Extreme stress events in a forensic hospital setting: prevalence, impact, and protective factors in staff

Abstract

The current research explored the prevalence of stressful events in a forensic hospital setting, and
their impact on staff. A systematic review of the literature on responses following exposure to
extreme stress comprised 46 articles. This was followed by a Delphi study of professionals based
in a forensic hospital (n = 43) to explore views on the factors that affect responses to extreme
stress. This comprised three rounds to build consensus. Finally, a study of forensic hospital staff
was conducted (n = 153, 47% male) to capture current trauma symptoms. The systematic review
indicated three superordinate themes: outcomes adversely impacting staff and patients; personal
characteristics moderating the impact of events; and organisational and interpersonal support
moderating the impact of events. The Delphi supported these themes and noted the importance
of factors external to the workplace and internal factors, such as self-blame. The final study
demonstrated how a fifth of the workforce showed at least some trauma symptomology. Those
who experienced less burnout reported lower trauma symptoms, while staff who experienced
higher levels of secondary trauma at work reported higher levels of trauma symptoms. A higher
level of resilience was related to lower levels of trauma symptomology. Findings are discussed in
relation to the importance of recognising trauma in staff and implementing strategies to reduce
and/or buffer the impact of stress on wellbeing. In doing so, the research presents a new model
for consideration and development, the Impact and Amelioration of extreme stress events Model
(IA-Model).