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Assessing the impact of ongoing national terror: social workers in Israel.

The main goal of this study was to explore the connections between social workers' personal and professional exposure to national terror in Israel and their professional and personal distress experienced due to ongoing terror attacks. Data were collected from 406 social workers from Israel who worked in agencies that provide help to victims of terror and their families. The social workers reported low levels of burnout, low levels of stress, and medium- high levels of intrusive memories. Levels of personal and professional exposure were not associated with burnout, intrusive memories, or stress level. However, professional distress (burnout and intrusive memories) was positively associated with personal distress. In addition, a two-step hierarchical regression was conducted, revealing that when burnout and intrusive memories were added to the regression equation, the explained variance of the stress level increased. Neither burnout nor intrusive memories were found to be significant mediators between the independent variables and personal stress level, except in one case. Although the social workers coped relatively well with ongoing terror, it was clear that professional distress was associated with their personal stress.

KEY WORDS: burnout; national terror; resilience; social workers; stress

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The present study focused on the impact of ongoing national terror on social workers in Israel providing help to terror victims, their families, and communities. Living under the threat and horror of national terror attacks has been part of Israelis' daily experience in recent years, especially between 2000 and 2004, a period known as the "Second Intifada" (the Palestinian Uprising). The reality of national terror attacks in Israel places social workers on the frontline at three types of agencies: (1) municipal social service departments, where their tasks are to assist families searching for missing loved ones following a terror attack, accompany them to the morgue, make funeral arrangements, and offer crisis intervention to individuals, families, and communities; (2) hospital social service departments, where their tasks include informing families about injured relatives and intervening with the injured and their families during hospitalization; and (3) the National Insurance Institute, where they engage with a victim's family several days after injury or a funeral and offer long-term intervention, including supportive treatment and case management tailored to rehabilitation process requirements.

Due to the continuous threat of national terror, most of the agencies have already developed organized operational procedures for such situations. Attention is also paid to the impact of these tasks on social workers. However, existing knowledge fails to address several main issues: What happens to social workers who intervene in an ongoing situation of terror attacks? What happens to those who have the same reality as their clients? How does the penetration of terror into the supposedly safe setting of psychosocial intervention affect social workers' professional roles and personal stress levels? Thus, the main goal of this study was to explore the connections between social workers' professional and personal exposure to national terror and the professional and personal distress they experienced due to ongoing terror attacks.

IMPACT OF TERROR

National terror is defined as an act or threat of violence against noncombatants that has the objective of exacting revenge, intimidating, or otherwise influencing an audience (Primoratz, 1990; Stern, 1999). This definition highlights the two main elements that distinguish terrorism from other forms of violence: First, it is aimed at noncombatants and, therefore, differs from conventional military action; second, it uses violence for dramatic purposes, usually to instill fear in a targeted population.

Studies of direct victims of national terror attacks confirm that these individuals are at high risk of suffering from a distress reaction. Distress symptoms include generalized fear and anxiety, recurring thoughts about the attack, avoidant behavior, physiological symptoms, depression, daily functioning problems, and difficulties in relating to and trusting others. Such distress reactions can result in varying severity levels of posttraumatic stress disorder (PTSD).

One of the main predicting factors of these physical and psychological responses is the level of exposure to the terror attack. Level of exposure refers both to direct exposure--ranging from being injured in an attack to being within physical proximity of the event to being close to someone who was killed or injured--and indirect exposure, which refers to living under the threat of terror attacks and affects the entire population of Israel. If it is accepted that any relationship with a victim constitutes a type of exposure, it is reasonable to assume that social workers intervening with terror attack victims, their families, and communities are placed at high risk of experiencing some of the described symptoms. These, in turn, may lead to burnout (Maslach, 1982) or secondary traumatic stress (R. E. Adams, Figley, & Boscarino, 2008; Figley, 1995a, 1995b).

