ESPECÍFICAS
XVI. SOLUCIÓN DE DIFERENCIAS
The exploration of the differences in secondary traumatic stress symptoms in different professions was initially carried out using unrelated analysis of variance (ANOVA). Test of assumptions for unrelated ANOVA on each of the variables (compassion fatigue, burnout, compassion satisfaction, intrusion, avoidance, arousal and secondary traumatic stress) indicated that one of the key assumptions of equality of variances was violated for all of the study variables (with the exception of compassion fatigue), with Levene’s test being significant – at least < .05 level. The transformation of the data and screening for the outliers did not result in any improvements to the equality of variances in each profession group and therefore ANOVA
2 was an inappropriate test to use on this data. As such, the results of the ANOVA output were
unreliable. In order to avoid Type I Error, the non-parametric alternative to the unrelated ANOVA was employed to analyse differences in levels of secondary traumatic stress in each profession. Furthermore, a pair-wise comparison was done to examine more precisely where the difference lies. The level of significance was adjusted using Benferroni correction.
The descriptive statistics were calculated for each of the dependent variables and for each occupational group and are presented in Table 4.1a. In addition, the mean differences between all the groups were tested using the Kruskal-Wallis test and the pair-wise comparisons were done using Mann-Whitney U-test. The results of those tests are reported in Table 4.1b.
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Table 4.1a Means and Standard Deviations for all of the Study Variables for Each Professional Group
Variable A&E Doctor A&E Nurse Ambulance
Technician
Counsellor Psychiatrist Psychologist Social Worker
M SD M SD M SD M SD M SD M SD M SD GHQ-30 43.1 30.8 35.6 14.9 38.3 19.3 47.5 26.3 32.8 15.2 29 14.4 32.7 12.1 Pro-QOL_CS 34.2 7.4 31.2 3.5 30.9 2.9 27.4 5.8 34.1 5.7 35.3 5.5 32 4 Pro-QOL_BRN 29 8.1 30.6 2.3 31.6 4.3 33.7 5.2 28.8 4.9 27.4 4.7 29.7 3.2 Pro-QOL_STSS 30.9 10 32.8 6.2 33.4 5.3 35.8 7.7 29.9 8.7 28.6 7.2 31.7 4.5 Pro-QOL_CF 94.1 11.6 94.5 10.3 95.9 7.5 96.8 8.3 92.7 10.2 91.3 8.5 93.4 7.4 IES 43.7 28.8 52 11.5 50.7 11.1 58.6 16.5 42.7 21.3 39.9 15.9 46.7 8.1 STSS_S1 15.2 6.5 16.8 2.4 17.9 3.7 19 4.7 14.1 5.3 13.9 3.9 15.5 2 STSS_S2 21.5 9.1 23.6 3.8 23.1 4.3 26.3 6.4 19.8 7.5 19.1 5.2 21 3.2 STSS_S3 15.6 6.6 17.3 2.9 18.9 4.2 19.3 4.7 15.6 5.2 14.9 4 15.6 2.5 STSS 52.3 22.1 57.7 8.9 59.9 11.6 64.6 15.8 49.6 17.6 47.9 12.9 52.2 7.4
GHQ-30 – General Health Questionnaire 30 (possible minimum score is 0 indicating no decline in general health and possible maximum score is 90 indicating severe decline in general health); Pro-QOL_CS – Professional Quality of Life Questionnaire _ Compassion Satisfaction Scale (possible minimum score is 10 indicating no compassion satisfaction and possible maximum score is 50 indicating highest levels of compassion satisfaction); Pro-QOL_BRN – Professional Quality of Life Questionnaire _ Burnout Scale (possible minimum score is 10 indicating no burnout and possible maximum score is 50 indicating severe burnout); Pro-QOL_STSS – Professional Quality of Life Questionnaire _ Secondary Traumatic Stress Scale (possible minimum score is 10 indicating no secondary traumatic stress and possible maximum score is 50 indicating severe secondary traumatic stress); Pro-QOL_CF – Professional Quality of Life Questionnaire _ Compassion Fatigue (possible minimum score is 30 indicating no compassion fatigue and possible maximum score is 150 indicating severe compassion fatigue); IES – Impact of Event Scale (possible minimum score is 0 indicating no emotional distress and possible maximum score is 75 indicating severe emotional distress); STSS_S1 – Secondary Traumatic Stress Scale_ Intrusion (possible minimum score is 5 indicating absence of intruding thoughts and possible maximum score is 25 indicating high levels of intrusive thoughts); STSS_S2 – Secondary Traumatic Stress Scale_ Avoidance (possible minimum score is 7 indicating no avoidant behaviour/thoughts and possible maximum is 35 indicating high levels of avoidant behaviour/thoughts); STSS_S3 – Secondary Traumatic Stress Scale _ Arousal (possible minimum score is 5 indicating low arousal and possible maximum is 25 indicating high levels of arousal); STSS – Secondary Traumatic Stress Scale Total (possible minimum score is 17 indicating no secondary traumatic stress and possible maximum is 85 indicating high levels of secondary traumatic stress)
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Table 4.1b Kruskal-Wallis and Mann-Whitney U-test Results GHQ30 Pro- QOL_CS Pro- QOL_BRN Pro- QOL_STSS Pro- QOL_CF IES STSS_S1 STSS_S2 STSS_S3 STSS Kruskal-Wallis test 12.67* 38.50* 26.14* 14.71* 10.79 21.91* 32.70* 34.08* 24.23* 34.87*
A&E Doctor vs A&E Nurse 370 370 427.5 367 436 419.5 382.5 378.5 388 375.5
A&E Nurse vs Counsellor 441 246.5* 282.5 369.5 391.5 347.5 343.5 347 350.5 341
Counsellor vs Social Worker 355.5 203** 218* 288.5* 334 269* 255.5* 212* 279.5* 229*
Social Worker vs Psychiatrist 408.5 356.5 415 411.5 427 362 316 338 393.5 326.5
Psychiatrist vs Psychologist 353 397.5 394 429 414.5 431.5 437.5 446.5 436.5 433.5
Psychologist vs Amb.Tech. 288 231.5* 251.5* 290.5 281 280* 205* 236** 226.5* 206.5*
A&E Doctor vs Amb.Tech. 414.5 355.5 383.5 360 382 440.5 341 407 321.5 369
A&E Doctor vs Counsellor 427 226.5* 306 308.5 389.5 324 305 310.5 310 305
A&E Doctor vs Social Worker 346.5 411.5 439 413 436 419.5 447.5 417 446.5 435.5
