Recent Submissions

  • Psychological and physical health impacts of forensic workplace trauma

    Mistry, Dipti; Gozna, Lynsey (2021)
    Purpose: Health-care professionals working in inpatient forensic mental health settings are exposed to a range of traumatic and distressing incidents with impacts discussed variously as “burnout”, “compassion fatigue”, “secondary trauma stress” and “vicarious traumatisation”. This study aims to explore the short- and long-term psychological and physical health effects of trauma exposure in the workplace for frontline staff in a forensic setting. Design/methodology/approach: Semi-structured interviews were conducted with 14 nursing staff members working in the male personality disorders care stream in a Medium Secure Hospital. Findings: Thematic analysis yielded five themes: categories of trauma; how well-being is impacted; ways of coping and managing; protective factors; and systemic factors, with sub-themes within each of the superordinate themes. Practical implications: The findings demonstrate that some staff members were affected both physically and psychologically as a result of trauma-focused work whereas other staff members were unaffected. The psychological and physical health effects were broadly short-term; however, long-term effects on staff member’s social networks and desensitisation to working conditions were observed. A broad range of coping methods were identified that supported staff member’s well-being, which included both individual and organisational factors. Staff member’s health is impacted by exposure to workplace trauma either directly or indirectly through exposure to material, and there is a greater need to support staff members after routine organisational provisions are complete. Staff should receive education and training on the possible health effects associated with exposure to potentially traumatic material and events. Originality/value: This research has further contributed to understanding the staff needs of nursing staff members working with the forensic personality disorder patients within a secure hospital setting. This research has identified the following service developments: the need for ongoing support particularly after organisational provisions are complete; further prospects to engage in psychological formulations; greater opportunities for informal supervision forums; staff training to understand the potential health impact associated with trauma-focused work; supervisors being appropriately trained and supported to elicit impacts of trauma-focused work on staff members; and additional opportunities to discuss well-being or monitor well-being.
  • Voices from the frontline: the psychological impact and coping mechanisms used by healthcare staff during COVID-19

    Majumder, Pallab; Sales, Christian P. (2021)
    Background/Aims Healthcare workers have been affected by the physical and psychological consequences of working during the COVID-19 pandemic. This study explored the effects of the pandemic on the psychological wellbeing of UK healthcare workers, as well as the coping mechanisms used and the workplace support that they found helpful. Methods A self-administered questionnaire was distributed to healthcare workers across various settings, including primary care, community services, hospital settings and specialist or tertiary service settings. A convenience sample was used to select the participants. The responses were collected for 1 month at the height of the first wave of COVID-19 in the UK (10 April 2020-10 May 2020). Results were collated and analysed using the Statistical Package for the Social Sciences software. Results Responses to the questionnaire showed the negative emotional, behavioural and cognitive impact of the pandemic on staff, with many experiencing issues such as anxiety, anger, disrupted sleep and worries about contracting the virus. A concerning number also reported symptoms of severe psychological distress, including depersonalisation, derealisation, self-harm and suicidal thoughts. Practical coping mechanisms were generally preferred. Older, male staff were significantly less likely to reach out for support than their younger and female counterparts. Respondents also expressed a preference for practical support from their employer, such as more managerial support at work, time off and financial incentives.
  • Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

    das Nair, Roshan (2021)
    Background: Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. Objectives: This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. Data sources: The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. Review methods: Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I-2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. Results: A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I-2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I-2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I-2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. Limitations: Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. Conclusion: Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. Future work: Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. Study registration: This study is registered as PROSPERO CRD42017078690.
  • Childhood trauma and childhood mental disorder in military and employed civilian men

    Syed Sheriff, Rebecca (2020)
    We aimed to retrospectively investigate childhood trauma and childhood mental disorder in military and employed civilian men aged 18 to 54 years. Data, derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics National Survey of Mental Health and Wellbeing Study, were analyzed and compared using direct age standardization and logistic regression. A greater proportion of ADF reported childhood trauma, multiple trauma types, trauma onset below 12 years of age, and interpersonal trauma than civilian employed men. A greater proportion of ADF reported childhood noninterpersonal trauma, such as accidents, than civilian employed men, with a marked difference in those aged 45 to 54 years. In both populations, childhood disorder was associated with childhood trauma; however, childhood depression was not associated with childhood noninterpersonal trauma in either population. A deeper understanding of the longer-term risk and resilience conferred by different childhood trauma profiles is needed.
  • Associations among childhood trauma, childhood mental disorders, and past-year posttraumatic stress disorder in military and civilian men

