Personal trauma history and secondary traumatic stress in mental health professionals: A systematic review

Introduction: Caring for those who have been traumatized can place mental health professionals at risk of secondary traumatic stress, particularly in those with their own experience of personal trauma. Aim: To identify the prevalence of personal trauma history and secondary traumatic stress in mental health professionals and whether there is an association between these two variables in mental health professionals. Method: We preregistered


| INTRODUC TI ON
Mental health professionals' often work with patients who have faced some form of trauma.These patients will either be witness to, or victims of, child abuse, sexual violence, serious injury or threats of death (Ogińska-Bulik et al., 2021).It has been found that when the patients share their traumatic story with a mental health professional, the empathy the clinician feels towards those who are suffering makes them more vulnerable to experiencing their patient's pain (Beck & T., 2011) and can place them at risk of developing symptoms of post-traumatic stress disorder (Jacobs, 2017).
For clarity, below we briefly review different terms and how they have been operationalized in research.

| Defining secondary traumatic stress and related terms
Over the years trauma symptoms have been described using a number of terms including secondary traumatic stress, vicarious trauma (i.e.cognitive symptoms associated with indirect exposure) and compassion fatigue (i.e.trauma and burnout symptoms) (Greninacher et al., 2019).Burnout (World Health Organisation, 2019) is unrelated to post traumatic stress symptoms but represents a different concept which has both overlap and differences with the other terms.
We define these constructs in the following ways: Post Traumatic Stress Disorder (PTSD) is a mental health diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013).
Criterion A of the diagnostic criteria specify that an individual must have been exposed to a stressor (e.g.death, threatened death, actual or threatened sexual violence) in one of the following ways: (A1) through direct exposure; (A2) witnessing the trauma; (A3) learning that a relative or close friend was exposed to a trauma; (A4) or through 'experiencing repeated or extreme exposure to averse details of the traumatic event(s)' (American Psychiatric Association, 2013).The  gives two examples of this A4 criterion: first responders collecting human remains, or police officers exposed to details of child abuse.Whilst examples of mental health professionals meeting criterion A4 are missing, it is theoretically possible for such professionals to meet such criteria.However, as explained below, secondary traumatic stress may be considered a preferable term to differentiate between PTSD and the trauma reactions most likely to be experienced through indirect exposure in mental health professionals (Penix et al., 2020).

| Secondary traumatic stress
Secondary traumatic stress is an acute reaction that occurs when professionals become psychologically overwhelmed in their desire to support others (Orrù et al., 2021).Symptoms experienced by the professional often mirrors those of their clients who are suffering from PTSD (Ogińska-Bulik et al., 2021), but secondary traumatic stress can be differential from PTSD as a subclinical symptom picture, conceptualized as an index of stress rather than a clinical disorder (Penix et al., 2019).To measure for secondary traumatic stress the Secondary Traumatic Stress Scale (STSS) (Bride et al., 2004) is often used.This is a self-report questionnaire consisting of 17 Likert questions based on secondary post-traumatic stress symptoms, such as avoidance, intrusion and arousal (Jacobs et al., 2019).

Accessible Summary What Is Known on the Subject
• Mental health professionals have typically experienced more traumatic events in their own lives, compared with the general population.
• Mental health professionals work with patients who sometimes share their history and experience of traumatic events.
• Listening to these firsthand accounts of trauma can place the mental health professional at risk of experiencing secondary traumatic stress.
• Secondary traumatic stress refers to symptoms of posttraumatic stress that are caused by indirect exposure to trauma.

What the Paper Adds to Existing Knowledge
• Personal trauma history and secondary traumatic stress are common in mental health professionals.
• Mental health professionals are at higher risk of developing secondary traumatic stress when they have their own experiences of trauma.