BURNOUT AND SECONDARY TRAUMATIC STRESS IN SOCIAL WORK PRACTICE

Burnout is defined as "a state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that fails to produce the expected rewards" (Freudenberger & Richelson, 1980, p. 13). In general, burnout has been equated with alienation, depression, anxiety, loss of idealism, and loss of hope in response to stress (Maslach, 1982; Soderfeldt, Soderfeldt, & Warg, 1995). Social work is a helping profession with above-average risk of practitioner burnout, being very much client oriented and involving workers in complex social situations (K. B. Adams, Matto, & Harrington, 2001; Jayaratne & Chess, 1984). This article describes a unique phenomenon of burnout at work--one in which daily life, in and of itself, can increase the probability of personal and professional burnout.

The consequences of indirect knowledge of a traumatic event, acquired by helping someone close who experienced the trauma directly, have been widely discussed in the last two decades. Several names have been applied to these phenomena: "secondary traumatic stress" or "compassion fatigue" (Figley, 1988, 1995a), "vicarious traumatization" (McCann & Pearlman, 1990), and "traumatic countertransference." However, they are all very similar. In the present study, we use the term secondary traumatic stress (STSD), as defined by Figley (1988, 1995a), according to whom STSD symptoms are identical to those of PTSD (American Psychiatric Association, 1994). The difference between the syndromes lies in the exposure to the traumatic event: PTSD is a result of direct exposure, whereas STSD is an indirect effect of empathic care provided to a traumatized person.

Studies of secondary traumatization provide knowledge of specific variables regarding STSD development, such as a worker's caseload, personal and professional experience, and exclusive exposure to traumatized clients (Ghahramanlou & Brodbeck, 2000; Hyman, 2001; Myers & Wee, 2002). However, there is a paucity of knowledge of situations in which the trauma is not limited to one discrete event, but consists of a repeated experience over months or years or of situations in which social workers and clients live with the same threats and dangers.

Although some researchers claim that STSD represents a phenomenon distinct from burnout (R. E. Adams et al., 2008; Arvay, 2001), both constructs encompass several similar symptoms (K. B. Adams et al., 2001; R. E. Adams et al., 2008) and are often described as outcomes of stress experienced by helping professionals. Yet the similarities and differences between STSD and burnout have scarcely been specified, and the particular conditions leading to each syndrome have not been identified (Butollo, 1996; Kushnir & Melamed, 1992;Vicary & Searle, 2000). R. E. Adams et al. (2008) suggested the concept of compassion fatigue as a construct of both STSD and burnout. In the present study, we focused on the main STSD symptom--intrusive memories of thoughts, voices, or images that might occur during waking hours as well as in dreams.

COPING WITH NATIONAL TERROR

Different studies have emphasized personal and social variables that are often related to personal and social resources used when coping with stress, including hardiness (Kobasa, Maddi, & Kahn, 1982), sense of coherence (Antonovski, 1991), and social support (Kessler, Price, & Wortman, 1985). These resources are considered to be components of resilience. In this study, the sense of coherence concept (Antonovski, 1991) was used to explore personal resilience manifest in the coping process. Sense of coherence is based on the salutogenic approach (Antonovski, 1991) and complements the philosophy of social work, which focuses on human strength rather than on pathology (Saleebey, 1992).

As a social resource, social support has been found to be a buffer to stress in general (Kessler et. al., 1985; Thoits, 1995) and specifically to burnout (Carney et al., 1993; Leiter & Harvie, 1996; Ross, Altmaier, & Russel, 1989) and secondary traumatization (Follette, Polusny, & Milbeck, 1994; Munroe, 1991). Social support can be of a general nature, provided for any person by significant others, or it can be more specific, provided for social workers regarding their specific activities, by supervisors and peers in the workplace or significant others outside the workplace.

