Assessing secondary trauma in disaster relief clinicians

Boston University Medical Campus, Boston MA

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Abstract

The unprecedented devastating terrorist strikes in New York City and Washington, D.C. on September 11th 2001 were matched by an unparalleled response from emergency personnel to treat the emotional consequences of these events. In a disaster of the scale and scope of September 11th, it is anticipated that in addition to the mental health risk to civilians directly affected by the disaster, emergency mental health providers are at risk for developing secondary symptoms of acute and post stress disorders. A growing body of literature documents the phenomenon of secondary traumatization among mental health providers treating people with histories of traumatic exposure. However, very little is known about the sequelae of treating acutely traumatized survivors. In fact, assessment tools to evaluate the consequences of treating acute stress survivors do not currently exist. The primary aim of this RAPID grant application is to assess acute and post-traumatic stress disorders linked to treatment of survivors (secondary traumatization), in clinicians providing relief services at two different disaster sites in the aftermath of the terrorist attacks. Participants will be recruited from a pool of 120 International Association of Firefighters disaster relief providers (who reported to New York and delivered mental health care to firefighters lost in the collapse of the World Trade Center) and 100 Red Cross providers (who treated surviving family members and surviving airline personnel of those lost on the two hijacked planes that struck the World Trade Center). Clinicians will be identified by two study co-investigators who had primary on-site organizing responsibilities for mental health disaster relief for the New York City Fire Department at ground zero of the World Trade Center and the Red Cross at Boston Logan International Airport, respectively. These co-investigator roles will facilitate the sensitive recruitment necessary for the current project. Acute stress disorder will be measured by a standardized self-report inventory and PTSD will be assessed by standardized clinical interview at a 6-month post-disaster follow-up. Individual difference variables that may be related to the development of, or protection against, secondary trauma among disaster relief clinicians will also be measured. Mental health providers will be mailed a letter with informed consent, assessments, contact information for the follow-up assessments, and return postage. Clinicians who participate will be compensated for the time to complete both the self-report assessments and a six-month follow-up clinical interview. Data analyses will include logistic regression to examine the relationships between therapist factors (e.g., disaster service, type of training, level of experience) and symptom severity, as well as initial psychometric evaluation of the measures under development including factor analysis and reliability and validity analyses. Long-term research objectives for an NIMH R01 submission include a large-scale assessment study of secondary traumatization in mental health disaster relief workers across disaster types and characteristics (e.g. intentional and unintentional disasters).