A&E Doctor vs Psychiatrist 366 423.5 421.5 439 419 424 395.5 384.5 427 389
A&E Doctor vs Psychologist 331 391.5 379.5 414.5 384 384 382.5 359 405 376.5
A&E Nurse vs Social Worker 372 392.5 337.5 358.5 391 376.5 318.5 262.5* 339 283*
A&E Nurse vs Psychiatrist 355 301 331.5 361.5 391.5 300.5 260.5* 249** 313 248*
A&E Nurse vs Psychologist 333.5 250.5* 279 344 340.5 246.5* 237* 197.5** 274.5* 197.5**
A&E Nurse vs Amb.Tech. 435.5 413 392 397.5 361.5 401.5 390 397.5 352.5 431
Counsellor vs Psychiatrist 273* 153.5** 217.5* 290.5* 339 248.5* 217* 207.5* 258* 208.5*
Counsellor vs Psychologist 239.5* 127.5** 181** 269* 282* 202.5** 195.5** 163.5** 230* 167.5**
Counsellor vs Amb.Tech. 345.5 275.5* 345 297.5 447.5 306 403.5 312.5 430.5 353.5
Social Worker vs Psychologist 322 301 353.5 390.5 378.5 302.5 327.5 323.5 366.5 320
Social Worker vs Amb.Tech. 401.5 366.5 328.5 329 324.5 420.5 275* 323 266* 286.5
Psychiatrist vs Amb.Tech. 425.5 282* 311 327 328 330 229.5* 262.5* 269.5* 235.5*
5 As can be seen from Table 4.1a, participants reported, on average, morbidity on their
general health ranging from 28 to 47.5, which indicates that they experienced some but not severe weakness in general health. The analysis of mean differences and pair-wise comparisons reported in Table 4.1b show that overall there was a significant difference between professions in their reported morbidity on general health. However, the pair-wise comparison identified that significant differences were only found between psychologists and counsellors, and psychiatrists and counsellors, where counsellors reported a much higher decline in their general health than psychologists and psychiatrists.
With regard to the professional quality of life, participants reported compassion satisfaction ranging between 27.4 and 35.3 across all seven occupational groups, which indicates that participants’ derived average levels of pleasure from doing their work. The test of mean differences showed an overall significant difference between all seven groups. The pair-wise comparison furthermore revealed that psychologists, psychiatrists and A&E doctors on average reported significantly higher compassion satisfaction than councillors and ambulance technicians. Participants across all seven groups also reported average levels of burnout ranging from 27.4 to 33.7. There was overall significant difference between all seven groups in their levels of burnout; however, pair-wise comparison revealed that psychologists and psychiatrists reported significantly less burnout that counsellors and ambulance technicians. Participants across all seven groups also reported average levels of secondary traumatic stress ranging from 28.6 to 35.8. Overall there was a significant difference in levels of secondary traumatic stress between the groups, but pair-wise comparison showed that only psychologists, psychiatrists and social workers reported significantly less secondary traumatic stress than counsellors. On the overall measure of compassion fatigue, the scores ranged across groups between 91.3 and 96.8,
6 but there was no overall significant difference. The pair-wise comparison, however, showed that
psychologists reporting significantly less compassion fatigue than counsellors.
Examining emotional distress experienced at work, participants’ responses across groups ranged between 39.9 and 58.6, indicating a larger spread between the occupational groups than was observed on other measures of secondary traumatic stress and its related symptoms. Overall there was significant difference between occupational groups in their levels of emotional distress. The pair-wise comparison showed that psychologists and social workers reported significantly lower levels of emotional distress in comparison with counsellors, A&E nurses and ambulance technicians.
Analysing the secondary traumatic stress scale, on the subscale of intrusion participants’ scores across the occupational groups ranged between 13.9 and 17.9, and on the subscale of avoidance the scores ranged between 19.1 and 26.3, indicating that participants across groups experienced average levels of intrusive and avoidant thoughts and behaviour. Overall there was a significant difference between the occupational groups on their reported levels of intrusive and avoidant thoughts and behaviour. Pair-wise comparison showed that psychologists, psychiatrists and social workers reported significantly fewer intrusive and avoidant thoughts and behaviour than counsellors, ambulance technicians and A&E nurses. With regard to arousal, participants reported heightened levels of arousal across all seven occupational groups and their responses ranged between 14.9 and 19.3. There was also overall significant difference between occupational groups and pair-wise comparison revealed that psychologists, psychiatrists and social workers reported on average lower levels of arousal than counsellors and ambulance technicians. Similar results were obtained for the overall secondary traumatic stress scale. The overall responses across all occupational groups ranged between 47.9 and 64.4 indicating
7 experience of some secondary traumatic stress and there were significant differences between the
groups. The results of the pair-wise comparison on the full secondary traumatic stress scale were very similar to the results on its three subscales and showed that psychologists, psychiatrists and social workers on average experience significantly less secondary traumatic stress than counsellors, A&E nurses and ambulance technicians.