The Secondary Traumatic Stress Scale (STSS)

SUMMARY

The Secondary Traumatic Stress Scale (STSS; Bride, Robinson, Yegidis, & Figley, 2004) is an easy to administer 17-itemself-report measure of secondary trauma. Bride et al. (2004) reported a measure of three domains of traumatic stress specifically associated with secondary exposure to trauma: intrusion, avoidance, and arousal. The STSS was reported to have high levels of internal consistency reliability and indicated evidence of convergent, discriminant, and factorial validity. The purpose of this paper is to examine the reliability and validity of the STSS with a national, random sample of mental health social workers. To assess the fit of the data to the three-factor structure proposed by Bride et al., a confirmatory factor analysis was performed on data from 275 social workers who indicated exposure to client trauma. The model fit the data adequately although high factor intercorrelations strongly suggest a unidimensional scale. Subsequent confirmatory factor analysis of a unidimensional scale and a second order factor analysis yielded similar results. Findings indicate the need for further scale validation. Challenges remain for measuring and distinctly differentiating between secondary trauma symptoms of arousal, avoidance, and intrusion. Implications and suggestions for future research are discussed.     

Secondary traumatic stress and self-care inextricably linked

ABSTRACT

Increasingly trauma scholars are exploring the susceptibility of mental health providers to secondary trauma reactions. The current study explores the relationship between clinical social work practice with trauma-exposed clients and secondary traumatic stress among social workers. The intent of this study is to identify the role various factors play in the development of secondary trauma (also known as compassion fatigue). A simple random sample of National Association of Social Workers members were asked to participate. Participants completed an online survey that explored their exposure and responses to secondary traumatic stress. The online survey consisted of standardized measures including the Secondary Traumatic Stress Scale and The Coping Strategies Inventory which assesses secondary trauma and self-care strategies, respectively (Bober, Regehr, & Zhou, 2006; Bride, Robinson, Yegidis, & Figley, 2003). The magnitude of work (the extent and intensity of time working with trauma-exposed clients) is assessed by a non-standardized measure which consists of clinical caseloads composition questions. Job satisfaction is measured by items taken from the National Association of Social Workers’ workplace questionnaire (Whitaker & Arrington, 2008). 161 social workers completed the online survey. It required approximately 35 minutes to complete. This project empirically demonstrated that high-magnitude social work practice (providing therapeutic intervention to trauma survivors, i.e. military service members and veterans) is associated with higher levels of secondary trauma. There is also empirical evidence that self-care strategies can mitigate the impact of the secondary trauma. Educational and workforce implications for study findings are discussed.     

The Ripple Effect: Lessons Learned About Secondary Traumatic Stress Among Clinicians Responding to the September 11th Terrorist Attacks

Secondary Traumatic Stress (STS) symptoms experienced by mental health clinicians who treated clients for issues related to the terrorist attacks of 9/11 were intense and unprecedented. An exploratory study, using qualitative techniques as the primary information gathering method, was conducted to gain a better understanding about “indirect” exposure to terrorism. Twenty-six mental health clinicians participated in this research effort. As part of this study, questions regarding STS were explored. STS levels among clinicians who provided care to victims of 9/11 were high 30?months after the attacks. Most clinicians lacked experience providing disaster relief mental health care. Availability of supervision and agency support was described as “weak;” however, peer support was deemed helpful. Over the past decade, progress has been made in addressing STS issues. Implications are included for social work practice, disaster mental health administration, funding sources and policy. Recommendations for future research are identified.     

Rethinking professional quality of life for social workers: Inclusion of ecological self-care barriers

ABSTRACT

This study conducted a survey among social workers in a mid-Atlantic state in the U.S. and examined the relationship between self-care behaviors, self-care barriers and compassion satisfaction, burnout, and secondary traumatic stress (STS) from an ecological perspective. The study found that social workers had a moderate level of compassion satisfaction, low risk of burnout, and low risk of STS. Bachelor-degree social workers had higher levels of burnout and lower levels of compassion satisfaction than others. Multiple regression results showed that self-care behaviors and self-care barriers did not predict compassion satisfaction. Self-care behaviors and self-care barriers were significantly associated with the level of burnout. Self-care barriers significantly contributed to STS, while self-care behaviors did not significantly decrease STS. This study implies that promoting self-care behaviors and decreasing self-care barriers can promote higher levels of professional quality of life. In addition to social workers’ individual-level self-care activities that are often stressed in prior research on STS and burnout, employers, supervisors, family members, and community members play a critical role in promoting a manageable work-life balance for social workers, thereby allowing them to use more self-care behaviors, while reducing barriers to self-care and ultimately reducing risk of burnout and STS.     

