Psychological Distress, Professional Burnout, and Trauma in Palestinian Health Care Helpers: A Two-Wave Quantitative Longitudinal Study

Objective: The aim of this longitudinal study was to model the cumulative network of associations between trauma-related symptoms, professional burnout, and psychological distress in health care practitioners working in emergency settings. Method: The research was conducted with Palestinian health care helpers (N = 60) operating in Gaza and the West Bank. The study variables were evaluated via repeated quantitative self-report questionnaires collected in two waves and the associations among them were estimated using structural equation modeling, bootstrap methods, and Monte Carlo simulation. Results: The longitudinal structural model offered a good fit for the data (chi(2)(114) = 161.4, p = .02, NC = 1.42, nonnormed fit index [NNFI] = .950, comparative fit index [CFI] = .951, root mean square error of approximation [RMSEA] = .079), in support of the notion that trauma-related outcomes and professional burnout may be associated with mental health across different professional groups. Specifically, trauma-related symptoms wielded a direct effect on professional burnout (beta = .28) and psychological distress (beta = .11) at T0. Trauma-related symptoms were found to be more strongly associated with professional burnout (beta = .40) than with psychological distress (beta = .03) at T1. Conclusion: Emergency workers operating in an environment marked by instability and ongoing risk need to draw on sources of resistance and resilience to protect their mental health. We discuss both the clinical implications of these findings and future lines of inquiry. Clinical Impact Statement Palestinian health practitioners exposed to war and military violence are continuously exposed to stressful circumstances, with manifold repercussions in both the professional and the personal spheres. Our study illustrates the association between primary and secondary experiences of trauma and burnout symptoms and their impact on professional aid workers' psychological distress. We found that deteriorating work (and living) conditions place professional helpers at risk of emotional exhaustion and work withdrawal. Furthermore, experiencing burnout in a traumatic reality such as Palestine is a risk factor for workers' mental well-being. Our findings underline the importance of promoting health care workers' psychosocial functioning as an effective response to the consequences of war and military violence worldwide.