    Syed Sheriff, Rebecca (2019)
    To identify early life factors associated with posttraumatic stress disorder (PTSD), we investigated the association between childhood trauma and mental disorders with International Classification of Diseases (ICD)-diagnosed past-year PTSD in employed military and civilian men. Data were derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (N = 1,356) and the 2007 Australian Bureau of Statistics (ABS) National Survey of Mental Health and Wellbeing Study (N = 2,120) and analyzed using logistic regression and generalized structural equation modeling. After controlling for demographics, PTSD was associated with childhood anxiety, adjusted odds ratio (AOR) = 3.94, 95% CI [2.36, 6.58]; and depression, AOR = 7.01, 95% CI [2.98, 16.49], but not alcohol use disorders, in the ADF. In civilians, PTSD was associated with childhood anxiety only, AOR = 7.06, 95% CI [3.50, 14.22]. These associations remained significant after controlling for childhood and adult trauma in both populations and service factors and deployment, combat, or adult trauma in the ADF. In both populations, PTSD was associated with more than three types of childhood trauma: AOR = 2.97, 95% CI [1.53, 5.75] for ADF and AOR = 5.92, 95% CI [3.00, 11.70] for ABS; and childhood interpersonal, but not noninterpersonal, trauma: AOR = 3.08, 95% CI [1.61, 5.90] for ADF and AOR = 6.63, 95% CI [2.74, 16.06] for ABS. The association between childhood trauma and PTSD was fully mediated by childhood disorder in the ADF only. Taking a lifetime perspective, we have identified that the risk of PTSD from childhood trauma and disorder is potentially predictable and, therefore, modifiable.
  • Childhood trauma and the impact of deployment on the development of mental disorder in military males

    Syed Sheriff, Rebecca (2019)
    BackgroundChildhood adversity is associated with mental disorder following military deployment. However, it is unclear how different childhood trauma profiles relate to developing a post-deployment disorder. We investigated childhood trauma prospectively in determining new post-deployment probable disorder.MethodsIn total, 1009 Regular male ADF personnel from the Australian Defence Force (ADF) Middle East Area of Operations (MEAO) Prospective Study provided pre- and post-deployment self-report data. Logistic regression and generalised structural equation modelling were utilised to examine associations between childhood trauma and new post-deployment probable disorder and possible mediator pathways through pre-deployment symptoms.ResultsThere were low rates of pre-deployment probable disorder. New post-deployment probable disorder was associated with childhood trauma, index deployment factors (combat role and deployment trauma) and pre-deployment symptoms but not with demographic, service or adult factors prior to the index deployment (including trauma, combat or previous deployment). Even after controlling for demographic, service and adult factors prior to the index deployment as well as index deployment trauma, childhood trauma was still a significant determinant of new post-deployment probable disorder. GSEM demonstrated that the association between interpersonal childhood trauma and new post-deployment probable disorder was fully mediated by pre-deployment symptoms. This was not the case for those who experienced childhood trauma that was not interpersonal in nature.ConclusionsTo determine the risk of developing a post-deployment disorder an understanding of the types of childhood trauma encountered is essential, and pre-deployment symptom screening alone is insufficient. Copyright © Cambridge University Press 2019.
  • Childhood determinants of suicidality: comparing males in military and civilian employed populations

    Syed Sheriff, Rebecca (2018)
    BackgroundTo better understand the associations of childhood trauma and childhood disorder with past-year suicidality (thoughts, plans or attempts), we compared male military and civilian populations aged 18–60 years old.MethodsData derived from the 2010 Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study and the 2007 Australian Bureau of Statistics Australian National Survey of Mental Health and Wellbeing were compared using logistic regression and Generalized Structural Equation Modelling (GSEM).ResultsA greater proportion of the ADF experienced suicidality than civilians. Those who experienced childhood trauma that was not interpersonal in nature were not at increased odds of suicidality, in either population. A higher proportion of the ADF experienced three or more types of trauma in childhood and first experienced three or more types of trauma in adulthood. Both were associated with suicidality in the ADF and civilians. Childhood anxiety had a strong and independent association with suicidality in the ADF (controlling for demographics and childhood trauma, adult trauma and adult onset disorder). Childhood anxiety fully mediated the relationship between childhood trauma and suicidality in the ADF, but not in civilians.ConclusionsThese data highlight the need to take a whole life approach to understanding suicidality, and the importance of categorizing the nature of childhood trauma exposure. Importantly, childhood anxiety was not only associated with suicidality, it fully mediated the relationship between childhood trauma and suicidality in the more trauma exposed (military) population only. These findings have the potential to inform the development of strategies for suicide prevention.
  • Are acceptance and commitment therapy-based interventions effective for reducing burnout in direct-care staff? A systematic review and meta-analysis