RESEARCH QUESTIONS

On the basis of existing knowledge, we formulated the following two research questions: (1) What is the contribution of each exposure level and coping variable on burnout, intrusive memories, and stress level? We were specifically interested in finding out whether personal variables (personal exposure to national terror, resilience, and general social support) and professional variables (exposure to national terror at work, years of professional practicing, support for professional activities with victims of terror, and relevant training) make different contributions to Israeli social workers' professional and personal distress (burnout, intrusive memories, and stress level). (2) What is the contribution of each of the professional distress variables (burnout and intrusive memories) to the personal distress level (level of stress) of social workers in Israel?

METHOD

Sampling

The sample included 406 social workers from all over the state of Israel, employed in frameworks that, among other services, provide assistance for terror victims and their families (4.23% of entire list of active social workers in Israel during 2004) (see http://www.knesset.gov.il/mmm/data/docs/ m02054.doc). After obtaining permission to conduct the study from the Israel Ministry of Social Affairs, the National Insurance Institute, and the Ministry of Health, we randomly chose specific departments from all over the country, from areas both with and without a history of terror incidents. This process yielded 19 municipal social service departments (out of 264 departments in the entire country), 11 National Insurance Institute social service departments (out of 19 services), and eight hospital social service departments (out of 23 general hospitals in the entire country).The choice of departments from each type of service depended also on the number of workers in each workplace. We directly contacted each of the directors of the services sampled, explained the study aim, and requested their cooperation in distributing questionnaires to their staff. Most of the directors viewed the study as an additional workload that would interfere with the daily routine of their service. However, they agreed to inform their staff about the study and to forward the questionnaires. The questionnaires were sent by mail to each of the services, and the sealed envelopes were collected by secretaries, who mailed them back to us. Of the total 950 questionnaires sent, 415 (44%) were returned. Nine questionnaires were not included in the final sample due to missing data. The relatively low response rate to the questionnaire can be attributed to agencies that had very little or no experience working with victims of terror; the topic might have seemed irrelevant to the workers in these agencies, leading them to he less willing to invest time in completing the questionnaire. Data collection was performed between August 2003 and February 2004. The study was conducted according to the rules of the University of Haifa Ethics Committee and was authorized by the Israel Science Foundation.

A majority (58.4%) of the participants in this study worked in municipal social service departments, 24.1% worked in the National Insurance Institute, and 17.5% worked in hospitals. Most participants were women (91.5%), married (78.3%), and had children (79.8%). Their average age was 45.50 years (SD = 1.12), and their average years of professional practicing as social workers was 15.01 (SD = 1.20). The demographic characteristics (gender, age, marital status, and years in the field) of the sample represent the general population of social workers (see http://www.knesset.gov.il/mmm/data/docs/ m02054.doc).

Instruments

Personal Exposure to National Terror. This was measured by three questions: (1) "Have you ever been hurt during a terror attack?" (2) "Have you witnessed a terror attack, without being physically injured?" and (3) "Do you have family members or close friends who were hurt during a terror attack?" Response categories were dichotomous: yes or no. Three personal exposure levels were calculated on the basis of participants' direct or indirect exposure to terror attacks: Level 2 was allocated to participants who had been injured in or had witnessed a terror attack; level 1 was allocated to participants whose significant other (family member or friend) had been hurt during a terror attack; and level 0 was allocated to participants who had not been exposed to a terror attack, either directly or indirectly.

Exposure to National Terror at Work. This was measured using this question: "Have you professionally intervened with terror victims or their family members?" Participants who had no previous professional contact with terror victims and their families received a score of 0, and those who did have such contacts received a score of 1.

Personal Resilience. This was measured using the Sense of Coherence Scale (Antonovski, 1993). The scale includes 13 semantic differential items rated on a seven-point scale, ranging from 1 = low level and 7 = high level. The internal reliability was obtained by Cronbach's alpha coefficient, with high values ranging from .84 to .93. In the present study, Cronbach's alpha was .88.