Diagnosing Discrimination: Stress from Perceived Racism and the Mental and Physical Health Effects*

Differences in health between racial groups in the United States are significant and persistent. Many studies have documented these differences as a result of a variety of different social factors. An emerging emphasis is the impact of racism in its various forms on physical and mental health. Social stress theory conceptualizes racism as a social stresssor which can produce negative health consequences for racial minorities. This study uses binary logit and negative binomial regression models of four items from the 2004 Behavioral Risk Factor Surveillance System (BRFSS) to test social stress theory and examine the relationship between stress symptoms from perceived racism and overall health (N = 32,585). The effect of race on the experience of emotional and physical stress symptoms from racism is substantial. Furthermore, experiencing both emotional and physical stress from perceived racist treatment is an important factor in predicting the number of poor mental and physical health days, indicating that the experience of stress from perceived racism is related to overall poorer health.     

Effects of trauma exposure on anger, aggression, and violence in a nonclinical sample of men

This study assessed the impact of traumatic exposure and posttraumatic stress disorder (PTSD) symptoms on anger, aggression, and violence among civilian male college students. Results suggest that civilian men who have been exposed to a potentially traumatic event (PTE) and report symptoms of PTSD indicate more trait anger, more internal anger and hostility, and more aggression and violence than men who do not report symptoms of PTSD. Results are contrasted to those found in clinical samples of male veterans with PTSD and discussed in terms of understanding and treating anger and aggression in non-clinical, trauma-exposed populations.     

Impact of client suicide on social workers and counselors

Recent studies on the impact of client suicide on mental health professionals focus on psychiatrists and psychologists, while,in the current mental health system in our country, most clients receive services from other clinicians. This research focuses on the impact of client suicide on social workers and counselors as well as organizational responses to client suicide/attempt. Data were collected via interviews and survey of 121 clinicians. Client suicide impacts clinicians adversely in many ways. Many participants felt their agency/practice could have done more to support them during post-suicide management. Data presented in this report have the potential to aid in the creation of needed workforce development initiatives.     

Utilizing Compassion Fatigue Education in Hurricanes Ivan and Katrina

Compassion Fatigue is a state that includes the symptoms of Post-Traumatic Stress Disorder. This text reviews events following the Hurricane Ivan and Katrina disasters and how Compassion Fatigue education helped to identify and ameliorate symptoms of the problem. I worked in a community center in the Pensacola area for one week following Ivan and in a shelter in my residential area of Houma, Louisiana for two months following Katrina. Examples of traumatic stories and coping with my own secondary stress are given. Implications include education regarding CF for all mental health professionals, especially during and following work in disasters or with populations of the traumatized.     

Secondary traumatic stress, psychological distress, sharing of traumatic reminiscences, and marital quality among spouses of Holocaust child survivors

In this study, we examined the issue of secondary traumatic stress (STS) among spouses of Holocaust survivors who were children during the World War II. STS is defined as comprising the same components as posttraumatic stress disorder (PTSD), except that the person evidencing the symptoms has not actually been exposed to the traumatic event(s), but has developed them as a result of caring for someone with PTSD. Participants were 90 couples who completed self-report questionnaires regarding posttraumatic symptoms, psychological distress, and marital quality. The results showed that about one-third of the spouses suffered from some degree of STS symptoms. Secondary traumatic stress symptoms and psychological distress among spouses were significantly related to hostility, anger, paranoia, and interpersonal sensitivity in the survivor, but unrelated to whether the survivor had shared his/her reminiscences with the spouse. Female spouses were found to suffer more distress than male spouses, especially when their partner suffered high levels of PTSD. The results suggest that STS is, to a large degree, related to the demands of living with a symptomatic survivor, possibly more than to the empathic element thought to be central to this syndrome.     

Systemic traumatic stress: the couple adaptation to traumatic stress model

Research traditionally has focused on the development of symptoms in those who experienced trauma directly but overlooked the impact of trauma on the families of victims. In recent years, researchers and clinicians have begun to examine how individual exposure to traumatic stress affects the spouses/partners, children, and professional helpers of trauma survivors. However, empirically supported, theory-based literature that identifies the mechanisms by which interpersonal or "secondary trauma" occurs in response to traumatic events is limited. Here, we present the Couple Adaptation to Traumatic Stress Model, a systemic model of the development of interpersonal symptoms in the couple dyad based on empirical literature. Potential mechanisms and clinical vignettes are included to describe the systemic processes that occur with trauma couples. Areas for future research and clinical implications also are identified.     

