Psychological distress, Professional burnout and Secondary Trauma in Palestinian Healthcare Helpers: a Two Waves Quantitative Longitudinal Study.

Background: Due to exposure to traumatic events in stressful circumstances, rescue operators, and healthcare providers operating in zones affected by military conflict, are at risk of developing adverse psychological reactions with consequences on their subjective well-being. The comprehension of internal sources of functioning, acting as protective factors from the risk of trauma, is crucial in promoting well-being among the primary care workforce. The present longitudinal study aimed at modeling the cumulate system of association among secondary trauma, professional burnout, and psychological distress in healthcare helpers working in emergency settings characterized by low-intensity warfare. Sample and methods: The present study was conducted with Palestinian healthcare helpers (N=60) operating in Gaza and the West Bank The longitudinal design was conducted using repeated cross-sectional quantitative measures gathered in two waves (e.g., T0 and T1). The second wave of data was collected after six months. The maximum variation sampling method was adopted in surveying different categories of emergency workers (e.g., paramedics, physicians, nurses, and emergency volunteers). Outcome measures were assessed quantitatively by using self-reported questionnaires: Impact of Event Scale (IES-13), Maslach Burnout Inventory (MBI), and General Health Questionnaire (GHQ-12). Associations among variables were estimated by using structural equation modeling. Standardized total, direct, and indirect effects were estimated by using bootstrap methods and Monte Carlo simulation. Results: The General Health Questionnaire cumulative score revealed a medium to a high level of psychological distress (mean 15.78 [SD 6.04]) among healthcare helpers. The longitudinal structural model reported a good fit [χ2 (114)=161.4, p=.02, NC= 1.42, NNFI=.950, CFI = .951, RMSEA= .079) with the data supporting the idea that source of secondary trauma and professional burnout were associated with mental health across different professional groups. In particular, the direct effects of secondary trauma on professional burnout (β=.28) and psychological distress (β =.11) were found at T0. Secondary trauma was found to be more associated with professional burnout (β =.40) rather than psychological distress (β = .03) at T1. Finally, professional burnout was associated with psychological distress in both waves. Interpretation: Healthcare providers working in an environment marked by instability and ongoing risk should mobilize resources of resistance and resilience to protect their mental health. The model revealed that secondary trauma was longitudinally associated with psychological distress, both directly and indirectly, via professional burnout. Clinical implications and recommendations for training and supervision are discussed in terms of developing programs able to prevent the adverse effects of working in emergency settings.