What Are the Implications for Practice
• Identifying those who are most at risk of developing secondary traumatic stress has implications for education and health care settings.
• Embedding teaching about the possible psychological impacts of secondary traumatic stress for mental health professionals with their own experiences of trauma could lead to improved well-being of the practitioner and support services to retain skilled staff.
• In clinical services, those at risk of developing secondary traumatic stress in practice should receive targeted help and support, such as specialized supervision and debriefs.

| Vicarious trauma
Vicarious trauma refers to mental health professionals' cognitive schema becoming altered when working with patients who have been traumatized and will view new experiences with suspicion and a sense of cynicism (Pearlman & Mac Ian, 1995).Vicarious trauma differs from secondary traumatic stress in that secondary traumatic stress is acute and can occur from a single exposure while vicarious trauma is accumulative (Branson, 2019).While studies on the impact of secondary traumatic stress on mental health professionals' have not used the term 'cognitive schema', they report that the clinicians' views of the world are altered (Simon et al., 2006) and they struggle with their ability to continue to care for the patient and express warmth, empathy and understanding (Hoffman, 2009).Vicarious trauma is typically measured using the Trauma Symptom Inventory (TSI) Belief Scale (Jenkins & Baird, 2002) which assess for disruptions in areas for self and others.

| Compassion fatigue
Compassion fatigue occurs following prolonged exposure to client's traumatic material where the therapist will often re-experience their client's traumatic event (Robino, 2019).It is a combination of secondary traumatic stress and burnout, with professionals feeling both mentally and physically exhausted and struggling to cope with everyday life (Figley, 1999).Compassion fatigue is often measured using the Compassion Fatigue Self-Test (Stamm & Figley, 1996).While the compassion fatigue self-test is still used in studies it has developed into The Professional Quality of Life Scale which consists of three subscales compassion fatigue, burnout and compassion satisfaction (Stamm, 2010).

| Burnout
Burnout is defined as an occupational phenomenon resulting from chronic stress experienced in the workplace (Edú-Valsania et al., 2022).The cause of burnout differs from secondary traumatic stress and vicarious trauma and is related to organizational pressures placed on staff-such as an increased workload and staff shortages, rather than working with traumatized patients.However, the symptoms clinicians experience because of burnout are similar to those who experience secondary traumatic stress, which include feelings of fatigue and detachment (Kanno & Giddings, 2017).
These terms have substantial degrees of overlap, and may present with similar symptoms such as fatigue, cynicism, irritability and feelings of hopelessness.Secondary traumatic stress, vicarious trauma and compassion fatigue are all defined as developing in response to contact with traumatized patients, whereas burnout results from organizational pressures.PTSD symptoms can be present across secondary traumatic stress, vicarious trauma, compassion fatigue and burnout, however whereas PTSD is a mental health disorder, the other listed concepts are understood as indices of stress, typically not meeting full criteria for PTSD Figure 1 presents our construction of the overlaps and distinctions between concepts in diagrammatic form.

