ANALYSIS OF SECONDARY TRAUMATIC STRESS AMONG PHYSICIANS
Asian Journal of Advances in Medical Science, Volume 4, Issue 4,
Page 72-86
Abstract
The narrative review was important in understanding secondary traumatic stress among physicians. The primary aim of this narrative review was achieved by reviewing qualitative and quantitative studies to analyze if physicians were at-risk of being exposed to secondary traumatic stress when providing care to traumatized individuals. A review of the literature revealed a significant finding that identified 29 medical specialties that were more likely to be exposed to secondary traumatic stress associated with burnout when subjected to repetitive indirect traumatic exposures. An interesting finding showed that physicians were at a greater risk of secondary traumatic stress when they worked longer hours per day (12 hours or more), extended hours throughout the week (80 hours or more), and worked primarily overnight shifts. An unexpected finding in this narrative review revealed that physicians with dependents (e.g., a child/children) had an increased risk of being vulnerable to the effects of secondary traumatic stress. This noteworthy finding was compelling because factors that interlinked dependents to secondary traumatic stress among physicians were unanticipated. Though this narrative review contributes to the body of literature, further studies are necessary because research on secondary traumatic stress among physicians is limited and the lack of literature suggests needed future research.
Keywords:
- Physicians
- secondary traumatic stress
- vicarious trauma
- second victim
- indirect trauma
- compassion fatigue
- burnout
How to Cite
CUTHRELL, K. M., VILLAMAR, M., & GREEN, T. (2022). ANALYSIS OF SECONDARY TRAUMATIC STRESS AMONG PHYSICIANS. Asian Journal of Advances in Medical Science, 4(4), 72-86. Retrieved from https://www.mbimph.com/index.php/AJOAIMS/article/view/3202
References
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Cieslak R, Anderson V, Bock J, Moore B Peterson A, Benight C. Secondary traumatic stress among mental health providers working with the military: Prevalence and its work-and exposure-related correlates. Journal of Nerve Mental Disorder. 2013;201(11):917–925.
Nimmo A, Huggard P. A systematic review of the measurement of compassion fatigue vicarious trauma and secondary traumatic stress in physicians. Australasian Journal of Disaster and Trauma Studies. 2013;1:37-44.
Orru G, Marzetti F, Conversano C, Vagheggini G, Miccoli M, Ciacchini R, Panait E, Gemignani A. Secondary traumatic stress and burnout in healthcare Workers during COVID-19 Outbreak. Int. J. Environ. Res. Public Health. 2021;18(1):337.
Peebles-Kleiger M. Pediatric and neonatal intensive care hospitalization traumatic stressor: Implications for intervention. Bulletin of the Menninger Clinic. 2000;64:257-280.
Roden-Foreman J. Bennett M, Garret J, Powers M, Warren A, Garret J, Powers M, Warren A. Secondary traumatic stress in emergency medicine clinicians. Cognitive Behavior Therapy. 2017;46(6):522-532.
Guest R, Riches J. Physician burnout; 2020.
Available:https://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-education-and-research-center-for-occupational-safety-and-health/m20_handouts/Riches_MARCOEM_Oct_2020_10.7_1.pdf
Meadors P, Lamson A, Swanson M, White M, Sira N. Secondary traumatization in pediatric healthcare providers: compassion fatigue burnout and secondary traumatic stress. Journal of Death & Dying. 2009;60(2):103-128.
Medscape. Lifestyle burnout; 2020.
Available: https://www.medscape.com/slideshow/2020‐lifestyle‐burnout‐6012460#2
Morley C. Supporting physicians who work in challenging contexts: A role for the Academic health center. The Journal of the American Board of Family Medicine. 2012;25(6):756-758.
Westerdahl D. The necessity of high-fidelity simulation in cardiology training programs. American College of Cardiology. 2016; 67:1375-1378.
Weintraub A, Geithner E, Stroustrup A, Waldman E. Compassion fatigue burnout and compassion satisfaction in neonatologists in the US. Journal of Perinatology. 2016;36:1021-1026.