Social Support. This was measured using the Multidimensional Scale of Perceived Social Support (Zimmet, Dahhn, Zimmet, & Farley, 1988), as translated into Hebrew and validated by Statman (1995). The scale consists of 12 items rated on a seven-point Likert-type scale, ranging from I = fully do not agree to 7 = fully agree. Internal reliability, established by using Cronbach's alpha coefficient for the scale, was .88. In the present study, Cronbach's alpha was .95.

Professional Experience. This was measured by the number of years practicing as a professional social worker.

Relevant Training. Participants were asked to rate the adequacy of specific terror-related training they had received within their agencies on a five-point Likert-type scale, ranging from 1 = no training at all to 5 = suitable training (as perceived by the workers as fitting the requirements for intervention with terror victims).

Support for Professional Activities with Victims of Terror. The scale consisted of five items rated on a five-point Likert-type scale ranging from 1 = received no support to 5 = received a lot of support. The items were used to measure the participants' perceptions regarding the support they received from colleagues, directors and supervisors, family, friends, and Israeli society for professional activities with victims of terror. The scale was developed for the present study, and Cronbach's alpha for its five items was .79.

Burnout. This was measured by the Hebrew version (Etzion, 2000) of the Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1981, 1986). The inventory includes 25 items rated on a seven-point Likert-type scale, ranging from 0 = not at all to 6 = always, divided into three subscales: emotional exhaustion, depersonalization, and personal accomplishment. The internal reliability for the entire translated inventory as estimated by Cronbach's alpha coefficient was .80 (Etzion, 2000). In the present study, the Cronbach's alpha was .84. Because of the high Cronbach's alpha of the entire instrument, we used its means and standard deviations for the statistical analysis.

Intrusive Memories. We had originally intended to measure secondary traumatization. However, the instruments that measured stress level (the Brief Symptom Inventory [BSI]) and burnout (MBI) contain many items that are included in the Compassion Fatigue Self-Test (Figley, 1995b). Therefore, we added one item that specifically addressed one of the main symptoms that characterizes STSD and focuses on flashbacks and intrusive memories: "The work with terror victims never ends. Either the memories, the voices and/or images that the client talks about keep running through my head when I am awake and/or in my dreams." Responses were rated on a five-point Likert-type scale, ranging from 1 = never to 5 = very frequently. We refer to this variable as "intrusive memories."

Level of Personal Stress. This was measured by the Hebrew version (Gilbar & Ben-Zur, 2002) of the BSI (Derogatis & Spencer, 1982). This instrument is a self-report symptom scale designed to measure levels of psychopathology resulting from stress. The inventory consists of 53 items measuring nine symptom subscales, with each item rated on a five-point Likert-type scale, ranging from 0 = not at all to 4 = very much. In the present study, only three subscales were used: anxiety, depression, and somatization. Both the validity and the reliability of the BSI have been established in various studies (Derogatis & Savitz, 1999). In the present study, Cronbach's alpha was .89 for the entire instrument. Due to the high Cronbach's alpha of the entire instrument, we used its means and standard deviations for the statistical analysis.

RESULTS

The means and standard deviations of the studied variables are presented in Table 1. Participants reported a low level of burnout, a medium-high level of intrusive memories, and a low level of personal stress--scores are similar to those obtained from the entire Israeli population (Gilbar & Ben-Zur, 2002). Results indicated high levels of resilience and perceived social support among the study participants.

Because one focus of our study was assessment of whether personal and professional variables contribute to professional and personal distress (burnout, intrusive memories, and stress level), we first examined the associations between these variables (see Table 2). It is important to note that all the significant associations ranged between low (. 11) to medium (.55) intensity levels. In contrast to our assumption, intrusive memories were significantly associated only with the variable denoting support for professional activities with victims of terror. Surprisingly, personal stress level was associated with none of the professional variables except relevant training.