| Personal trauma histories in mental health professionals
Those professionals working in mental health are attracted to work within this area mainly out of a desire to help and support others (McKenzie et al., 2020).The knowledge and expertise required to work in this field is not just learnt from their education and training but is often drawn from their own experiences (Jenkins et al., 2011).
It has long been acknowledged within healthcare that those attracted to working in mental health often suffer from their own traumatic life events (Somoray et al., 2017).Chaverri et al. (2018), study of mental health professionals found 109 of the 153 (71.2%) participants had experienced some form of personal trauma.
Many studies have found that those mental health professionals who have experienced a traumatic event in their own life are more likely to experience secondary traumatic stress (Zerach & Ben-Itzchak Shalev, 2015).When attempting to identify the risk factors F I G U R E 1 Conceptual diagram illustrating overlaps between trauma concepts and burnout.
for secondary traumatic stress in mental health professionals, numerous studies have found that having a personal history of trauma can increase the risk of a mental health professional experiencing secondary traumatic stress (Hensel et al., 2015); although, other research has found that there is no significant link between secondary traumatic stress and a clinician's own trauma history (Creamer & Liddle, 2005).
Studies vary on how they determine whether a mental health professional has their own history of personal trauma with the majority asking the participant to answer either yes or no to whether they have experienced trauma within their own lives (Brockhouse et al., 2011).Others have formulated their own questions based on symptoms of post-traumatic stress disorder (Corbett-Hone & Johnson, 2022).Validated measures such as the Trauma History Questionnaire (Hooper et al., 2011), The Traumatic Attachment Belief Scale (TABS) (Pearlman, 2003), The Life Events Checklist −5 (Gray et al., 2004) and The Impact Event Scale-revised (Weiss & Marmar, 1997) have also been used.
Previous research has however varied in the use of terms for secondary traumatic stress, measures used and population studied.
To ensure a robust and thorough review of the literature the inclusion criteria will include all concepts of secondary traumatic stress and validated measures will be included, along with all mental health professionals.
It is possible that a personal trauma history may make a mental health professional more vulnerable to suffering from secondary traumatic stress as has been found among substance misuse workers (Cosden et al., 2016), in rape crisis staff (Dworkin et al., 2016) and those in the field of medical trauma care (Ogińska-Bulik et al., 2021).While these are challenging and complex fields of health care, mental health professionals also support some of the most vulnerable patient groups.These patients will often share their history and experience of traumatic events with the clinician.Busy and overstretched working environments will often mean there is no direct access to supervision (Rothwell et al., 2021) and the professionals' codes of confidentiality mean they are unable to share with family and friends for support (Nursing & Midwifery Council, 2018).
If we consider then that those who are attracted to work in the field of mental health care often share similar traumatic experiences to their patients and that there is a likelihood, they are at a heightened risk of suffering from secondary traumatic stress it can be argued that the impact on their health is a concern and may have an impact on retention.
To our knowledge there has been one previous systematic reviews of the literature on secondary traumatic stress and personal trauma history in mental health professionals.This is Leung et al. (2022), review on a personal history of trauma and experience of secondary traumatic stress, vicarious trauma and burnout in mental health workers.Leung et al. (2022) study identified 26 quantitative studies of personal trauma history and secondary traumatic stress in mental health professionals, of which 17 reported a positive association.A table has been placed in the supporting documents to show the differences between this review and the student researchers.Fundamentally however Leung et al. (2022) has included burnout as variable and states that burnout is caused by exposure to a client's traumatic experiences when burnout has been clearly defined in the literature as being caused being caused by organizational pressures such as the impact of short staffing resulting in high caseloads and poor retention of staffing (Rayner et al., 2020).Leung et al. (2022) also acknowledges compassion fatigue as being closely linked to secondary trauma and include it as a search term but do not report on compassion fatigue findings.In addition, the definition of mental health professionals was broad, and included volunteers, advocates, child protection workers and those who work in protective services.In particular, the review included nine studies which focussed or included non-clinical social workers who were not working in a mental health setting.Only a single reviewer was used unless there were queries regarding the inclusion criteria.There were also limitations placed on the included number of studies being captured with the first 1000 being collected and the range was between years 2000 to June 2021.The review did stipulate if the studies included needed to use a valid tool to assess for vicarious trauma or secondary traumatic stress and did not report the prevalence of personal trauma history and secondary traumatic stress, which is crucial data for both clinical practice settings and researchers.
Finally, the quality assessment of studies was not reported at the itemlevel, only as a summary score, meaning that there was a lack of detail about the strengths and limitations of individual studies.

| AIMS
The review aimed to: (1) identify the prevalence of personal trauma and secondary traumatic stress in mental health professionals and: (2) identify whether there is an association between personal trauma history and secondary trauma in mental health professionals.

| ME THODS
We undertook a systematic review following PRISMA guidelines (Page et al., 2021), and pre-registered our protocol in PROSPERO.

| Search strategy and selection criteria
The systematic review was undertaken following a pre-registered protocol on PROSPERO (CDR42022322939).With the support of an independent librarian the Population, Exposure and Outcome (PEO) framework was used to define concepts and terms (Bettany-Saltikov & McSherry, 2016) (Table 1).Medline, EMBASE, PsyINFO, Web of Science and CINHAL were searched using the following keywords in combination (seconda*trauma OR secondary traumatic stress OR compassion fatigue OR vicarious trauma*).Rather than mental health professional and personal trauma being used as keywords these were screened for using the title and abstract.Following the findings of a scoping review undertaken by one of the authors (AH), an intentionally broad search strategy was used because of the nonspecific use Mental Health Professionals was not used as a search term due to the wide variation of the term used in practice.This was screened using a robust inclusion and exclusion criteria and reviewers' expertise from working in this field.
Exposure: Personal trauma 'An event, or series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being' (Substance Abuse and Mental Health Services Administration, p.7, 2014).
An intentionally broad search was used for Mental health professionals because of the nonspecific use of outcome measures across the various terms used in the literature (Hensel et al., 2015) Outcome: Secondary traumatic stress Secondary traumatic stress Secondary traumatic stress is the behavioural and emotional consequences of exposure to traumatic events experienced by significant others (Figley, 1995).
It is characterized by Post Traumatic Stress Disorder (PTSD) symptoms and been recognized in the Diagnostic Statistical of Mental Disorders, 5th Edition (DSM-5) (American Psychiatric Association., 2013).
Vicarious trauma Wilson and Lindy (1994) describe vicarious trauma as a form of PTSD with Herman and Harvey (1997) stating vicarious trauma is the traumatic countertransference form with the therapist experiences the same terror, rage and anguish as the patient.