Elwood L, Mott J, Lohr J, Galovski T. Secondary trauma symptoms in clinicians: A critical review of the construct specificity and implications for trauma-focused treatment. Clinical Psychology Review. 2011;31:25– 36.
Ganau M, Netuka D, Broekman M, ZOi C, Tsianaks E, Schwake M, Balak N, Sekhar A, Ridwan S, Clusmann H. Neurosurgeons and the fight with COVID-19: a position statement from the EANS individual membership committee. Acta Neurochirugica: The European Journal of Neurosurgery. 2020; 162:1777-1782.
Hamilton S, Tran V, Jamieson J. Compassion fatigue in emergency medicine: The cost of caring. Emergency Medicine Australasia. 2016;28:100-103.
Hu Y, Fix M, Hevelone N, Lipsitz S, Greenberg C, Weissman J, Shapiro J. Physicians’ needs in coping with emotional stressors: the case for peer support. Archives of Surgery. 2012;147(3):212-217.
Karanikola M, Ginnakopoulou M, Mpouzika M. Kaite C, Tsiaousis G, Papthanassoglou E. Dysfunctional psychological responses among intensive care unit nurses: a systematic review of the literature. Revista da Escola de Enfermagem da USP. 2015;49(5):847-857.
Morrison L, Joy J. Secondary traumatic stress in the emergency department. Journal of Advanced Nursing. 2016;72(11):2894-2906.
Riley G. Understanding the stresses and strains of being a doctor. The American Journal of Australia; 2004.
DOI:doi.org/10.5694/j.1326-5377.2004.tb06322.x
Roz H, Mondal S, Priyanka P, Raval D. A study on occupational stress and burnout among cardiologists: A cross-cultural perspective. Indian Journal of Health & Wellbeing. 2016;7(3):282-288.
Wu A. Medical error: the second victim. BMJ. 2000;320-327.
Manjusha A, Marques F, Redger E, Willis B, Gaughan J, Hoehn K. Feeling burnt out? You are not alone; 2015.
Available:https://aap.confex.com/aap/2015/webprogrampress/Paper31100.html
Bride B, Robinson M, Yegidis B, Figley C. Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice. 2004;14(1):27-35.
Chambers A. "Burnt: A narrative exploration of burnout in medicine.”; 2019.
Available:https://jdc.jefferson.edu/si_hum_2021_phase1/10/
Broche T. Death dying and the ICU nurse. Dimension of Critical Nursing. 2003;22:173-179.
Dominguez-Gomez E, Rutledge D. Prevalence of secondary traumatic stress among emergency nurses. Journal of Emergency Nursing. 2009;35:199– 204.
Mairean C. The relationship between secondary traumatic stress and personal posttraumatic growth: Personality factors as moderators. Journal of Adult Development. 2016;23:120-128.
Bellolio M, Cabrear D, Sadosty A, Hess E, Campbell R, Lohse C, Sunga K. Compassion fatigue in similar emergency medicine residents compared to other medical and surgical specialties. Western Journal of Emergency Medicine. 2013;15:629-635.
Khan A, Khan M, Bokhari S. Association of specialty and working hours with compassion fatigue. PAFMJ. 2016;662(1):143-146.
Isobel S, Angus-Leppan G. Neuro-reciprocity and vicarious trauma in psychiatrists. Australasian Psychiatry. 2018;26(4):388-390.
Pinental G, Rodrigues S, Silva P, Vilarinho A, Vaz R, Paulo J, Cunha P. A wearable approach for intraoperative physiological stress monitoring of multiple cooperative surgeons. International Journal of Medical Informatics. 2019;129:60-68.
DeLucia J, Bitter C Fitzergerald J, Greensberg M Dalwari P, Buchanana P. Prevalence of post-traumatic stress disorder in emergency physicians in the United States. West of Journal Emergency Medicine. 2019;20(5):740-746.