In the second stage of analysis, we conducted three models of linear regression for each of the dependent variables (burnout, intrusive memories, and stress level) (see Table 3). All three models were statistically significant. The independent variables explained 33.2% of the burnout, 5.7% of the intrusive memories, and 22.5% of the stress level. An interesting finding of this study was that professional exposure was not significant in the explanation of each of the dependent variables, and personal exposure was significant only in explaining burnout.

To answer our question regarding contribution of burnout and intrusive memories resulting from ongoing work with victims of terror to personal distress, we conducted three models of two-step hierarchical regressions. In the first step, all the independent variables were entered into the regression equation in all three models. The second step was different for each of the models: In the first model, burnout was entered into the regression equation; in the second, intrusive memories was entered; and in the third, both burnout and intrusive memories were entered (see Table 4).

All three models were statistically significant. Burnout added 33.0% to the explained variance of the personal stress level; intrusive memories added 21.2%; and when both were entered, burnout added 31.1% and intrusive memories 18.8%. However, it is noticeable that although the change in F in the second step of all three models was statistically significant, it made only a relatively low additional contribution to the explained variance of the personal stress level (3.7% in adding burnout, 6.9% in adding intrusive memories, and 9.7% in adding both variables).Yet it is possible to see that adding burnout and intrusive memories separately and together resulted in some decrease in the values of the regression coefficient of almost all independent variables. Thus, it is possible to assume that burnout and intrusive memories mediate, to some extent, between the personal and professional independent variables and personal stress level.

To test the mediation assumption, we used the Aroian version of the Sobel test (Baron & Kenny, 1986). The results indicated that only intrusive memories significantly mediated between support for professional activities with terror victims and personal stress levels (z = 2.513, p < .001). Thus, in spite of the contribution of burnout and both burnout and intrusive memories to the explained variance of the personal stress level, they cannot be considered as mediators or partial mediators between the independent variables and personal stress level.

DISCUSSION

The results of this study show that social workers, in the context of personal and professional exposure to terror, reported low levels of personal stress, low levels of burnout, and medium levels of intrusive memories. They also reveal that level of professional distress (burnout and intrusive memories) is associated with level of personal distress (level of stress). These results are similar to those of R. E. Adams et al. (2008). Although these studies used different measurement instruments, both showed that social workers who were exposed to terror victims did not report burnout, but did report STSD symptoms (intrusive memories, in our case). Both studies found an association between professional and personal distress.

Unlike ours, some studies have claimed that working with traumatized clients often increases personal stress level, manifesting as STSD symptoms or burnout (Arvay, 2001; Figley, 1995a, 1995b; Freudenberger & Kichelson, 1980; Hyman, 2001; Lind, 2000; Pearlman & MacIan, 1995). Studies of social workers in Israel have produced mixed results. Dekel, Hantman, Ginzburg, and Solomon (2006) focused exclusively on hospital social workers and produced findings similar to those of the current study. They found that social workers reported lower levels of psychological distress than was the norm among the general population and a medium mean level of STSD. Another qualitative study that focused on hospital social workers (Somer, Buchhinder, Peled-Avram, & Ben-Yizhack, 2004) found that workers reported relatively high stress levels as a result of intervention with terror victims and their families.

The difference in findings between the present study and many others could be explained by the study context and by some methodological limitations. The high degree of resilience demonstrated by the workers we studied typifies Israeli society as a whole and its general coping with the high rate of terror attacks during the Second Intifada (Lavee, 2004; Tuval-Mashiach & Shalev, 2005). Therefore, this resilience among social workers can be attributed not only to personal and professional variables, but also to the social variable of being part of a resilient society with a high rate of exposure to terror. In light of this, we can assume that no real difference exists between the overall social worker population and those working with terror victims and their families. General exposure to terror is very high in Israel, as it is a very small country with a close-knit population. Hence, news of a national terrorist attack travels fast and affects everyone, either directly or indirectly. The immediacy and intensity of exposure creates an atmosphere of angst that engulfs the entire population, and almost no one remains detached. It could be that the absence of a clear-cut distinction between personal and professional levels of exposure made it difficult to find a genuine control group of social workers who had neither personally nor professionally been exposed to national terror. This somewhat artificial grouping was apparently out of line with reality.

