Secondary trauma and impairment in clinical social workers.

BACKGROUND: Secondary traumatic stress (STS), symptomatology resulting from indirect exposure to trauma, is one potential negative effect from engaging in clinical social work. Yet, little is known about the relationship between STS and workers' distress and impairment due to their work. OBJECTIVE: The purpose of this paper was to explore STS in a national sample of clinical social workers (N = 539). METHOD AND RESULTS: A structural equation model demonstrating good model fit indicated that STS mediated the association between trauma exposure at work and reports of significant distress and impairment (ß = .08, p < .01; 95 % CI = .03, .12). Likewise, STS mediated the association between working with children aged 13 and under and reports of significant distress and impairment (ß = .05, p < .05; 95 % CI = .02, .09). Results indicated that the model accounted for 25 % of the variance in significant distress and impairment (R2 = .25, p < .001) and 5% of the variance in STS (R2 = .05, p < .05). CONCLUSIONS: Implications for agencies working with child welfare are provided, including a discussion of addressing STS and significant distress and impairment at the individual and larger agency levels.

Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation.

In a large national survey in Cambodia (N = 2689), the present study investigated the prominence of certain culturally salient symptoms and syndromes in the general population and among those with anxious-depressive distress (as determined by the Hopkins Symptom Checklist-25, or HSCL). Using an abbreviated Cambodian Symptom and Syndrome Addendum (CSSA), we found that the CSSA complaints were particularly elevated among those with anxious-depressive distress. Those with anxious-depressive distress had statistically greater mean scores on all the CSSA items as well as severity of endorsement analyzed by percentage: among those with HSCL caseness, 75.3% were bothered "quite a bit" or "extremely" by "thinking a lot" (vs. 27.5% without caseness); 53.8% were bothered by "standing up and feeling dizzy" (vs. 13.8%); and 45.6% by blurry vision (vs. 16.8%). In a logistic regression analysis to predict anxious-depressive distress, 51% of the variance was accounted for by five predictors: "weak heart," "thinking a lot," dizziness, "khyâl hitting up from the stomach," and sleep paralysis. Using ROC analysis, a cut-off score of 1.81 on the CSSA was optimal as a screener to indicate anxious-depressive distress, giving a sensitivity of 0.86. The study results suggest that to avoid category truncation (i.e., the omission of key complaints that are part of an assessed distress domain) when profiling anxious-depressive distress among Cambodia population that items other than those in standard psychopathology measures should be assessed such as "thinking a lot," "weak heart," "blurry vision," and "dizziness upon standing up."

Exploring Contextual Trauma in Cambodia: A Sociointerpersonal Perspective on Posttraumatic Stress Disorder.

Trauma literature has proposed multiple theories of trauma development, maintenance, and transmission, which has led to a lack of clarity surrounding trauma in individuals, families, and communities. We investigated the impact of community-level trauma experiences on individual posttraumatic stress disorder (PTSD) symptoms using a sociointerpersonal model of PTSD (Maerker & Horn, 2013). A nationally representative sample (N = 2, 690) of Cambodian households across all regions of the country was surveyed regarding individual trauma experiences during and after the Khmer Rouge regime, symptoms of PTSD, and current stressors. Individual experiences of war trauma and current stressors were aggregated based on the district in which each individual lived. District mean and individual war trauma and current stressors were included in a multilevel model as predictors of individual levels of PTSD. Findings indicated that mean trauma experiences, ß = .05, p < .001, and current stressors, ß = .10, p < .001, in the district in which individuals live were positively and significantly associated with their individual PTSD symptoms. Individual war trauma, ß = .02, p < .001, and current stressors, ß = .08, p < .001, were also positively and significantly associated with individual PTSD symptoms. District trauma experiences accounted for 7% of the variance in individual PTSD symptoms, R2 Level 1 = .21, R2 Level 2 = .80. Additionally, current stressors at both the individual and district levels had a greater impact on individual PTSD symptoms than war trauma at either level of the model. Implications for policy and intervention are presented.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Explorando el trauma contextual en Camboya: Una perspectiva socio-interpersonal del TEPT TRAUMA CONTEXTUAL EN CAMBOYA La literatura sobre el trauma ha propuesto teorías múltiples del desarrollo, la mantención, y la transmisión del trauma, lo cual ha llevado a una carencia de claridad en torno al trauma en los individuos, las familias, y las comunidades. Estudiamos el impacto de las experiencias del trauma a nivel comunitario en los síntomas del trastorno de estrés postraumático (TEPT) a nivel individual usando el modelo sociointerpersonal del TEPT (Maerker & Horn, 2013). Una muestra representativa a nivel nacional (N = 2.690) de los hogares de Camboya en todas las regiones del país fue encuestada con respecto a las experiencias individuales de trauma durante y luego del régimen de Khmer Rouge, síntomas del TEPT y estresores actuales. Las experiencias individuales de traumas por conflictos armados y los estresores actuales fueron agregados basados en el distrito en el cual cada individuo vivía. La media por distrito y trauma individual por conflictos armados y estresores actuales fueron incluidos en un modelo multinivel como predictores de los niveles individuales del TEPT. Los hallazgos indicaron que las experiencias de trauma media, ß = .05, p < .001, y los estresores actuales, ß = .10, p < .001, en el distrito en que los individuos vivían se asociaron positiva y significativamente con sus síntomas individuales del TEPT. El trauma por conflictos armados a nivel individual, ß = .02, p < .001, y los estresores actuales, ß = .08, p < .001, se encontraron también positiva y significativamente asociados con los síntomas individuales del TEPT. Las experiencias de trauma del distrito explicaron un 7% de la varianza de los síntomas individuales del TEPT, R2 Nivel 1 = .21, R2 Nivel 2 = .80. Adicionalmente, los estresores actuales tanto a nivel individual como a nivel del distrito tuvieron un impacto más alto en los síntomas individuales del TEPT que el trauma por los conflictos armados en cada nivel del modelo. Se presentan las implicaciones para las políticas y la intervención.

Mental Health Indicators of Suicide in Cambodian Women.

Global suicide rates are steadily increasing, and suicide completions in Asia outnumber those in Western countries. Young females are especially at risk, with higher rates of completion and lack of suicide support because of familial and cultural stigma and constraints. Lack of infrastructure to systematically record suicide deaths and attempts makes studying suicide in low- and middle-income countries challenging. Given the critical public health need for suicide intervention and prevention, research on suicide is crucial. The present study adds to the lack of information regarding suicide in Cambodia by exploring reports of attempted suicide by women from a nationally representative sample of Cambodian women (N = 1813). In a series of logistic regression models, findings indicate that a culturally salient measure of Cambodian syndromes, symptoms of depression, and posttraumatic stress disorder contributed to increased odds of attempting to commit suicide. Implications for policymakers and interventionists within Cambodia and Asian contexts are discussed.