Choi G. Organizational impacts on the secondary traumatic stress of social workers assisting family violence or sexual assault survivors. Adm Soc Work. 2011;35 225– 242.
Tracey D, Tarn M, Eldridge R. What should be done to support the mental health of healthcare staff treating COVID-19 patients? British Journal of Psychiatry. 2020;217:537-549.
Yap Q, Tan Y, Wang Z, Chan Y, Ho R, Hamid A, Landaluce-Olavarria A, Pellino G, Gauhar V, et. al. Psychological health of surgeons in a tie of COVID-19. A global surgery. Annals of Surgical; 2021.
DOI: 10.1097/SLA.0000000000004775
Yaakubov L, Hoffman Y, Rosenbloom R. Secondary traumatic stress vicarious posttraumatic growth and their association in emergency room physicians and nurses. 2020;11(1):1830462.
Hollingswort C, Wesely C, Huckridge J, Finn G, Griksaitis M. Impact of child death on pediatric trainees. Archives of Disease in Childhood. 2017;103:14-18.
Lanctot N, Guay S. The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences. Aggressive Violent Behaviors. 2017;19:492-501.
Singh M, Thapa A, Shandera S, Suri A, Singh M Vinay B, Sharma B. Intraoperative pulse and blood pressure recordings of neurosurgeons: A pilot study of cardiovascular performance. Neurosurgery. 2010; 66 (5):893-899.
Vasquez J, Uvin P, Rodriquez-Socarras M, Skjold-Kingo P, Gomez-Rivas J. Fatigue syndrome: Stress burnout and depression in Urology. Archivos Espanoles de Urologia. 2018;71(1):46-54.
Zimmermann T, Bock C, Kahl K. The impact of post-traumatic stress on the mental state of university hospital physicians: A cross-sectional study. BMC Psychiatry. 2022;22(85):2-9.
Hernandez-Wolfe P, Killiam K, Engstrom D, Gangsei D. Vicarious resilience vicarious trauma and awareness of equity in trauma work. Journal of Humanistic Psychology. 2014;1-20.
Loerbroks A, Glaser J, Vu-Erickmann P, Angerer P. Physician burnout work engagement and the quality of patient care. Occupational Medicine. 2017;67 (5):356-362.
Ludick M, Fidley C. Toward a mechanism for secondary trauma induction and reduction: Reimagining a theory of secondary traumatic stress. Traumatology. 2017;22:112-123.
Quinal L, Harford S, Rutledge DN. Secondary traumatic stress in oncology staff. Cancer Nursing. 2009; 32(4):E1–E7.
Mairean C, Cimpoesu D, Turliuc N. The effects of traumatic situations on emergency medicine practitioners. Revisa De Cercetare SI Interventie Sociala. 2014;44:279-290.
Ruitenburt M, Fringes-Dresen M, Sluiter J. The prevalence of common mental disorders among hospital physicians and their associations with self-reported ability: a cross-section study.BMS Health Service Res. 2012;12:292-208.
Vandeusen K, Way I. Vicarious trauma: An exploratory study of the impact of providing sexual abuse treatment on clinicians’ trust and intimacy. Journal of Child Sexual Abuse. 2006;15(1):69-85.
Zafar W, Khan U, Siddiqui S. Jamal iS, Razzak J. Workplace violence and self-reported psychological health: coping with post-traumatic stress mental distress and burnout among physicians working in the emergency departments compared to other specialties in Pakistan. Journal of Emergency Medicine. 2016;50(1):167–177.
Zelikovsky N, Robins P/. Meltzer L. The experience of secondary traumatic stress upon care providers working within a children’s hospital. Journal of Pediatric Nursing. 2006; 24(4):270-279.
Sweeney M, Patel R, Baker C, Greenberg N, Piper S, Shergil S, Tracy D, Plymen C. If not now when? Enhancing cardiologists' psychological well-being as a COVID-19. BMJ. 2021;107 (7):593-595.
