How Secondary Is Secondary Traumatic Stress? Associations between Vicarious Trauma and Adverse Childhood Experiences

Background and Purpose:

The enduring effects of adverse childhood experiences (ACEs) on mental and physical health are well documented. A less studied area is the impact of ACEs on professional well-being, particularly for human service staff working with clients who experience adversity and trauma. This study explores whether ACEs are associated with secondary traumatic stress (STS), burnout, and intent to quit in a sample of home visitors serving predominately low-income families.

Methods:

The sample comprised 301 staff who worked directly with families in a statewide home visiting network and who participated in an annual online survey administered between 2015-2020. This study used data from participant responses to the baseline survey. We used the Childhood Experiences Survey to measure five forms of maltreatment ACEs and five other forms of household dysfunction. ACE scores were recoded into three categories: none; one to three; four or more. STS was measured with the Secondary Traumatic Stress Scale (range = 17-74), which was dichotomized to indicate moderate-to-high STS (≥ 38). Three subscales of the Copenhagen Burnout Inventory (range = 0-100) were used to measure burnout, with thresholds of 50 or greater denoting high levels of personal, work, and client burnout. A single item asked participants about the likelihood of leaving their job within the year. Responses were dichotomized to identify those likely or very likely to leave.

We estimated the prevalence of ACEs, STS, burnout, and intent to quit. Logistic regression was used to assess the extent to which ACEs were associated with each outcome, controlling for race/ethnicity, education level, caseload count, and time in current position.

Results:

Over half of respondents (51.0%) reported 1-3 ACEs, while a quarter (24.9%) reported four or more. Moderate-to-high STS was reported by 17.3% of respondents. The prevalence of high personal burnout, work burnout, and client burnout was 33.9%, 23.3%, and 7.0% respectively. Over a quarter (26.4%) of respondents were likely or very likely to leave their job. Compared to respondents with no ACEs, those with four or more had significantly greater odds of moderate-to-high STS (OR = 6.7, CI = 2.1, 21.6), high personal burnout (OR = 2.6, CI = 1.2, 5.4), and high work burnout (OR = 3.4, CI = 1.4, 7.9). Experiencing four or more ACEs was not significantly associated with client burnout or intentions to quit. The outcomes of respondents with one to three ACEs did not differ significantly from respondents with no ACEs.

Conclusions and Implications

The strong association between high ACEs and moderate-to-high STS among respondents is noteworthy, given that a quarter of the sample had at least four ACEs. Burnout is also associated with high ACEs, albeit less so than STS. These findings raise questions about the connection between primary and secondary adversity: The differential risk of STS based on a professional’s own history of adversity suggests it is difficult to untangle the etiology of primary trauma symptoms derived from personal experiences and secondary trauma symptoms derived from work experiences. Targeted strategies to mitigate STS among direct practice professionals will be discussed.