The lack of difference between exposure levels may also have been due to the time lapse between the most recent terror attack in which the workers intervened and their completion of the questionnaires. During this time lapse, the social workers may have developed a functional defense mechanism of denial that allowed them to cope by continuing their regular daily activities following the attack (Shamai & Ron, 2009). Some said that they would have been unable to complete the questionnaire had they received it soon after an attack. This raises the question as to whether the present study findings might have been different if the data had been collected closer to the actual event.

It can be hypothesized that the high levels of personal resilience, social support, specific support for the professional activities with terror victims, and relevant training counterbalanced the stress effects of exposure to working with victims and their families (Jayaratne & Chess, 1984; Ross et al., 1989; Soderfeldt et al., 1995). However, the only coping variable found to contribute to the personal and professional distress levels (manifest in burnout and stress level) was personal resilience. Social support in general was found to have no association with burnout, intrusive memories, or personal stress level, as in R. E. Adams et al. (2008). Specific support for professional activities with victims of terror was associated with intrusive memories and personal stress level. Nonetheless, the unexpectedly positive direction of these associations needs to be explained. It could be that the workers who experienced intrusive memories to a large degree were those who sought and received more support for their activities. Feedback for social workers can be conveyed in the form of recognition. It acknowledges their activities with terror victims, as well as the pain and other feelings that may subsequently arise, and is one of the basic elements in treating helping professionals working with traumatized clients (Valent, 2002). It seems that the social workers were informed about the importance of their training and were able to request and receive recognition from colleagues, supervisors, and directors. In many cases, family members and friends provided recognition by expressing appreciation for the social workers' intervention with victims and their families.

The lack of association between resilience and intrusive memories also needs to be explained. It is noteworthy that R. E. Adams et al. (2008) found no associations between sense of mastery and secondary traumatization. Although the variables were not identical, they measured a similar phenomenon. On the basis of these two studies and a qualitative study that explored the experience of social workers in ongoing terror situations (Shamai & Ron, 2009), it seems that further knowledge is needed to broaden our understanding of the intrusive memories and secondary traumatization phenomenon. According to the findings of Shamai and Ron, the workers experienced high levels of intrusive memories during the three or four days following the terror attack. These memories then subsided, as apparently happened with the majority of the Israeli population. However, in the quantitative results, the social workers reported a medium level of intrusive memories, even several months after their last interventions with terror victims. One could ask whether the workers perceived some of the symptoms as signs of empathy and commitment to their clients rather than as something pathological.

The result showing a medium level of intrusive memories compared with the low level of burnout raises an additional question: Could it be that intervention with terror victims breaks social workers' daily routine and, therefore, counterbalances the risk of burnout, which may indirectly increase the risk of intrusive memories?

The limitations of this study relate to the relatively low percentage of responses (44%), the time lapse between the last terror-related intervention and the date of completing the questionnaire, and the question of the measurement instruments' sensitivity in identifying small differences among fairly homogeneous groups. In spite of these limitations, however, it is possible to conclude that social workers in Israel cope with and adjust successfully to the traumatic situation of ongoing national terror attacks on both the professional and the personal level. It is also clear that professional distress contributes to personal distress.

Therefore, this study supports the continuation of specific training for social workers regarding intervention with terror victims, which should relate also to personal aspects (Shamai, 1998, 2003). In addition, directors and supervisors should be trained to provide special support to workers during and after intervention with victims, and they should also receive acknowledgment for this support. Still, the similarities and differences between studies on the impact of working and living in a shared situation under a threat of terror call for further investigation, taking into account the meaning that social workers ascribe to the different aspects of professional and personal distress created by this threat and the impact of culture and context in responding to and helping traumatized clients.