Shi L, Wag L, Jia X. Prevalence and correlates of symptoms of post-traumatic stress disorder among Chinese healthcare workers exposed to physical violence: a cross-sectional study. BMJ Open. 7:e016810.
Youssef J, Salvatore C, Benedetta T. Burnout among neurosurgeons and residents in neurosurgery: A systematic review and meta-analysis of the literature. World Neurosurgery. 2020;143:529-534.
Dirik D, Sak R, Tuba Sahin-Ska I. Compassion fatigue among obstetricians and gynecologists. Current Psychology. 2021;40:4237-4254.
Kruper A, Domeyer-Klenske D, Treat R, Pilarski A, Kaljo K. Secondary traumatic stress in Ob-Gyn: A mixed method analysis assessing physician impact and needs. Journal of Surgical Education. 2021; 78(3):1024-1034.
Bride B. Prevalence of secondary traumatic stress among social workers. Social Work. 2007;52(1):63-70.
Cieslak R, Anderson V, Bock J, Moore B Peterson A, Benight C. Secondary traumatic stress among mental health providers working with the military: Prevalence and its work-and exposure-related correlates. Journal of Nerve Mental Disorder. 2013;201(11):917–925.
Nimmo A, Huggard P. A systematic review of the measurement of compassion fatigue vicarious trauma and secondary traumatic stress in physicians. Australasian Journal of Disaster and Trauma Studies. 2013;1:37-44.
Orru G, Marzetti F, Conversano C, Vagheggini G, Miccoli M, Ciacchini R, Panait E, Gemignani A. Secondary traumatic stress and burnout in healthcare Workers during COVID-19 Outbreak. Int. J. Environ. Res. Public Health. 2021;18(1):337.
Peebles-Kleiger M. Pediatric and neonatal intensive care hospitalization traumatic stressor: Implications for intervention. Bulletin of the Menninger Clinic. 2000;64:257-280.
Roden-Foreman J. Bennett M, Garret J, Powers M, Warren A, Garret J, Powers M, Warren A. Secondary traumatic stress in emergency medicine clinicians. Cognitive Behavior Therapy. 2017;46(6):522-532.
Guest R, Riches J. Physician burnout; 2020.
Available:https://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-education-and-research-center-for-occupational-safety-and-health/m20_handouts/Riches_MARCOEM_Oct_2020_10.7_1.pdf
Meadors P, Lamson A, Swanson M, White M, Sira N. Secondary traumatization in pediatric healthcare providers: compassion fatigue burnout and secondary traumatic stress. Journal of Death & Dying. 2009;60(2):103-128.
Medscape. Lifestyle burnout; 2020.
Available: https://www.medscape.com/slideshow/2020‐lifestyle‐burnout‐6012460#2
Morley C. Supporting physicians who work in challenging contexts: A role for the Academic health center. The Journal of the American Board of Family Medicine. 2012;25(6):756-758.
Westerdahl D. The necessity of high-fidelity simulation in cardiology training programs. American College of Cardiology. 2016; 67:1375-1378.
Weintraub A, Geithner E, Stroustrup A, Waldman E. Compassion fatigue burnout and compassion satisfaction in neonatologists in the US. Journal of Perinatology. 2016;36:1021-1026.
Elwood L, Mott J, Lohr J, Galovski T. Secondary trauma symptoms in clinicians: A critical review of the construct specificity and implications for trauma-focused treatment. Clinical Psychology Review. 2011;31:25– 36.
Ganau M, Netuka D, Broekman M, ZOi C, Tsianaks E, Schwake M, Balak N, Sekhar A, Ridwan S, Clusmann H. Neurosurgeons and the fight with COVID-19: a position statement from the EANS individual membership committee. Acta Neurochirugica: The European Journal of Neurosurgery. 2020; 162:1777-1782.
Hamilton S, Tran V, Jamieson J. Compassion fatigue in emergency medicine: The cost of caring. Emergency Medicine Australasia. 2016;28:100-103.
