Predictors of Secondary Traumatic Stress Symptoms in Police Offi cers Exposed to Secondary Trauma

. Police officers are particularly exposed to work-related stress and one of the difficult situations they face is contact with trauma victims. Such exposure may entail a range of negative consequences for helpers, such as symptoms of secondary traumatic stress (STS) and risk of secondary traumatic stress disorder (STSD). The aim of this study is to establish the predictors of STS symptoms among police officers who have been exposed to secondary trauma in the line of duty. The following factors have been assessed as potential predictors: personality traits, rumination on their experiences, and a sense of self-efficacy in coping with trauma experienced by others. The research was carried out from June to October 2021 at the Police Academy in Szczytno, Poland, among participants of training and professional courses for police officers. Out of 790 surveyed officers, the results of 682 officers who reported direct contact with trauma victims were taken into account. Four standard measurement tools, i.e. the Secondary Traumatic Stress Inventory, The NEO Five-Factor Inventory, The Event Related Rumination Inventory, The Secondary Trauma Self-Efficacy Scale, were used, along with a survey developed for the purpose of the study. The participants demonstrated a relatively low risk of experiencing negative consequences of exposure to secondary trauma: a low risk of developing STSD was observed for 86.1% of the participants and a high risk was observed for 13.9%. The symptoms of STS were positively correlated with ruminations on the traumatic events experienced by clients, especially intrusive ones. Intrusive ruminations turned out to be the main predictor of STS. With regard to personality traits, STS was most closely associated with neuroticism. A sense of self-efficacy was negatively correlated with symptoms of STS. Although the study on police officers working with trauma victims showed rather low intensity of STS symptoms, it is advisable to expand their the competencies in coping with trauma, including reducing the tendency to ruminate on the traumatic events experienced by clients.


Introduction Secondary Traumatic Stress
Police officers experience a range of stressors in connection with their work. Conn and Butterfield propose a threefold classification for stressors. The first category, organisational stress, includes all types of nuisance resulting from the specifics of the job (e.g. shift work, preparation of appropriate documentation). The second Internal Security, January-June category includes cases that threaten the officer's sense of security as a result of traumatic experiences, such as PTSD (Post-Traumatic Stress Disorder). Finally, the third category is related to exposure to the traumatic experiences of other people, with the most common being accidents and violence; such indirect exposure to trauma can result in the development of secondary traumatic stress (STS) symptoms. 1 Although many studies examined the negative effects of direct experience of traumatic events among police officers, little research was devoted to their indirect exposure to trauma. Just like representatives of other professions confronted with victims of trauma (doctors, nurses, therapists, social workers), police officers may also be particularly susceptible to specific psychological costs, most often in the form of STS symptoms.
The term Secondary Traumatic Stress (STS) characterises a set of symptoms occurring in people having contact with other individuals who have directly experienced trauma. 2 The concept of STS was popularised by Figley, who described it as 'the stress of helping other people suffering from trauma'. 3 Helpers who engage in longterm contact with the victims of trauma, despite not having experienced trauma themselves, begin to view reality through their eyes; they also feel similar emotions and display similar reactions and behaviour. In some sense, they themselves become victims of trauma. In other words, the concept of STS is understood as a set of specific behavioural and emotional consequences that an individual experiences after confronting the trauma experienced by another human being. According to Figley, STS reflects PTSD, with the difference that, in the first case, it refers to people indirectly exposed to trauma. 4 The symptoms of STS (just like PTSD) fall into four categories: intrusion, avoidance, negative changes in the cognitions and/or mood, as well as increased arousal and reactivity. 5 Certain symptoms, such as recurring memories, insomnia or nightmares, can also occur in those exposed to secondary trauma. They may also avoid thoughts and situations related to past events, they may have negative beliefs about the world and themselves, and demonstrate excessive reactivity when recalling events experienced by clients. A high intensity of STS symptoms can lead to a disorder referred to as Secondary Traumatic Stress Disorder (STSD). This kind of stress can give rise to other symptoms relating to the emotional, cognitive and 1  Internal Security, January-June behavioural sphere, including a sense of fear, dread, helplessness, or symptoms of depression. 6 Other terms such as compassion fatigue and vicarious traumatisation are also used in relation to this issue. The concept of compassion fatigue as a condition comprising various cognitive, emotional and behavioural components was introduced by Figley as one affecting therapists and nurses. The first component is manifested as an excessive preoccupation with the trauma suffered by others, apathy and problems with concentration. 7 The emotional component includes loss of strength, guilt, sadness and anger, while the behavioural component includes excessive excitability, irritation or sleep problems. 8 Furthermore, Newell et al. portray compassion fatigue as a condition that arises before secondary traumatic stress. 9 In contrast, the term vicarious traumatisation (VT) was introduced to describe changes in the worldview of professionals as a result of their empathetic commitment to helping clients who experienced trauma. 10

