Exposure to Client Trauma, Secondary Traumatic Stress, and the Health of Clinical Social Workers: A Mediation Analysis

Background and Purpose: While it is widely acknowledged that providing services to traumatized populations may negatively impact the mental health of clinicians, little is known about the impact of exposure to traumatized clients and secondary traumatic stress (STS) on the physical health status of clinicians. As such, the twofold purpose of this study was to: (1) survey the prevalence of STS among clinical social workers, and (2) examine the interrelationships between exposure to client trauma, STS, and the perceived health of clinical social workers. Specifically, the study sought to determine if STS mediates the relationship between exposure to clients’ traumas and perceived health. To our knowledge, this was the first study to investigate the impact of trauma work on the general health perceptions of professionals, whether clinical social workers or otherwise.

Methods: This cross-sectional study included a sample of 539 clinical social workers across fields of practice, all members of the National Association of Social Workers (NASW). Regarding measures, indirect trauma exposure was measured via the single item: “What percentage of your clients meet the criteria for PTSD?”. The Secondary Traumatic Stress Scale was used to measure STS, and the General Health Subscale of the Medical Outcomes Study Short Form Health Survey was used to measure respondents perceived physical health status. Data was analyzed using IBM SPSS statistics version 21. To examine the extent to which social workers experience STS, frequencies were calculated for each of the symptoms by response (i.e., never, rarely, sometimes, often, and very often). The range of scores, percentiles, summary statistics and endorsement of criteria for the symptom clusters and full STS were likewise calculated. Next, a mediation analysis using Hayes’ (2013) PROCESS macro for SPSS was conducted with exposure to traumatized clients as the independent variable, STS as the mediating variable, and health perceptions as the dependent variable; controlling for age, gender, years of experience, and hours worked.

Results: Nearly all respondents reported that their caseload included trauma survivors, and that client trauma is addressed in the services they provide. More than half of the sample (n=284, 55.3%) reported little to no STS, 29.8% (n=153) reported mild STS, 8.8% (n=45) reported moderate STS, and 6.2% (n=16) were evenly split between high and severe STS. Mediation analyses revealed that exposure to traumatized client populations indirectly influenced clinical social workers’ physical health perceptions by way of STS. No evidence was found to support the notion that indirect exposure to trauma influenced health perceptions independent of its effect on STS.

Conclusions and Implications: Findings call for increased attention toward prevention and amelioration of STS symptomology among direct service providers, given its potential adverse impact on physical health. Current best practice approaches suggest that to address STS a two-pronged perspective that considers both individual and organizational factors is most beneficial. As such, prioritizing STS-related organizational efforts alongside professionals’ self-care is recommended. Future research is warranted to explore specific aspects of physical health most affected by STS; as well as develop and evaluate relevant efforts intended to address STS symptomology.