Hu Y, Fix M, Hevelone N, Lipsitz S, Greenberg C, Weissman J, Shapiro J. Physicians’ needs in coping with emotional stressors: the case for peer support. Archives of Surgery. 2012;147(3):212-217.
Karanikola M, Ginnakopoulou M, Mpouzika M. Kaite C, Tsiaousis G, Papthanassoglou E. Dysfunctional psychological responses among intensive care unit nurses: a systematic review of the literature. Revista da Escola de Enfermagem da USP. 2015;49(5):847-857.
Morrison L, Joy J. Secondary traumatic stress in the emergency department. Journal of Advanced Nursing. 2016;72(11):2894-2906.
Riley G. Understanding the stresses and strains of being a doctor. The American Journal of Australia; 2004.
DOI:doi.org/10.5694/j.1326-5377.2004.tb06322.x
Roz H, Mondal S, Priyanka P, Raval D. A study on occupational stress and burnout among cardiologists: A cross-cultural perspective. Indian Journal of Health & Wellbeing. 2016;7(3):282-288.
Wu A. Medical error: the second victim. BMJ. 2000;320-327.
Manjusha A, Marques F, Redger E, Willis B, Gaughan J, Hoehn K. Feeling burnt out? You are not alone; 2015.
Available:https://aap.confex.com/aap/2015/webprogrampress/Paper31100.html
Bride B, Robinson M, Yegidis B, Figley C. Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice. 2004;14(1):27-35.
Chambers A. "Burnt: A narrative exploration of burnout in medicine.”; 2019.
Available:https://jdc.jefferson.edu/si_hum_2021_phase1/10/
Broche T. Death dying and the ICU nurse. Dimension of Critical Nursing. 2003;22:173-179.
Dominguez-Gomez E, Rutledge D. Prevalence of secondary traumatic stress among emergency nurses. Journal of Emergency Nursing. 2009;35:199– 204.
Mairean C. The relationship between secondary traumatic stress and personal posttraumatic growth: Personality factors as moderators. Journal of Adult Development. 2016;23:120-128.
Bellolio M, Cabrear D, Sadosty A, Hess E, Campbell R, Lohse C, Sunga K. Compassion fatigue in similar emergency medicine residents compared to other medical and surgical specialties. Western Journal of Emergency Medicine. 2013;15:629-635.
Khan A, Khan M, Bokhari S. Association of specialty and working hours with compassion fatigue. PAFMJ. 2016;662(1):143-146.
Isobel S, Angus-Leppan G. Neuro-reciprocity and vicarious trauma in psychiatrists. Australasian Psychiatry. 2018;26(4):388-390.
Pinental G, Rodrigues S, Silva P, Vilarinho A, Vaz R, Paulo J, Cunha P. A wearable approach for intraoperative physiological stress monitoring of multiple cooperative surgeons. International Journal of Medical Informatics. 2019;129:60-68.
DeLucia J, Bitter C Fitzergerald J, Greensberg M Dalwari P, Buchanana P. Prevalence of post-traumatic stress disorder in emergency physicians in the United States. West of Journal Emergency Medicine. 2019;20(5):740-746.
Choi G. Organizational impacts on the secondary traumatic stress of social workers assisting family violence or sexual assault survivors. Adm Soc Work. 2011;35 225– 242.
Tracey D, Tarn M, Eldridge R. What should be done to support the mental health of healthcare staff treating COVID-19 patients? British Journal of Psychiatry. 2020;217:537-549.
Yap Q, Tan Y, Wang Z, Chan Y, Ho R, Hamid A, Landaluce-Olavarria A, Pellino G, Gauhar V, et. al. Psychological health of surgeons in a tie of COVID-19. A global surgery. Annals of Surgical; 2021.
DOI: 10.1097/SLA.0000000000004775
Yaakubov L, Hoffman Y, Rosenbloom R. Secondary traumatic stress vicarious posttraumatic growth and their association in emergency room physicians and nurses. 2020;11(1):1830462.