Secondary Traumatic Stress among policemen
Most of the research conducted so far among policemen relates to the effects of direct exposure to traumatic events, i.e. PTSD. The available data shows that this syndrome was recognised in 8% of British and 15% of Swiss police officers. 11 However, few studies have examined the severity of symptoms of STS among policemen and even fewer have addressed the determinants of the presence of STS in this group.
While some evidence indicates that police officers experience less negative consequences from secondary exposure to trauma than the representatives of other professions 12 , Maran et al. suggest that police officers in fact experience higher levels of STS than health professionals. 13 A meta-analysis of research conducted 6 Bride B.E, Prevelance of secondary traumatic stress…, op. cit., pp. 63-70. 7  Internal Security, January-June among representatives of various emergency services (Greinacher et al.) found that STS occurred in 4-13% of respondents. 14 The degree of STS symptoms may vary according to the type of exposure to trauma experienced by police officers. A high level of STS is mainly seen among police officers dealing with problems associated with children; indeed, more than half of the respondents (51%) of a study conducted in Great Britain experienced symptoms of STS. 15 STS symptoms were also identified among South African officials dealing with domestic violence, child protection and sexual crimes. 16 Another study found that 70% of the studied police officers dealing with the problem of child abuse on the internet demonstrated STS symptoms. 17

Correlation of STS with personality, rumination and self-effi cacy
There are many factors that determine the development of PTSD and STS symptoms. These include environmental factors such as the type and level of exposure to trauma, workload and seniority or social support, as well as subjective variables, which include some personality traits, low self-efficacy in dealing with trauma and ruminations on traumatic experiences.
Many authors point out the importance of pre-traumatic susceptibility factors in the development of PTSD. 18 The conducted research on PTSD confirms the role of neuroticism as a factor contributing to the occurrence of the symptoms of this syndrome. 19 Neuroticism is also believed to play an important role in the development of the negative consequences of secondary exposure to trauma. People with high neuroticism tend to be more pessimistic, less able to deal with stress and less willing to seek social support. 20 A positive relationship between neuroticism and Internal Security, January-June STS was demonstrated among study participants involved in dealing with cases related to child abuse on the Internet. 21 Similarly, in surveys conducted among representatives of medical personnel in Romania, a positive correlation was established between neuroticism and dysfunctional beliefs, treated as an indicator of secondary traumatisation. 22 However, one of the most important factors influencing the severity of the negative effects of traumatic events experienced is the cognitive activity undertaken by the individual, most often expressed in the form of cognitive processing of trauma. One form of such processing is rumination on the event experienced. According to a cognitive model of PTSD developed by Ehlers and Clark, ruminations are understood as contemplation on the events experienced and their consequences (intrusive ruminations). They are regarded as a maladaptive style of cognitive processing of trauma and can contribute to the development of PTSD. 23 However, such cognitive processing may also include deliberate ruminations aimed at finding an effective way of dealing with a given situation. 24 This kind of rumination is of an adaptive nature and, as a rule, does not increase the severity of PTSD symptoms. Nevertheless, generally speaking, research conducted in this area indicates a positive correlation between ruminations, especially intrusive ones, and the development of PTSD. 25 The role of cognitive activity in the manifestation of negative consequences of secondary exposure to trauma is emphasised in the theoretical models developed for STS. The Ecological Framework of Trauma model developed by Dutton and Rubinstein emphasises cognitive coping strategies, treated as a form of cognitive processing of trauma, as well as personal and environmental factors. 26 Coping strategies are important because the goal of a coping mechanism is to manage the demands that the traumatic situation places on the individual. Another concept is McCann and Pearlman's Constructivist Theory of Self-development, which focuses on identifying changes and abnormalities in cognitive schemas that may be important for secondary trauma. 27 However, it should be emphasised that little research has been done in this area so far. A positive relationship was found 21 Tehrani N, Extraversion, neuroticism and secondary trauma in internet child abuse investigators. Occupational Medicine, 2016, Vol. 66, No. 5, pp. 403-407. 22 Mairean C, Turliuc M, Predictors of vicarious trauma beliefs among medical staff. Journal of Loss and Trauma, 2013, Vol. 18, No. 5, pp. 414-428. 23 Ehlers A, Clark D.M, A cognitive model of posttraumatic stress disorder. Behavioral Research and Therapy, 2000, Vol. 38, pp. 319-345. 24 Cann A, Calhoun L.G, Tedeschi R.G, Triplett K.N, Vishnevsky T, Lindstrom C.M, Assessing posttraumatic cognitive processes: the Event Related Rumination Inventory. Anxiety, Stress &Coping, 2011, Vol. 24, pp. 137-156. 25  Internal Security, January-June in a group of probation officers exposed to secondary trauma between the presence of STS symptoms and rumination on the traumatic events experienced by their clients. 28 A factor that seems to prevent the development of negative consequences of secondary exposure to trauma is self-efficacy. A sense of self-efficacy expresses the individual's belief about their own competences and the possibility of achieving the intended goal. 29 Self-efficacy was categorised as generalised and specific; the former is formed on the basis of life experiences and concerns the perception of oneself as a person with the competence to deal with different life situations, while the latter refers to specific situations. 30 Available studies indicate that selfefficacy negatively correlates with STS symptoms. 31

