Mental Health Workers Faced Greater Risk of Developing PTSD Symptoms When Working with More Post-Sept. 11 Patients

NEW YORK CITY, June 25???Social workers who cared for larger numbers of patients traumatized by the Sept. 11 terrorist attacks were more likely to ???catch??? psychological trauma from those patients, according to a new study by researchers from The New York Academy of Medicine. The study was based on post-Sept. 11 interviews with New York City social workers and appears in the latest issue of the International Journal of Emergency Mental Health.

Therapists are more likely to suffer from PTSD due to counseling patients.

???That trauma can be vicariously transmitted from patient to therapist has been suspected, but never really proven, until now,??? said lead author Joseph Boscarino, Ph.D., M.P.H., a Senior Scientist in the Academy Division of Health and Science Policy. ???The World Trade Center disaster provided a unique opportunity to test whether this can really happen. It appears that this may be a serious occupational hazard for mental health workers.???

The study of ???secondary trauma,??? as the phenomenon is called, confirmed that mental health professionals who counsel a larger number of traumatized patients are at greater risk of developing symptoms of posttraumatic stress disorder (PSTD), such as disturbing and vivid flashbacks, difficulty concentrating and a state of hyper-arousal. Social workers actually experience flashbacks of their patients' experiences.

But the research also uncovered positive news: having a supportive work environment is extremely protective against this happening. A ???supportive work environment??? was measured by the extent and quality of information available at therapists??? workplaces to enhance their service delivery and prevent psychological distress. When this was absent from the workplace, the mental health professional was at much higher risk.

To test whether secondary trauma is a real condition and is distinct from other professional hazards faced by counselors (such as job burnout and compassion fatigue), researchers conducted a random survey of 236 social workers who provided varying levels of counseling to people affected by the World Trade Center disaster. The social workers were also involved in varying levels of disaster recovery efforts. Scientists measured the levels of therapists??? involvement in World Trade Center counseling/recovery and compared them to therapists??? levels of PTSD symptoms related specifically to working with traumatized clients. These levels of secondary trauma symptoms among the social workers were also compared to levels of job burnout in order to discern whether the two conditions and their causes are distinct.

Social workers who provided higher levels of post-Sept. 11 counseling experienced more secondary trauma symptoms that were traceable to working with those clients. In contrast, job burnout was not associated with involvement in Sept. 11 counseling efforts. Researchers found that 27 percent of the social workers???the ones who provided post Sept. 11-related counseling to the most patients???suffered from secondary trauma symptoms traced to these counseling activities.

While past studies have reported an association in therapists between developing trauma and working with traumatized patients, it has been difficult to determine the source of therapists??? trauma symptoms. Most studies of vicarious trauma did not focus on outcomes following treatment related to a specific event (like the World Trade Center disaster). Most studies also failed to include a ???control??? group of therapists that had been less-exposed or never exposed to traumatized patients affected by a given event, Boscarino said. Prior studies further failed to account for the fact that some mental health counselors may have experienced personal trauma and PTSD before ever entering the profession. ???Many mental health counselors may have gone into this field because of their personal trauma experiences,??? said Boscarino, a Vietnam veteran. PTSD is a disabling anxiety disorder that can afflict disaster survivors, combat veterans and victims of sexual assaults and other traumatic events.

Co-authors of the study, entitled ???Compassion Fatigue Following the September 11 Terrorist Attacks: A Study of Secondary Trauma Among New York City Social Workers,??? are Richard E. Adams, Ph.D., Research Associate in the Academy Division of Health and Science Policy and Charles Figley, Ph.D., Professor of Social Work at Florida State University.

The New York Academy of Medicine is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on urban populations, especially the disadvantaged.

Posted on June 25, 2004

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