See no evil,hear no evil,speak no evil: assessing complex trauma in young children

Complex trauma generally refers to a child's exposure to multiple traumatic events often within the context of an interpersonal relationship. Childhood traumatic events are commonplace and can have significant implications for physical and mental health. However, traumatic events are often not assessed by clinicians involved in their care. This paper outlines an approach to assessing complex trauma in young children in clinical settings. This approach involves an initial interview, an assessment of traumatic events and trauma symptoms in the child, an assessment of the parent–child interaction, an understanding of the child's functioning in multiple settings, and an assessment of parental trauma where relevant. Complex trauma takes time to assess and is dependent on the parent's ability to recognise and acknowledge the effect trauma has had. The paper concludes with some of the challenges when assessing complex trauma in young children in clinical settings.     

The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.

The survey data presented here are on the national prevalences of major life-time perceived discrimination and day-to-day perceived discrimination; the associations between perceived discrimination and mental health; and the extent to which differential exposure and differential emotional reactivity to perceived discrimination account for the well-known associations between disadvantaged social status and mental health. Although more prevalent among people with disadvantaged social status, results show that perceived discrimination is common in the total population, with 33.5 percent of respondents in the total sample reporting exposure to major lifetime discrimination and 60.9 percent reporting exposure to day-to-day discrimination. The associations of perceived discrimination with mental health are comparable in magnitude to those of other more commonly studied stressors, and these associations do not vary consistently across subsamples defined on the basis of social status. Even though perceived discrimination explains only a small part of the observed associations between disadvantaged social status and mental health, given its high prevalence, wide distribution, and strong associations with mental health, perceived discrimination needs to be treated much more seriously than in the past in future studies of stress and mental health.     

The Contribution of Role Characteristics and Supervisory Functions to Supervision Effectiveness

This study examined the factors that contribute to the perceived effectiveness of supervision for child welfare workers. Specifically, we examined role characteristics such as: exposure to child abuse cases, years of work experience, and role stress, as well as the supervisory functions of administration, education, and emotional support to effectiveness of supervision. The findings revealed that the supervisory function of administration, as well as social workers’ high exposure to child abuse cases and role stress, correlated negatively with perceived supervision effectiveness. In contrast, the use of the supervisory functions of education and support correlated positively with perceived supervision effectiveness. The findings suggest that high exposure to child abuse cases and role stress can impair social workers’ ability to benefit from effective supervision. In addition, the study highlights the importance of the supervisory functions of support and education and their positive impact on this population of social workers in Israel.     

The relationship between financial strain,perceived stress,psychological symptoms,and academic and social integration in undergraduate students

ABSTRACT

Objective: Financial strain may directly or indirectly (i.e., through perceived stress) impact students’ psychological symptoms and academic and social integration, yet few studies have tested these relationships. The authors explored the mediating effect of perceived stress on the relationship between financial strain and 2 important outcomes: psychological symptomology and academic and social integration. Participants: Participants were 157 undergraduate students. Data were collected from December 2013 to March 2014. Methods: Cross-sectional data collection conducted using online survey software. Results: It was found that perceived stress mediated the relationship between financial strain and (a) psychological symptomology and (b) academic and social integration. Both models included first-generation status as a covariate. Conclusions: Results suggest that perceived stress is an important intervention target for reducing psychological symptoms and improving academic and social integration for undergraduate students. Implications for university health centers and mental health professionals include incorporating a public health model to minimize stress risk.     

Stress, negative social exchange, and health symptoms in university students

Although social support has been studied extensively in terms of its role in the relationship between stress and health, less attention has been devoted to the impact of negative social interactions. In this investigation, the authors examined the unique contributions of positive social support and negative social exchange in the relationship between stress and health symptoms, using data from 206 undergraduates at a large state university. Negative social exchange accounted for more variance in physical health symptoms than did life-event stress, daily hassles, or social support. The relationship between negative social interaction and physical symptoms was not the result of variance shared with psychological well-being. The importance of attending to negative aspects of social interaction among university students in terms of their health and well-being is discussed.     