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Pnina Ron, PhD, is senior lecturer, and Michal Shamai, PhD, is associate professor, School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. This study was sponsored by the Israel Science Foundation. Address correspondence to Pnina Ron, School of Social Work, University of Haifa, Haifa, 31905, Israel; e-mail: pitzyron@ research.haifa.ac.il.

Original manuscript received September 23, 2008

Final revision received July 29, 2009

Accepted November 18, 2009
Table 1: Means and Standard
Deviations of Independent and
Dependent Variables (N = 406)

Variable M SD

Professional exposure (0-1) (a) 84 0.37
Years of professional practice 15.01 1.20
Support for professional activities (1-5) (b) 4.05 0.76
Relevant training (1-5) (c) 3.10 1.17
Personal exposure (0-2) (d) 0.35 0.63
Social support (1-7) (e) 6.11 0.92
Resilience (1-7) (f) 5.12 0.58
Burnout (1-7) (g) 1.82 0.60
Intrusive memories (1-5) (h) 3.70 1.09
Personal stress (0-4) (i) 0.79 0.52

(a) 0 = no previous professional contact with terror victims
and their families, 1 = previous professional contact with
terror victims and their families.

(b) 1 = received no support, 5 = received a lot of support.

(c) 1 = no training at all, 5 = suitable training.

(d) 0 = no exposure to terrorist attack, 2 = injury in or
witness of terrorist attack.

(e) 1 = fully don't agree, 7 = fully agree.

(f) 1 symbolizes low level, 7 symbolizes high level.

(g) 0 = never, 6 = always.

(h) 1 = never, 5 = very frequently.

(i) 0 = not at all, 4 = very much.

Table 2: Matrix of Pearson Correlations between Studied Variables

Variable 1 2 3 4

1. Professional exposure -- .11 * -.04 .21 ***
2. Years of professional practice -- .18 *** .40 ***
3. Support for professional activities -- .32 ***
4. Relevant training --
5. Personal exposure
6. Social support
7. Resilience
8. Burnout
9. Intrusive memories
10. Personal stress

Variable 5 6 7

1. Professional exposure .10 .00 .01
2. Years of professional practice .09 .02 .21 ***
3. Support for professional activities .06 .22 *** .25 ***
4. Relevant training .06 .15 ** .20 ***
5. Personal exposure -- .04 -.04
6. Social support -- .51 ***
7. Resilience --
8. Burnout
9. Intrusive memories
10. Personal stress

Variable 8 9 10

1. Professional exposure .01 .01 .04
2. Years of professional practice -.14 ** .01 -.03
3. Support for professional activities -.17 *** .22 *** .00
4. Relevant training -.18 *** .05 -.1 3 **
5. Personal exposure .07 .05 .03
6. Social support -.30 *** -.01 -.21 ***
7. Resilience -.55 *** .02 -.43 ***
8. Burnout -- .08 .44 ***
9. Intrusive memories -- .21 ***
10. Personal stress --

** p < .01. **** p < .001.

Table 3: Linear Regression Predicting Burnout, Intrusive Memories and
Level of Stress

 Burnout

Independent Variable B SE [beta]

Professional exposure .004 .098 .002
Years of professional practice .012 .026 .63
Support for professional activities -.006 .039 -.116
Relevant training -.063 .028 -.116 *
Personal exposure .088 .044 .091 *
Social support -.005 .035 -.008
Resilience -.575 .057 -.542 ***

F 23.94 *** (df=7,341)
[R.sup.2] .332

 Intrusive Memories

Independent Variable B SE [beta]

Professional exposure .167 .211 .043
Years of professional practice .012 .054 .014
Support for professional activities .343 .084 .238 ***
Relevant training -.036 .058 -.038
Personal exposure .083 .092 .049
Social support -.080 .073 -.069
Resilience -.017 .119 -.009

F 2.892 ** (df=7, 338)
[R.sup.2] .057

 Level of Stress

Independent Variable B SE [beta]

Professional exposure .035 .090 .019
Years of professional practice .049 .023 .117 *
Support for professional activities .097 .036 .145 **
Relevant training -.056 .025 -.128 *
Personal exposure .069 .039 .087
Social support -.006 .031 .012
Resilience -.393 .050 -.455 ***

F 14.144 *** (df=7,341)
[R.sup.2] .225

* p < .05 ** p < .01 *** p < .001.

