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      Secondary Traumatization in Caregivers Working With Women and Children Who Suffered Extreme Violence by the “Islamic State”

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          Introduction: Refugees fleeing persecution, torture, or sexual violence are at high risk of developing both acute and chronic psychological disorders. Systematic violence, as committed against the Yazidi minority in Northern Iraq by the terror organization known as the Islamic State (IS), can be seen as a particularly traumatic burden to the victims, but also to caregivers providing treatments and assistance to them. The intense exposure to traumatic content may cause secondary traumatization in respective caregivers. This study aims (1) to identify the prevalence of secondary traumatization in caregivers working with traumatized women and children from Northern Iraq; (2) to determine the specific distressing factors and resources of the caregivers; as well as (3) to analyze whether caregivers' personal history of trauma or flight, attachment styles, working arrangements as well as support offers qualify as risk or resilience factors for secondary traumatization.

          Materials and Methods: In this cross-sectional study, N = 84 caregivers (social workers, psychotherapists/physicians, and interpreters) in the context of a Humanitarian Admission Program (HAP) for women and children traumatized by the so called IS were investigated about their work-related burdens and resources. Secondary traumatization was assessed with the Questionnaire for Secondary Traumatization (FST). To identify relevant determinants for secondary traumatization multiple linear regression analyses were performed.

          Results: Secondary traumatization was present in 22.9% of the participating caregivers, with 8.6% showing a severe symptom load. A personal history of traumatic experiences, a personal history of flight, a higher number of hours per week working in direct contact with refugees as well as a preoccupied attachment style were detected as risk factors for secondary traumatization. A secure attachment style could be identified as a resilience factor for secondary traumatization.

          Discussion: Caregivers working with traumatized refugees are at high risk of developing secondary traumatization. Based on the findings of this study and theoretical considerations, a framework of classification for different types of trauma-associated psychological burdens of caregivers working with traumatized refugees is proposed. Implications for the training and supervision of professionals in refugee- and trauma-care are discussed.

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          Most cited references 24

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          Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists.

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            Patterns and Universals of Adult Romantic Attachment Across 62 Cultural Regions

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              Working with the psychological effects of trauma: consequences for mental health-care workers--a literature review.

              This literature review explores how interacting with seriously traumatized people has the potential to affect health-care workers. The review begins with an introduction to post-traumatic stress disorder as being one of the possible negative consequences of exposure to traumatic events. The report proceeds with examining the concepts of vicarious traumatization, secondary traumatic stress, traumatic countertransference, burnout and compassion fatigue, as potential adverse consequences for workers who strive to help people who are traumatized. The differences between these concepts are also discussed. The notion of compassion satisfaction is examined as findings have demonstrated that it is a protective factor which can be used as a buffer to prevent the aforementioned concepts. Conversely, findings have shown that a history of previous stressful life events in helpers is a potential risk factor. The review concludes with an overview of the concepts considered, but cautions against generalization of the findings owing to the dearth of longitudinal studies into the issues raised and also the lack of investigation into the many different types of trauma.

                Author and article information

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                05 June 2018
                : 9
                1Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen , Tübingen, Germany
                2Department of Non-Christian Religions, Values, Minorities and Northern Iraq Projects, Ministry of State of Baden-Württemberg , Stuttgart, Germany
                3Department of Mental Health and Addiction, Baden-Württemberg Cooperative State University Villingen-Schwenningen , Villingen-Schwenningen, Germany
                4Harvard Humanitarian Initiative, Harvard University , Cambridge, MA, United States
                5Rehabilitation Psychology and Psychotherapy, Department of Psychology, University of Freiburg , Freiburg, Germany
                6Department of Child and Adolescence Psychiatry and Psychotherapy, University Hospital Tübingen , Tübingen, Germany
                7Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg , Heidelberg, Germany
                Author notes

                Edited by: Christina Maria Van Der Feltz-Cornelis, Tilburg University, Netherlands

                Reviewed by: Christina Papachristou, Charité Universitätsmedizin Berlin, Germany; Alejandro Magallares, Universidad Nacional de Educación a Distancia (UNED), Spain

                *Correspondence: Jana K. Denkinger jana.denkinger@

                This article was submitted to Psychosomatic Medicine, a section of the journal Frontiers in Psychiatry

                Copyright © 2018 Denkinger, Windthorst, Rometsch-Ogioun El Sount, Blume, Sedik, Kizilhan, Gibbons, Pham, Hillebrecht, Ateia, Nikendei, Zipfel and Junne.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 6, Tables: 8, Equations: 0, References: 53, Pages: 14, Words: 8467
                Funded by: Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg 10.13039/501100003542
                Award ID: 42-04HV.MED(17)/10/1
                Original Research


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