Vicarious traumatization,secondary traumatic stress,and burnout in sexual assault and domestic violence agency staff

This study investigated three occupational hazards of therapy with trauma victims: vicarious trauma and secondary traumatic stress (or "compassion fatigue"), which describe therapists' adverse reactions to clients' traumatic material, and burnout, a stress response experienced in many emotionally demanding "people work" jobs. Among 101 trauma counselors, client exposure workload and being paid as a staff member (vs. volunteer) were related to burnout sub-scales, but not as expected to overall burnout or vicarious trauma, secondary traumatic stress, or general distress. More educated counselors and those seeing more clients reported less vicarious trauma. Younger counselors and those with more trauma counseling experience reported more emotional exhaustion. Findings have implications for training, treatment, and agency support systems.     

Impact of the Most Frequently Reported Traumatic Events on Community Mental Health Clients

This survey of 354 community mental health clients examined the relative impact of client self-reported events that they deemed “most traumatic” for predicting posttraumatic stress syndrome (PTSD) symptom severity. Results of the voluntary survey revealed the most traumatic lifetime events to be (in descending order of frequency): sudden death of a loved one, sexual abuse, physical abuse, suicide attempt, and having been in a serious/life-threatening accident. These factors were then tested for gender differences, and regression models were developed to test the predictive power of traumatic events relative to primary diagnosis, psychosocial well-being, other key psychiatric indicators, and drinking to cope with negative emotions. Results demonstrated that sexual abuse was reported to be among the strongest predictors of PTSD symptom severity. Separate regression models also revealed important gender differences. Implications for social work assessment of seriously mentally ill clients are suggested.     

The role of self-care on compassion satisfaction,burnout and secondary trauma among child welfare workers

Child welfare workers are routinely exposed to multiple traumatic events when working with children and families, and are at an increased risk of experiencing burnout and secondary trauma. Self-care is often recommended as a restorative or protective activity against the negative effects of working with traumatized individuals, although few studies have examined the benefit of self-care empirically. Trauma-informed self-care (TISC) includes being aware of one's own emotional experience in response to exposure to traumatized clients and planning/engaging in positive coping strategies, such as seeking supervision, attending trainings on secondary trauma, working within a team, balancing caseloads, and work–life balance. Compared with generic personal care activities, TISC is likely to be especially relevant for child welfare workers. This study examined the role of TISC on compassion satisfaction, burnout and secondary trauma which was assessed by administering surveys to a sample of 104 child welfare case managers and supervisors. Almost one third of the sample reported high levels of burnout (29.8%) and secondary trauma (28.8%), and low levels of compassion satisfaction (31.7%). Results suggested that workers who engaged in higher levels of TISC experienced higher levels of compassion satisfaction and lower levels of burnout, although there was no relationship with secondary trauma. Findings provide preliminary evidence that TISC may be a beneficial practice to reduce risk of burnout and preserve workers' positive experience of their job, however workers experiencing secondary trauma are likely to need additional specialized intervention to assist them with their recovery.     

Professional quality of life of adult protective service workers

Adult Protective Services (APS) workers are exposed to substantial occupational hazards and job stress, but these stressors are underdocumented. Therefore, we sought to describe APS workers’ work environments and responses to occupational hazards and stressors, including compassion fatigue, burnout, and secondary traumatic stress. Survey data were gathered with closed-ended questionnaires administered to APS workers in an urban setting. Virtually all workers (97%) reported exposure to one or more environmental hazards in their work, and 80% reported hazard exposure in the past month. Workers also reported mixed responses to their work environment and to experiences with supervision. A sizable minority (22.7%) was at high risk for burnout, 24.6% were at risk for secondary traumatic stress, and 19.9% reported low compassion satisfaction. The results document multiple stressors in APS work. The APS partner is committed to ongoing efforts to better support its staff, and these findings can inform future efforts to enhance supervisor support and worker self-care, to minimize burnout and secondary traumatic stress.     

The Role of Parental Posttraumatic Stress,Marital Adjustment,and Dyadic Self‐Disclosure in Intergenerational Transmission of Trauma: A Family System Approach

Research indicates that posttraumatic stress symptoms (PTSS) induced by war trauma may be transmitted to veterans’ wives and offspring (secondary traumatic stress; STS). However, the interplay between family members’ characteristics has not been accounted for in such processes. Taking a family systems perspective, we examine the contributions of fathers’ PTSS, mothers’ STS, marital adjustment, and self‐disclosure of both parents to offspring's STS and test whether marital quality applies as a mechanism of parent–child transmission. Combat veterans and former prisoners of war (N = 123), their spouses, and adult offspring were investigated in a multiple‐step mediation analysis. The results highlight the mother's crucial role in trauma transmission and suggest that strengthening the marital relationship may buffer the transmission of fathers’ PTSS to offspring.