    Tickle, Anna C. (2018)
    Purpose Work-related stress amongst staff working in direct care roles in mental health and intellectual disability settings is associated with a range of problematic outcomes. There has been a proliferation of research into the use of acceptance and commitment therapy (ACT)-based interventions in this staff population. The purpose of this paper is to review the extant literature. Design/methodology/approach A systematic search of the literature was conducted, and seven studies identified which met the criteria for inclusion in the review, of which four were eligible for meta-analysis. Findings Results of the meta-analysis were most convincing for the effectiveness of ACT-interventions to reduce psychological distress within a subgroup of those with higher distress at baseline. There was no statistically significant effect for the amelioration of burnout, nor for an increase in psychological flexibility (a key ACT construct). Research limitations/implications Conceptual issues are considered including the purpose and treatment targets of ACT interventions, such as supporting valued living rather than diminishing stress per se. Methodological issues are discussed around the measurement of psychological flexibility. Originality/value This review makes recommendations for future research and for the implementation of ACT-interventions for work-related stress in these settings.
  • Psychological support post-release of humanitarian workers taken hostage: The experience of the International Committee of the Red Cross (ICRC)

    Regel, Stephen (2018)
    Following release, former hostages face many challenges and may struggle to regain control over their lives. Research and evidence on how to effectively address the needs of hostages during their release and afterwards is lacking. The International Committee of the Red Cross has extensive experience in managing hostage situations and has strengthened the practice of care offered to its own affected staff by developing an inter-professional comprehensive seven phase care model adapted to incidents of extended duration with multiple stressors. This includes strong coordination between the different actors involved, combined with long term peer, social and organisational support, as well as workplace reintegration with guidance by colleagues, and specialised counselling when necessary, to ensure positive outcomes, and minimise permanent sequelae. © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
  • Early interventions following traumatic bereavement

    Regel, Stephen (2014)
    A 'traumatic bereavement' is such when the loss is sudden, violent or unexpected; for example, a road traffic collision, suicide or homicide. The experience is terrifying and shocking; individuals cannot prepare for, or protect themselves from, the event. Many traumatically bereaved people find their profound shock, loss or grief is compounded by a lack of help at this terrible time. They need early support, information and advice to help them cope, understand the reactions they are experiencing, and make sense of what has happened. Accessing early support following a traumatic bereavement can make a significant difference to someone's long-term recovery. This report explores: common reactions to traumatic bereavement and how they develop; the role of assessment; and some strategies to manage the challenges that arise as a consequence.
  • A study of outcomes of patients treated at a UK major trauma centre for moderate or severe injuries one to three years after injury

    das Nair, Roshan (2017)
    Objective: To assess return to work outcomes of major trauma patients treated at a level 1 UK major trauma centre and evaluate factors associated with improved outcomes. Design: Cross-sectional cohort design. Subjects: In total, 99 patients at one, two or three years post-discharge from a Major Trauma Centre with an injury severity score above 9, in full-time work or education prior to injury, aged 18-70 and discharged between April 2012 and June 2015. Main Measures: Self-report questionnaire including the Trauma Outcome Profile, the Multiple Sclerosis Neuropsychological Screening questionnaire and questions pertaining to work and education. Results: Of the 99 patients in full-time work pre-injury, 65 made a complete return to work, 15 made an incomplete return to work and 19 did not return to work, where incomplete return to work was defined as working below 80% of previous working hours. In all, 25 participants scored below the cut-off point on physical disabilities, 46 below the cut-off point on mental functioning and 38 below the cut-off point on social interaction. Reduced anxiety and higher mental functioning were consistently associated with complete return to work. Conclusion: In all, 66% of patients with moderate to severe injuries made a complete return to work. A range of psycho-social, physical and functional health issues were persistent at long-term follow-up.
  • Staff well-being: a survey of stress and stressors in a community mental health service

    Diamond, Ross; McAdam, Melanie (1999)
    Working in the health service, and in mental health in particular, is acknowledged to be one of the most stressful occupations. MELANIE McADAM and ROBERT DIAMOND report the findings of a survey of its staff by one mental health trust and discuss the implications for service organization and management.
  • Is post‐traumatic stress disorder a helpful concept for adults with intellectual disability?