Compassion fatigue
Compassion fatigue closely relates to PTSD symptoms (Hensel et al., 2015).While it commonly conceptualized by having two dimensions Secondary Traumatic stress and Burnout (Rauvola et al., 2019), it is often used interchangeably with Secondary Traumatic stress (Greninacher et al., 2019), with the latter deemed a more userfriendly term (Figley, 1995).

Burnout
Is not specific to exposure to traumatic material and can affect individuals in any professional role as it develops in the setting of prolonged exposure to stressful demands at work (Cieslak et al., 2013) of outcome measures for measuring personal trauma in the literature (Hensel et al., 2015) and the wide variety of professional titles for Mental Health Professionals (Table 1).Results were reported adhering to PRISMA guidelines (Figure 2).Searchers were conducted on the 1st April 2022, and repeated across all databases on the 17th August, 2023.Studies were imported into Covidence, and deduplicated prior to articles being independently screened by two authors (AH) and (XH) in two stages.Firstly, using titles and abstracts and then full text Inclusion/exclusion criteria (maybe seen in Table 1).

Studies were included if they
• Assessed either personal trauma history OR secondary trauma, secondary traumatic stress, vicarious trauma, or compassion fatigue (Table 1).
• Reported on one or both of the following: a.The correlation between personal trauma history and secondary trauma/secondary traumatic stress/vicarious trauma/compassion fatigue.
And/or b.The prevalence of either personal trauma history and/or secondary trauma/secondary traumatic stress/vicarious trauma/compassion fatigue (Table 1).
• The sample was comprised of mental health professionals.These professionals included mental health nurses, psychiatrists, social workers, psychologists, occupational therapists and counsellors who have experienced their own trauma.
• The sample also included student mental health professionals of the professional background mentioned above if they had placements in a mental health setting and who have experienced their own trauma.
• Searches were limited to empirical articles published in English.
• Only valid measures producing quantitative data to assess the prevalence of secondary traumatic stress, secondary trauma, vicarious trauma and compassion fatigue were included.

Studies were excluded if;
• Reported on burnout only (Table 1).
• We excluded qualitative studies, books, book chapters, personal blogs, commentaries, conference abstracts and thesis.

| Data extraction and analysis
Information was extracted independently using a standardized prepiloted form for all studies by the two reviewers (AH, XH).Data

| Risk of bias (quality) assessment
Two review authors (AH, XH) independently assessed the risk of bias in included studies using the Newcastle-Ottawa Scale (Wells et al., 2013)

| Data synthesis
Due to the heterogeneity of the studies included in the review, a meta-analysis was not possible.Instead, a narrative synthesis was completed as recommended by Popay et al. (2006).Findings were organized according to the key research questions: the association between personal trauma history and secondary traumatic stress; the prevalence of personal trauma history in mental health professionals; the prevalence of secondary traumatic stress in mental health professionals.The study focus, study design and quality were also reported on within the data synthesis.

| Risk of bias
The adapted Newcastle Ottwa Scale was used to assess the qualities of the studies included in the review.Findings are available in Table 3.In general, studies were of moderate quality.Out of a total score of 8, with high scores representing low risk of bias, five studies scored 6 or above, 17 studies scored between 3 and 5, and 1 study scored between 0 and 2. We found that the majority of the studies sample size were representative of their target sample with the exception of (Diehm et al., 2019;Iyamuremye & Brysiewicz., 2015;Killian, 2008;& Ray et al., 2013).However, the sample size was justified and deemed satisfactory in only four studies (Devilly et al., 2009;Linley & Joseph, 2007;Makadia et al., 2017& Pearlman & Mac Ian, 1995).The non-response rate was defined and deemed satisfactory and characteristics of responders in three studies (Corbett-Hone & Johnson, 2022;Mangoulia et al., 2015;Pearlman & Mac Ian, 1995).
The outcome per group was reported appropriately in all other than Pearlman and Mac Ian (1995), Iyamuremye and Brysiewicz (2015) and Killian (2008).

