google Scholar 

  • Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42(10), 1129–1148.

    Article  PubMed  Google Scholar 

  • Benight, C. C., & Cieslak, R. (2011). Cognitive factors and resilience: how self-efficacy contributes to coping with adversities. In S. M. Southwick, B. T. Litz, D. Charney & M. J. Friedman (Eds.), in Resilience and mental health challenges across the lifespan (Southwick 45–55). Cambridge: Cambridge University Press.

    Google Scholar 

  • Ben-Porat, A. (2017). Competence of Trauma social workers the relationship between field of practice and secondary traumatization, personal and environmental variables. Journal of interpersonal violence, 32(8), 1130–1291. doi:10.1177/0886260515588536.

    Article  Google Scholar 

  • Berceli, D., & Napoli, M. (2006). A proposal for a mindfulness-based trauma prevention program for social work professionals. Complementary Health Practice Review, 11(3), 153–165.

    Article  Google Scholar 

  • Boscarino, J. A., Figley, C. R., & Adams, R. E. (2004). Compassion fatigue following the September 11 terrorist attacks: A study of secondary trauma among New York City social workers. International Journal of Emergency Mental Health, 6(2), 57.

    PubMed  PubMed Central  Google Scholar 

  • Bride, B. E. (2004). The impact of providing psychosocial services to traumatized populations. Stress. Trauma and Crisis: An International Journal, 7(1), 29–46. doi:10.1080/15434610490281101.

    Article  Google Scholar 

  • Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63–70. doi:10.1093/sw/52.1.63.

    Article  PubMed  Google Scholar 

  • Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Development and validation of the secondary traumatic stress scale. Research on Social Work Practice, 14(1), 27–35. doi:10.1177/1049731503254106.

    Article  Google Scholar 

  • Choi, G. (2011). Secondary traumatic stress of service providers who practice with survivors of family or sexual violence: A national survey of social workers. Smith College Studies in Social Work, 81, 101–119. doi:10.1080/00377317.2011.543044.

    Article  Google Scholar 

  • Cloitre, M., Cohen, L. R., Edelman, R. E., & Han, H. (2001). Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse. Women & Health, 34(3), 1–17. doi:10.1300/J013v34n03_01.

    Article  Google Scholar 

  • Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social Work, 48(4), 451–459. doi:10.1300/J013v34n03_01.

    Article  PubMed  Google Scholar 

  • D’Andrea, W., Sharma, R., Zelechoski, A. D., & Spinazzola, J. (2011). Physical health problems after single trauma exposure when stress takes root in the body. Journal of the American Psychiatric Nurses Association, 17(6), 378–392. doi:10.1177/1078390311425187.

    Article  PubMed  Google Scholar 

  • Figley, C. R. (1999). Compassion fatigue: Toward a new understanding of the costs of caring. In C. R. Figley (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, & educators (pp. 3–28). Baltimore: Sidran Press.

    Google Scholar 

  • Gabert-Quillen, C. A., Selya, A., & Delahanty, D. L. (2015). Posttraumatic stress disorder symptoms mediate the relationship between trauma exposure and smoking status in college students. Stress and Health, 31(1), 78–82. doi:10.1002/smi.2543.

    Article  PubMed  Google Scholar 

  • Godfrey, K. M., Lindamer, L. A., Mostoufi, S., & Afari, N. (2013). Posttraumatic stress disorder and health: a preliminary study of group differences in health and health behaviors. Annals of General Psychiatry, 12(30), 1–8. doi:10.1186/1744-859X-12-30.

    Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.

    Google Scholar 

  • Hemmingsson, E., Johansson, K., & Reynisdottir, S. (2014). Effects of childhood abuse on adult obesity: A systematic review and meta-analysis. Obesity Reviews, 15(11), 882–893. doi:10.1111/obr.12216.

    Article  PubMed  Google Scholar 

  • Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. The American Journal of Psychiatry, 164(1), 150–153.

    Article  PubMed  Google Scholar 

  • Irish, L., Kobayashi, I., & Delahanty, D. L. (2009). Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. Journal of Pediatric Psychology. doi:10.1093/jpepsy/jsp118.

    PubMed  PubMed Central  Google Scholar 

  • Irish, L. A., Gabert-Quillen, C. A., Ciesla, J. A., Pacella, M. L., Sledjeski, E. M., & Delahanty, D. L. (2013). An examination of PTSD symptoms as a mediator of the relationship between trauma history characteristics and physical health following a motor vehicle accident. Depression and Anxiety, 30(5), 475–482. doi:10.1002/da.22034.