    Clegg, Jennifer (2005)
    Background Research using the concept of Post-Traumatic Stress Disorder (PTSD) with adults with intellectual disability (ID)assumes they perceive and react to traumatic events in a similar way to non-disabled adults. Reactions to trauma displayed by children may be relevant to adults with ID as well. Methods Two focus groups were held with professionals and practitioners to explore the relevance of criteria from child as well as adult literature to adults with ID who experience trauma. Descriptive thematic analysis was carried out. Results Abuse, parental bereavement, and having children removed were considered common sources of trauma. Similarities identified between disabled and non-disabled adults were flashbacks and nightmares; distressed by reminders; avoidance; hypervigilance and increased arousal. Differences were the frequent occurrence of multiple rather than single events, which were considered significant in generating chronic problems similar to those described as PTSD; also the occurrence of physical health problems and behavioural re-enactments. Discussion and conclusions Experienced professionals and practitioners considered most of the ideas from PTSD research with non-disabled adults to be relevant to adults with ID who experience trauma, but that some behaviour reported in research with children was also relevant. Topics and questions for use in clinical and research practice with individuals who have experienced trauma were proposed.
  • Exploring the meaning of trauma with adults with intellectual disabilities

    Clegg, Jennifer (2006)
    Background: Previous research investigating post-traumatic stress disorder assumed that adults with intellectual disabilities would react to trauma in the same way as those in the non-disabled population. This study explored the personal experience of trauma in a small group of adults with intellectual disabilities. Methods: Semi-structured interviews, developed from a pilot study involving focus groups, were used to interview six adults with mild intellectual disabilities from a clinical population, about their experiences of trauma. The transcripts were analysed using Interpretative Phenomenological Analysis (IPA). A quantitative measure, the Posttraumatic Diagnostic Scale [PDS; Foa et al. (1997) Psychological Assessment vol. 9, pp. 445-451] was used in conjunction with the individual interviews. Results: One theme, whether individuals perceived the world to be a dangerous or a safe place, connected the five themes that emerged from the data. The themes were identified as: (i) how the trauma affected me, (ii) I avoid things that remind me of the trauma, (iii) I am prepared for danger in the future, (iv) the tension of talking or not talking and (v) the struggle of who to blame. Conclusions: The results were related to previous theoretical frameworks and the methodological limitations of the research acknowledged. The clinical implications of the findings for disclosure, assessment and therapeutic intervention were discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
  • The relationship between coping style and psychological distress in people with head and neck cancer: A systematic review

    Morris, Nicole; Tickle, Anna C.; Biswas, Sanchia (2017)
    OBJECTIVE: Individuals diagnosed with head and neck cancer (HNC) are at an elevated risk of experiencing psychological distress and a reduced quality of life. The aim of this review was to systematically examine and assess the quality of empirical evidence on the associations between coping mechanisms and psychological distress among people with HNC. METHODS: CINAHL, MEDLINE, PsycINFO, EMBASE and Web of Science were accessed to conduct this review. Studies were included if they used reliable and valid measures to investigate the relationship between coping style and psychological distress. Study quality was assessed and rated according to pre-set criteria, and showed variability in relation to selection methods. RESULTS: 12 studies (nine cross-sectional and three prospective designs) involving 1281 patients were reviewed. There was considerable heterogeneity in study samples and coping measures. Moderate to large associations between disengagement coping mechanisms (e.g. avoidance) and psychological distress were observed. Engagement coping strategies (e.g. direct action) were not consistently associated with psychological distress across studies. CONCLUSIONS: Several studies observed a significant relationship between coping styles aimed at disengaging and distancing from cancer and increased psychological distress. To understand directionality of these associations and further develop an understanding of temporal features of the relationship between coping styles and distress, longitudinal designs could be used in future research.
  • Histories of trauma in client members of therapeutic communities