| Characteristics of the studies
All studies were cross-sectional in design collecting data at one time point.Two studies used mixed methods designs, collecting and analysing both quantitative and qualitative data within the same study, and for which only the quantitative results were used in this review (Iyamuremye & Brysiewicz, 2015;Killian, 2008).Studies were almost all conducted in Western countries, with the most frequent locations being Two recruited international samples (McKim & Smith-Adcock, 2014;Pearlman & Mac Ian, 1995) and two studies were conducted in Africa (Iyamuremye & Brysiewicz, 2015;MacRitchie & Leibowitz, 2010).

| Participant characteristics
Professional titles of the participants in the studies varied.These were: mental health workers (Iyamuremye & Brysiewicz, 2015; TA B L E 3 Quality assessment.
Secondary traumatic stress was typically measured with the Professional-Quality of Life scale (Pro-QOL) which identifies symptoms of compassion fatigue, compassion satisfaction and burnout.
When asking MHP's whether they had experienced trauma in their lives two studies asked the participants to state either yes or no (Linley & Joseph, 2007;Pearlman & Mac Ian, 1995).Some of the studies asked Another study asked questions concerning history of trauma and trauma resolution (Diehm et al., 2019), and then personal history of trauma and resolutions of personal trauma (Makadia et al., 2017).
Some of the studies used ratings.In one study, participants rated their personal trauma history from 0 to 10, with 0 representing no trauma and 10 representing extreme personal trauma history (Rayner et al., 2020); another asked about eight lifetime traumatic events-for example, have you ever been attacked with a weapon?and then coded these into categories (none, one event or more than one event) (Rossi et al., 2013).
Some authors asked a number of questions.For instance,

| Personal trauma history
For 19 out of the 23 studies that reported on the prevalence of personal trauma history in the mental health professionals, 13 of the studies used percentages to present their data, with prevalence ranging from 21.2% (Somoray et al., 2017) to 83.3% (Corbett-Hone & Johnson, 2022).Taking the three main study locations used, we can compare the proportion of MHPs who have experienced trauma with those within general populations (Table 4).This suggests that in American, Australia and the UK, significantly higher proportions of MHPs experienced trauma compared with the general population of their own country.

| DISCUSS ION
The key findings of our review are as follows: firstly, that personal trauma history and secondary traumatic stress are common in mental health professionals; and secondly, that we identified an association between a mental health professional's personal trauma history and secondary traumatic stress symptoms.The prevalence of a personal trauma history ranged from 19% to 83.1%, with mental health professional's experiencing personal trauma history in 22 of the 23 studies captured in our review.This means that those professionals who work in the field of mental health are likely to have experienced their own trauma.Eighteen studies reported on whether mental health professionals' experienced secondary traumatic stress, and prevalence ranged from 19.2% to 70%.This signifies that mental health professionals who work with people who have been traumatized are at risk of experiencing secondary traumatic stress.
Our results found that 13 of the 18 studies which investigated the association between personal trauma history and secondary traumatic stress found a statistically significant positive relationship between these variables, albeit the correlation is of small magnitude.
This means that mental health professionals with a personal history of trauma are at heightened risk of suffering from secondary traumatic stress when working with those who have been traumatized.
Our findings on the correlation between personal trauma history and secondary traumatic stress are in keeping with those reported in the review by Leung et al. (2022), which adopted a broader definition of mental health professionals.
Our findings should be interpreted with some caution due to methodological weaknesses of the included studies.All the studies captured in this review were cross-sectional in design.Several authors identified this as a limitation of their research and recommended that future longitudinal research take place to assess for causation (Creamer & Liddle, 2005;La Mott & Martin, 2019;Linley & Joseph, 2007;Makadia et al., 2017;Ray et al., 2013;Somoray et al., 2017).Furthermore, using a yes/no question to determine the presence of past trauma does not take into consideration that trauma can be viewed differently, and perceptions can vary (Dunkley & Whelan, 2006).Asking the participant to respond using either a yes or no does not consider the characteristics of trauma.For example, a history of interpersonal trauma (child abuse) versus impersonal trauma (natural disaster).It also fails to measure the impact of the trauma or the influence of previous therapy.A valid assessment tool is needed to measure for personal trauma and anticipate for these factors.Our estimates of the prevalence of personal trauma and secondary traumatic stress will also be influenced by selection bias, in that participants with personal experience of these issues may have been more likely to participate in studies compared to mental health professionals with no experience of such issues.
The definition of trauma is understood quite broadly by participants, and it may be that those recruited into the studies did not, in fact, work with trauma but other psychological difficul- ties and yet identify themselves as trauma therapists (Makadia et al., 2017;Pearlman & Mac Ian, 1995).Finally, some studies had a low response rate which limited the generalisability of their findings (Adams & Riggs, 2008;Creamer & Liddle, 2005;Devilly et al., 2009;Killian, 2008;Mangoulia et al., 2015).