Table 4: Two-Step Hierarchical Regressions of Personal and
Professional Variables Assessing Effects of Burnout and Intrusive
Memories on Stress Level

 Step 1

Variable B SE [beta]

 First model

Professional exposure .035 .090 .019
Years of professional practice .049 .023 .117 *
Support for professional activities .097 .036 .145 **
Relevant training -.56 .025 -.128 *
Personal exposure .069 .039 .087
Social support -.006 .031 -.012
Resilience -.393 .050 -.455 ***
Burnout#

F 14.144 *** (df= 7,338)
[DELTA]F
[R.sup.2] .225
[DELTA][R.sup.2]

 Second model

Professional exposure .035 .090 .019
Years of professional practice .049 .023 .117 *
Support for professional activities .097 .036 .145 **
Relevant training -.56 .025 -.128 *
Personal exposure .069 .039 .087
Social support -.006 .031 -.012
Resilience -.393 .050 -.455 ***
Intrusive memories#

F 14.144 *** (df=7,338)
[DELTA]F
[R.sup.2] .225
[DELTA][R.sup.2]


 Third model

Professional exposure .035 .090 .019
Years of professional practice .049 .023 .117 *
Support for professional activities .097 .036 .145 **
Relevant training -.56 .025 -.128 *
Personal exposure .069 .039 .087
Social support -.006 .031 -.012
Resilience -.393 .050 -.455 ***
Burnout#
Intrusive memories#

F 14.144 *** (df= 7,338)
[DELTA]F
[R.sup.2] .225
[DELTA][R.sup.2]

 Step 2

Variable B SE [beta]

 First model

Professional exposure .028 .083 .016
Years of professional practice .044 .022 .106 *
Support for professional activities .100 .033 .154 **
Relevant training -.039 .024 -.088
Personal exposure .044 .037 .056
Social support -.007 .029 -.012
Resilience -.238 .055 -.276 ***
Burnout# .268 .046 .330 ***

F 17.714 *** (df= 9,336)
[DELTA]F 23.937 *** (df= 2,336)
[R.sup.2] .294
[DELTA][R.sup.2] .069

 Second model

Professional exposure .019 .087 .010
Years of professional practice .048 .022 .114 *
Support for professional activities .063 .036 .094
Relevant training -.053 .024 -.120 *
Personal exposure .061 .038 .077
Social support .001 .030 .003
Resilience -.391 .049 -.453 ***
Intrusive memories# .099 .023 .212 ***

F 14.923 *** (df=8,337)
[DELTA]F 16.626 *** (df= 1,337)
[R.sup.2] .262
[DELTA][R.sup.2] .037

 Third model

Professional exposure -.016 .084 .009
Years of professional practice .044 .022 .106 *
Support for professional activities .071 .034 .106 *
Relevant training -.038 .023 -.085
Personal exposure .041 .037 .051
Social support -.000 .029 .000
Resilience -.244 .054 -.283 ***
Burnout# .254 .045 .311 ***
Intrusive memories# .087 .022 .188 ***

F 17.031 *** (df= 9,336)
[DELTA]F 23.937 *** (df= 9,336)
[R.sup.2] .322
[DELTA][R.sup.2] .097

Note: Boldface indicates that the variable was entered in step 2.
* p < .05. ** p < .01. *** p < .001.

Note: Boldface is indicated with #.
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Author:Ron, Pnina; Shamai, Michal
Publication:Social Work Research
Article Type:Report
Geographic Code:7ISRA
Date:Mar 1, 2011
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