    Evans, Chris; Manning, Nick (2006)
    This paper presents further data from the ATC/NLCB Therapeutic Communities Research Project, based on findings from the 306 social histories collected as part of this project. The project focused on people with personality disorders in therapeutic communities, and this paper explores some of the traumatic experiences of this sample of client members prior to their admission to a therapeutic community. We look particularly at early separations from main carers and family of origin; at losses and disability, and at experiences of physical and sexual abuse in childhood and adulthood, and see what, if any, relationship these have with personality disorders for this study sample. We also explore whether the different clients in the different types of therapeutic communities have different traumatic experiences, as evidenced by these social histories. The paper discusses the implications of these findings. © The Authors.
  • Factors associated with strain in carers of people with traumatic brain injury

    Boycott, Naomi (2013)
    Objective: To explore factors associated with strain in carers of patients with traumatic brain injury.; Design: Cross-sectional cohort study.; Participants: Forty-eight carers of patients with traumatic brain injury admitted to a neurosurgical unit over a 9-year period were assessed an average of 9.3 years after injury.; Measures: Caregiver Strain Index (CSI), Neurobehavioral Functioning Inventory (NFI), Glasgow Outcome Scale (GOS), Virginia Prediction Tree Score, and carer and patient demographics.; Procedure: Carers were assessed via postal survey for levels of strain using the CSI and for their perception of the patients' disabilities using the NFI.; Results: Elevated levels of strain were found in 42% of carers. Using logistic regression, outcome as rated by the patients' general practitioner on the GOS and all subscales of the NFI (except Somatic) explained 41% to 57% of the variance in strain and predicted group membership correctly in 72.9% of cases. No individual variable contributed significantly to the explained variance in the model.; Conclusion: A number of factors appear to combine to result in feelings of strain, but the GOS could be used as a crude screening tool. Interventions for cognitive, behavioral, and emotional difficulties may be most useful for carers.;
  • Reviews of Trauma and Spider

    Baker, Charley (2010)
    Reviews the books, Trauma by Patrick McGrath (2009) & Spider by Patrick McGrath (2002). Spider is narrated by an individual with schizophrenia, released into the community following the reduction in asylum beds, who experiences scant 'care' in the community and retreats back into the psychosis that saw him admitted to hospital originally. Taking the literary trope of the unreliable narrator to the extreme, this novel teaches us much about the fallibility of memory, the alteration of perspectives and memory with psychosis, and crucially the experience of a terrifying psychosis. Trauma is narrated by a psychiatrist, who slowly deteriorates psychologically following the death of his mother. The complexity of his personal relationships-with his brother, his ex-wife (with whom he beings having sex with again after his mother's funeral) and his daughter-are made further difficult by his burgeoning relationship with the strange, chaotic and damaged Nora, who he feels needs psychiatric treatment that he cannot provide. This is a multilayered tale-he attempted to treat his ex-wife's brother Danny for post-traumatic stress disorder, or PTSD following the Vietnam War, ending his relationship with his wife after finding Danny dead through suicide. This unresolved trauma begins to encroach upon his post-Mother's-death existence as he begins to re-examine his fractured memories of childhood. The text contains much on the clinical syndrome PTSD, but also on the trauma of life and loss en masse, the psychological effects of which can be far reaching in individuals who fail, because of semi-abusive childhoods, to develop necessary mental resources to cope. McGrath combines believable and understandable characters with mental health problems, empathy towards experiences and clinically recognizable syndromes and symptoms. His novels are not only enjoyable, but striking, emotive and serve as examples of material useful for medical education. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Vicarious traumatization: Implications for the mental health of health workers?

    Sabin-Farrell, Rachel (2003)
    It has been suggested that a unique feature of some mental heath practitioners' work is exposure through their role as therapists to clients' descriptions of and reactions to trauma, and that these experiences may actually indirectly cause distress and traumatization to the therapist. This proposed phenomenon has been termed "vicarious traumatization" (VT) and is the focus of the current review. The concept of VT, together with other related concepts such as "burnout," "compassion fatigue," "secondary traumatic stress" (STS), and "work stress" are appraised. Psychological mechanisms that might be theoretically involved in VT are considered. The measurement of VT is reviewed alongside the limited research evidence supporting its existence. Factors such as direct trauma exposure and the personal attributes of mental health workers, which have been suggested to be associated with VT, are also assessed. It is concluded that the evidence to support the existence of VT is meager and inconsistent. Future research needs to be directed at distinguishing VT from other sources of distress arising within the workplace. Finally, the organizational relevance of VT and its possible implications for the management of mental health workers are critically appraised.;

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