| Implications for training and practice
There is a common acknowledgment in the workplace that those attracted to a career in this field of mental health are often those with some knowledge and experience of difficult life events.Despite this, there is lack of acknowledgment within mental health professional's training to help prepare the student for when they are in practice.
Embedding teaching about the possible psychological impacts of secondary traumatic stress for those mental health professionals with their own experiences of trauma could lead to improved well-being of the practitioner and support the services to retain skilled staff.
It would mean that, when in practice those that are able to identify themselves at increased risk of suffering from secondary traumatic stress, could receive targeted support from the organization with the development of specialized supervision and debriefs.As found in Dunkley & Whelan's. (2006) study where strong supervision reduced disruptions in clinicians' belief symptoms.

| Implications for research
Further research would benefit from adequately-powered studies with a prospective design, to understand the association of personal trauma history and secondary traumatic stress over time.Studies should use validated tools to measure personal trauma history and secondary traumatic stress, and the field would benefit from consensus about which tools have the best psychometric properties, which would require a review of the evidence.In terms of prospective designs, it would be important to investigate whether there are particular periods of time when mental health professionals with a history of personal trauma history are more vulnerable to developing secondary traumatic stress, such as soon after qualification.
Qualitative studies are also needed: firstly, to develop a richer understanding of the mechanisms by which a personal trauma history might be associated with secondary traumatic stress, as well as relevant risk and protective factors; secondly, to inform hypotheses for future research; and thirdly, to better understand what services, supervisors and trainers can put in place to help and assess the impact of this.

| Limitations
Publications included were written in English, meaning that we may have missed studies, particularly from Global Majority countries.Ethnicity was also not discussed in many of the studies captured in the review and therefore places limits on the generalisability of the findings.Given that studies typically report small correlations between personal trauma history and secondary traumatic stress, many of the studies in our review are likely to be underpowered.Studies reporting on the prevalence of personal trauma and secondary traumatic stress may have also been influenced by selection bias where those experiencing these issues would be more likely to participate in their studies.Another limitation of this review was that all the papers captured were of cross-sectional design.This would have excluded those mental health professionals who may have left the workplace after developing secondary traumatic stress, as well as limiting our understanding about the relationship between personal trauma history and secondary traumatic stress over time.For example, it is not clear at what point in their careers mental health professionals are most likely to develop secondary traumatic stress, which makes it harder for educators, supervisors and managers to know who is most vulnerable in terms of career stage.It could also be argued that trainees have not qualified as mental health professionals and should not have possibly been included in the review.The prevalence of personal trauma history and secondary traumatic stress ranged widely across studies, which likely reflects differences in how these variables were measured, as well as possible variation across different mental health professional groups.

