Effects of Posttraumatic Growth and Subjective Well–being on Cumulative trauma Among Aid Workers exposed to War and Violence in Palestine

Background Professional health workers (social workers, helpers, practitioners) operating in war-like conditions are at risk of experiencing feelings of stress, exhaustion and burnout due to their direct and indirect involvement in traumatic events. The Palestinian aid workers specifically faced increased levels of poverty and unemployment since the beginning of the second Intifada in 2000. In such contexts, professional helpers are frequently impacted by a similar type of trauma to that found in their clients. Methods The present study used structural equation analysis (SEM) to model how distress in the aftermath of traumatic events influences subjective well-being (SWB) via the indirect effect of posttraumatic growth (PTG) in two groups of Palestinian professional helpers from the Gaza Strip and West-Bank (n=201) and Israel (n=57). Posttraumatic Growth Index ( PTGI-10), Positive and negative affects-20 (PANAS- 20), WHO-5 brief wellbeing index and Impact of events scale (IES-13) questionnaires were administered to test the hypotheses that cumulative trauma would be negatively and directly related to subjective well-being; levels of trauma would be positively and directly related to posttraumatic growth, and posttraumatic growth (PTG) positively and directly related to subjective wellbeing. Findings The 76.1% of Israeli Palestinians and 88.6% of Palestinians had witnessed at least three traumatic episodes whereas the percentages of professional helpers exposed to at least 10 traumatic episodes were 47.8% and 60.1% respectively. The median number of traumatic events was 9 for Israeli Palestinians and 12 for the other sub-group. The data confirmed the moderate levels of traumatization in the helpers involved in this study. In comparison with data gathered in different contexts but with similar samples, professional helpers’ mean GHQ-12 scores (m=17.81±5.77) were found to be uncommonly high. Concerning well-being (WHO-5), it may be concluded that 48.8% of helpers obtained a raw score of less than 50 indicating a state of “poor well-being” whereas 9.7% appeared to be in need of further investigation for depression symptoms under the ICD-11 criteria. Levels of positive affect (m=26.6±5.98) experienced by these Palestinian helpers were similar to those of a British non-clinical sample (m=31.3±7.65). Consequently, we set out to evaluate the plausibility of a structural model in which the direct effect of trauma on subjective well-being was mitigated by posttraumatic growth. The findings show that posttraumatic growth contributes to mitigating and buffering (in the order of approximately 10%). The standardized direct effect of trauma on subjective wellbeing (β1,3 = -.53, p < .001) showed that exposure to traumatic events had a negative effect on helpers’ subjective wellbeing. The direct effect of trauma on posttraumatic growth (β2,3 = .16, p < .001) pointed out that posttraumatic growth was positively influenced by levels of trauma. Finally, the direct effect of posttraumatic growth on subjective well-being was .27. Interpretation The construct of posttraumatic growth contributes to explaining how helpers working in extremely dangerous conditions maintain good psychological functioning and ability to adjust the trauma in terms of perceived subjective well-being. Promoting PTG in emergency services contexts can enhance wellbeing and prevent psychological suffering in helpers exposed to war and violence.