Hollingswort C, Wesely C, Huckridge J, Finn G, Griksaitis M. Impact of child death on pediatric trainees. Archives of Disease in Childhood. 2017;103:14-18.
Lanctot N, Guay S. The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences. Aggressive Violent Behaviors. 2017;19:492-501.
Singh M, Thapa A, Shandera S, Suri A, Singh M Vinay B, Sharma B. Intraoperative pulse and blood pressure recordings of neurosurgeons: A pilot study of cardiovascular performance. Neurosurgery. 2010; 66 (5):893-899.
Vasquez J, Uvin P, Rodriquez-Socarras M, Skjold-Kingo P, Gomez-Rivas J. Fatigue syndrome: Stress burnout and depression in Urology. Archivos Espanoles de Urologia. 2018;71(1):46-54.
Zimmermann T, Bock C, Kahl K. The impact of post-traumatic stress on the mental state of university hospital physicians: A cross-sectional study. BMC Psychiatry. 2022;22(85):2-9.
Hernandez-Wolfe P, Killiam K, Engstrom D, Gangsei D. Vicarious resilience vicarious trauma and awareness of equity in trauma work. Journal of Humanistic Psychology. 2014;1-20.
Loerbroks A, Glaser J, Vu-Erickmann P, Angerer P. Physician burnout work engagement and the quality of patient care. Occupational Medicine. 2017;67 (5):356-362.
Ludick M, Fidley C. Toward a mechanism for secondary trauma induction and reduction: Reimagining a theory of secondary traumatic stress. Traumatology. 2017;22:112-123.
Quinal L, Harford S, Rutledge DN. Secondary traumatic stress in oncology staff. Cancer Nursing. 2009; 32(4):E1–E7.
Mairean C, Cimpoesu D, Turliuc N. The effects of traumatic situations on emergency medicine practitioners. Revisa De Cercetare SI Interventie Sociala. 2014;44:279-290.
Ruitenburt M, Fringes-Dresen M, Sluiter J. The prevalence of common mental disorders among hospital physicians and their associations with self-reported ability: a cross-section study.BMS Health Service Res. 2012;12:292-208.
Vandeusen K, Way I. Vicarious trauma: An exploratory study of the impact of providing sexual abuse treatment on clinicians’ trust and intimacy. Journal of Child Sexual Abuse. 2006;15(1):69-85.
Zafar W, Khan U, Siddiqui S. Jamal iS, Razzak J. Workplace violence and self-reported psychological health: coping with post-traumatic stress mental distress and burnout among physicians working in the emergency departments compared to other specialties in Pakistan. Journal of Emergency Medicine. 2016;50(1):167–177.
Zelikovsky N, Robins P/. Meltzer L. The experience of secondary traumatic stress upon care providers working within a children’s hospital. Journal of Pediatric Nursing. 2006; 24(4):270-279.
Sweeney M, Patel R, Baker C, Greenberg N, Piper S, Shergil S, Tracy D, Plymen C. If not now when? Enhancing cardiologists' psychological well-being as a COVID-19. BMJ. 2021;107 (7):593-595.
Shi L, Wag L, Jia X. Prevalence and correlates of symptoms of post-traumatic stress disorder among Chinese healthcare workers exposed to physical violence: a cross-sectional study. BMJ Open. 7:e016810.
Youssef J, Salvatore C, Benedetta T. Burnout among neurosurgeons and residents in neurosurgery: A systematic review and meta-analysis of the literature. World Neurosurgery. 2020;143:529-534.
Dirik D, Sak R, Tuba Sahin-Ska I. Compassion fatigue among obstetricians and gynecologists. Current Psychology. 2021;40:4237-4254.
Kruper A, Domeyer-Klenske D, Treat R, Pilarski A, Kaljo K. Secondary traumatic stress in Ob-Gyn: A mixed method analysis assessing physician impact and needs. Journal of Surgical Education. 2021; 78(3):1024-1034.
Bride B. Prevalence of secondary traumatic stress among social workers. Social Work. 2007;52(1):63-70.
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