| CON CLUS ION
In conclusion, our review highlights that both personal trauma history and secondary traumatic stress are common in mental health professionals.Across our included studies, we found that personal trauma history and secondary traumatic stress were present in at least one fifth of mental health professionals, whilst at the higher end of the range, personal trauma history was present in over four fifths of mental health professionals, whilst secondary traumatic stress was present in over two thirds of mental health professionals.Secondly, we found that personal trauma history is associated with secondary traumatic stress, suggesting that personal trauma history is a potential risk factor for developing secondary traumatic stress.This means that those involved in training, supervising and managing mental health professionals should be aware that a high proportion of the mental health workforce has a history of trauma, and that this history may put such professionals at higher risk of developing traumatic stress.This is likely to have major consequences for staff wellbeing and retention.More research is needed to understand the relationship between personal trauma history and secondary traumatic stress in greater depth, for instance through qualitative studies.Quantitative studies adopting prospective designs are also a priority, which can provide insights into both risk and protective factors for those mental health professionals with a personal trauma history.Improving the evidence base is required so that mental health professionals with a history of personal trauma can potentially be at reduced risk of developing secondary traumatic stress.

| RELE VAN CE TO MENTAL HE ALTH NUR S ING
This systematic review identified that mental health professionals with a personal history of trauma are at heightened risk of suffering from secondary traumatic stress.In specialized areas like mental health, retention of professionals, including nurses is a fundamental issue.This study identifies those mental health professionals who are at higher risk of developing secondary traumatic stress, enabling health care providers to ensure additional and targeted support is given.

13652850, 0 ,
Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jpm.13082by Test, Wiley Online Library on [09/07/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License TA B L E 1 Population, exposure and outcome with inclusion & exclusion rationale.

13652850, 0 ,
Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jpm.13082by Test, Wiley Online Library on [09/07/2024].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License records.Non-consensus was resolved by a third reviewer (TJ).Finally, we searched the reference list of studies assessed during the full-text stage to identify additional studies.In addition, Google Scholar was searched using the same keywords and published review articles on Secondary Traumatic Stress were surveyed to identify any appropriate articles not found in the database search.
extracted included author, date of publication, title of the article, country, study focus, study population, design, response rate, sample size, measure used and prevalence.The correlation® between personal trauma and secondary trauma was extracted where possible.Calculation of reliability was dependent on percentage of consensus between investigators when searching and screening articles.Any variance was discussed by the investigators (AH & XH) but, if unable to reach an agreement reviewer (TJ) was asked to make the final decision.Study authors were contacted and asked to provide the following information where this was missing: Pearson's correlation and the p value; and the percentage of participants who report (a) history of personal trauma and (b) secondary traumatic stress.
Figure2and a summary of the main characteristics of the studies in their own original questions to investigate whether the MHP's had a history of trauma.Some used only one question; whether the participant had ever received a formal diagnosis of Post-Traumatic Stress Disorder (Corbett-Hone & Johnson, 2022); or experienced direct exposure to violent crimes (MacRitchie & Leibowitz, 2010).
Adams & Riggs. (2008) asked questions about whether the participant had personally been involved in a natural disaster, witnessed or been a participant in combat, been a victim of violent crime, a victim of physical, sexual or emotional abuse as a child, an adult victim of sexual assault or rape, been involved in a physically abuse relationship, or witnessed someone being seriously injured or killed.Somoray et al. (2017) asked participants to state whether their history of trauma was personal or work-related, and to give descriptions of the trauma experienced, as well as the perceived severity of the trauma, defining a traumatic event according to the DSM-5, 4th edition (American Psychiatric Association., 1994) Ray et al. (2013) asked if they had a history of trauma related to childhood physical abuse/sexual abuse/psychological abuse emotional abuse or neglect.Mangoulia et al.'s.(2015) precise questions were not listed.They asked participants if they had experienced a traumatic event in which they could have been killed or if they had experienced the death of a loved one.Sodeke-Gregson et al. (2013) asked their own questions but did not give an example of these.Cieslak et al. (2013) developed the Secondary Traumatic Exposure Scale for their study.Devilly et al. (2009) adapted the STSS.Buchanan et al. (2006) used two questions from the IES-Revised (IES-R).Creamer and Liddle (2005) used the Life Events Scale (LEC); Dunkley and Whelan (2006) the Trauma Scale Inventory (TABS); Killian (2008) Trauma History Questionnaire (THQ); La Mott and Martin (2019) Adverse Childhood Experiences (ACE); McKim and Smith-Adcock (2014) the Stressful Life Experiences Short Form (SLES); and Chaverri et al. (2018) Post-traumatic Stress Disorder Checklist Civilian and Military versions (PCL).