    Article  PubMed  Google Scholar 

  • Kintzle, S. M. (2012). Secondary traumatic stress in military healthcare providers: An examination into empathy and emotional separation as moderating variables (Doctoral dissertation). Retrieved from http://dbs.galib.uga.edu/cgi-bin/write_stats.cgi?stattype=fulltext&dbscode=getd&format=pdf&redirect=http://getd.libs.uga.edu/pdfs/kintzle_sara_m_201205_phd.pdf.

  • Lauterbach, D., Vora, R., & Rakow, M. (2005). The relationship between posttraumatic stress disorder and self-reported health problems. Psychosomatic Medicine, 67(6), 939–947. doi:10.1097/01.psy.0000188572.91553.a5.

    Article  PubMed  Google Scholar 

  • Lee, J. J. (2012). Social work practice with trauma survivors: Investigating risk and protective factors for secondary traumatic stress in a national sample of social workers (Doctoral dissertation). Retrieved from http://dbs.galib.uga.edu/cgi-bin/write_stats.cgi?stattype=fulltext&dbscode=getd&format=pdf&redirect=http://getd.libs.uga.edu/pdfs/lee_jacquelyn_j_201208_phd.pdf.

  • Lee, J. J., & Miller, S. E. (2013). A self-care framework for social workers: Building a strong foundation for practice. Families in Society: The Journal of Contemporary Social Services, 94(2), 96–103. doi:10.1606/1044-3894.4289.

    Article  Google Scholar 

  • McFarlane, A. C. (2010). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9(1), 3–10. doi:10.1002/j.2051-5545.2010.tb00254.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • McHorney, C. A., Ware, J. E. Jr., & Raczek, A. E. (1993). The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247–263.

    Article  PubMed  Google Scholar 

  • Pacella, M. L., Hruska, B., & Delahanty, D. L. (2013). The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review. Journal of Anxiety Disorders, 27(1), 33–46. doi:10.1016/j.janxdis.2012.08.004.

    Article  PubMed  Google Scholar 

  • Pérez, L. G., Abrams, M. P., López-Martínez, A. E., & Asmundson, G. J. (2012). Trauma exposure and health: The role of depressive and hyperarousal symptoms. Journal of Traumatic Stress, 25(6), 641–648. doi:10.1002/jts.21762.

    Article  PubMed  Google Scholar 

  • Pietrzak, R. H., Schechter, C. B., Bromet, E. J., Katz, C. L., Reissman, D. B., Ozbay, F., … Southwick, S. M. (2012). The burden of full and subsyndromal posttraumatic stress disorder among police involved in the World Trade Center rescue and recovery effort. Journal of Psychiatric Research, 46(7), 835–842. doi:10.1016/j.jpsychires.2012.03.011.

    Article  PubMed  Google Scholar 

  • Rauch, S. A. M., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Journal of Rehabilitation Research and Development, 49(5), 679–688. doi:10.1682/JRRD.2011.08.0152.

    Article  PubMed  Google Scholar 

  • Rauch, S.A.M., Grunfeld, T.E.E., Yadin, E., Cahill, S. P., Hembree, E., & Foa, E. B. (2009). Changes in reported physical health symptoms and social function with prolonged exposure therapy for chronic posttraumatic stress disorder. Depression and Anxiety, 26, 732–738. doi:10.1002/da.20518.

    Article  PubMed  Google Scholar 

  • Rauch, S.A.M., Morales, K. H., Zubritsky, C., Knott, K., & Oslin, D. (2006). Posttraumatic stress, depression, and health among older adults in primary care. Journal of Geriatric Psychiatry, 14, 316–324.

    Article  Google Scholar 

  • Rytwinski, N. K., Avena, J. S., Echiverri-Cohen, A. M., Zoellner, L. A., & Feeny, N. C. (2014). The relationships between posttraumatic stress disorder severity, depression severity and physical health. Journal of Health Psychology, 19(4), 509–520. doi:10.1177/1359105312474913.

    Article  PubMed  Google Scholar 

  • Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes. Advances in Mind Body Medicine, 20, 18–29.

    PubMed  Google Scholar 

  • Scott, K. M., Koenen, K. C., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Benjet, C., … Kessler, R. C. (2013). Associations between lifetime traumatic events and subsequent chronic physical conditions: A cross-national, cross-sectional study. PLoS ONE, 8(11), e80573. doi:10.1371/journal.pone.0080573.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shipherd, J. C., Clum, G., Suvak, M., & Resick, P. A. (2014). Treatment-related reductions in PTSD and changes in physical health symptoms in women. Journal of Behavioral Medicine, 37(3), 423–433. doi:10.1007/s10865-013-9500-2.

    Article  PubMed  Google Scholar 

  • Sledjeski, E. M., Speisman, B., & Dierker, L. C. (2008). Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). Journal of Behavioral Medicine, 31(4), 341–349. doi:10.1007/s10865-008-9158-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Strozier, A. L., & Evans, D. S. (1998). Health and distress in social workers: Results of a national survey. Smith College Studies in Social Work, 69(1), 60–77.

    Article  Google Scholar 

  • Subica, A. M., Claypoole, K. H., & Wylie, A. M. (2012). PTSD’s mediation of the relationships between trauma, depression, substance abuse, mental health, and physical health in individuals with severe mental illness: Evaluating a comprehensive model. Schizophrenia Research, 136(1), 104–109. doi:10.1016/j.schres.2011.10.018.

    Article  PubMed  Google Scholar 

  • Thordardottir, E. B., Valdimarsdottir, U. A., Hansdottir, I., Resnick, H., Shipherd, J. C., & Gudmundsdottir, B. (2015). Posttraumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors. Journal of Anxiety Disorders, 32, 103–111.

    Article  PubMed  Google Scholar 

  • Ting, L., Jacobson, J. M., Sanders, S., Bride, B. E., & Harrington, D. (2005). The secondary traumatic stress scale (STSS): Confirmatory factor analyses with a national sample of mental health social workers. Journal of Human Behavior in the Social Environment, 11(3–4), 177–194. doi:10.1300/J137v11n0309.

    Article  Google Scholar 

  • Tucker, A., & Norton, C. L. (2012). The use of adventure therapy techniques by clinical social workers: Implications for practice and training. Clinical Social Work Journal, 41, 333–343. doi:10.1007/s10615-012-0411-4.

    Article  Google Scholar 

  • Tuten, M., Morris-Compton, D., Abrefa-Gyan, T., Hwang, J., & Harrington, D. (2016). Predictors of the use of evidence-based interventions among National Association of Social Work (NASW) members. Journal of Evidence-Informed Social Work, 13, 253–262.

    Article  PubMed  Google Scholar 

  • Wachen, J. S., Shipherd, J. C., Suvak, M., Vogt, D., King, L. A., & King, D. W. (2013). Posttraumatic stress symptomatology as a mediator of the relationship between warzone exposure and physical health symptoms in men and women. Journal of Traumatic Stress, 26(3), 319–328. doi:10.1002/jts.21818.

    Article  PubMed  Google Scholar 

  • Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.

    Article  PubMed  Google Scholar 

  • Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health survey manual and interpretation guide. Boston: The New England Medical Centre.

    Google Scholar 

  • Wegman, H. L., & Stetler, C. (2009). A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosomatic Medicine, 71(8), 805–812. doi:10.1097/PSY.0b013e3181bb2b46.

    Article  PubMed  Google Scholar 

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Acknowledgements

Research reported in this paper was supported by the National Institutes of Health under award number K01DA024718. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Ruth Gottfried is grateful to the Haruv Institute in Jerusalem, Israel, for the award of a Haruv Institute postdoctoral research fellowship that supported her work on this manuscript.

Funding

This study was funded by the National Institutes of Health under award number K01DA024718 to Dr. Bride. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. School of Social Work, College of Health and Human Services, University of North Carolina Wilmington, McNeill Hall 3090, 601 South College Road, Wilmington, NC, 28403-5979, USA

    Jacquelyn J. Lee

  2. Haruv Institute, David Yellin Academic College of Education, 7 Maagal Beit Hamidrash St., 91035, Jerusalem, Israel

    Ruth Gottfried

  3. School of Social Work, Georgia State University, 1243 Urban Life Building, 100 Decatur Street, Atlanta, GA, 30302-3995, USA

    Brian E. Bride

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  1. Jacquelyn J. Lee
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  2. Ruth Gottfried
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Correspondence to Jacquelyn J. Lee.

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Conflict of interest

Jacquelyn Lee declares that she has no conflict of interest. Ruth Gottfried is funded by a postdoctoral fellowship from The Haruv Institute. Brian Bride has received funding from the National Institutes of Health.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Lee, J.J., Gottfried, R. & Bride, B.E. Exposure to Client Trauma, Secondary Traumatic Stress, and the Health of Clinical Social Workers: A Mediation Analysis. Clin Soc Work J 46, 228–235 (2018). https://doi.org/10.1007/s10615-017-0638-1

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