Materials and Methods
The purpose of the study was to establish the predictors of risk of STS among police officers after exposure to secondary trauma. The independent variables tested comprised personality traits, ruminations on the events experienced by clients and secondary trauma self-efficacy. Professional experience in helping people after traumatic events and the number of hours in a week devoted to working with trauma victims were indicators of secondary exposure to trauma. The controlled variables were the sex, age and police division of the respondents.
It was assumed that ruminations, especially intrusive ones, and neuroticism would be positively associated with the severity of STS symptoms, while extraversion, openness to experience, agreeableness, conscientiousness, and secondary trauma self-efficacy would be negatively associated. Based on the Ehlers and Clark PTSD model 32 , it may be supposed that the main predictor will be intrusive ruminations.
The research was conducted from June to October 2021 at the Police Academy in Szczytno (Poland). The project was specifically approved by the National Police 28 Ogińska-Bulik, N, Juczyński Z, Kiedy trauma innych staje się własną. Negatywne i pozytywne konsekwencje pomagania osobom po doświadczeniach traumatycznych. Warsaw: PWN, 2020, pp. 125-177. 29 Bandura A, Self-efficacy: Headquarters. The study involved 790 police officers, all of whom were university graduates who had taken postgraduate vocational training. These officers work in organisational units of the Police throughout Poland on a daily basis. The study was voluntary and anonymous.
In total, data was collected from 682 police officers (86.3% of the total sample) who worked directly with trauma victims and who fully completed the questionnaires provided to them. The participants represented three divisions of the police force: Uniformed Branch (n=200), Criminal Investigation (n=385) and Support Services (n=69); 28 people did not indicate affiliation to any police division. Their clients had experienced various types of traumatic events. The most common were various types of violence (n=443), death (n=336), accidents (n=201).
The group comprised 512 men and 157 women (13 people did not indicate their sex). The age of the participants ranged from 24 to 60 years (M=40.03, SD=4.41). The length of time working as a police officer assisting trauma victims ranged from 1 to 30 years (M=11.53, SD=5.42). The weekly number of hours devoted to helping trauma victims at work varied from 1 to 50 (M=10.89, SD=10.46).
The study employed a survey comprising questions about sex, age, police division, work experience as a police officer assisting trauma victims, and the weekly number of hours devoted to working with trauma victims. The last two variables were taken as an index of exposure to secondary trauma. In addition, the following three standard research tools were used: Secondary Traumatic Stress Inventory (STSI) is a modification of the Post-Traumatic Stress Disorder Checklist developed by Weathers et al. 33 The present study used the Polish adaptation by Ogińska-Bulik et al. 34 It is a self-report measure created for the purpose of monitoring, screening, and diagnosing individuals providing help to trauma survivors. It contains 20 items/reactions to traumatic situations which refer to symptoms of posttraumatic stress disorder ('Repeated, disturbing, and unwanted memories of the stressful experience'). The STSI includes four dimensions: intrusions, avoidance, negative alterations in cognition and mood, as well as alterations in arousal and reactivity. In line with the instructions provided, the participants indicated the level to which they experienced each symptom over the previous month in connection with the help they provided recipients. All answers are given on a 5-point scale from 0 ('not at all') to 4 ('extremely'). The Cronbach's alpha coefficient was 0.90 for the entire inventory with values of 0.71, 0.85, 0.89 and 0.87 for the four dimensions (Ogińska-Bulik, & Juczyński, 2020) 35 .
The NEO Five-Factor Inventory (NEO-FFI), developed by Costa and McRae 36 , was used in its Polish adaptation by Zawadzki et al. 37 to assess five personality 33  Internal Security, January-June dimensions: extraversion, neuroticism, openness to experience, conscientiousness and agreeableness. The tool consists of 60 items ('I am not a worrier') with responses given on a scale ranging from 1 (strongly disagree) to 5 (completely agree). The Cronbach's alpha coefficients for the inventory ranged from 0.60 to 0.82.
The Event Related Rumination Inventory (ERRI) developed by Cann et al. 38 was adapted to Polish conditions by Ogińska-Bulik and Juczyński. 39 The tool contains two subscales, each of which consists of 10 statements. The first concerns intrusive ruminations ('I thought about the event when I did not mean to') and the second includes deliberate (reflective) ruminations ('I thought about whether I could find meaning in my experience'). The scores are calculated independently for each subscale. The instructions for completing the scale were modified, asking participants to rate the ruminations in relation to events experienced by their clients. The Cronbach's alpha coefficient for the Polish version was 0.96 for intrusive ruminations and 0.92 for deliberate ruminations.
The Secondary Trauma Self-Efficacy (STSE) Scale was developed to evaluate the perceived ability to cope with the challenging demands resulting from working with traumatised clients and to deal with secondary traumatic stress symptoms. It also concerns the ability to control emotional and cognitive reactions related to indirect exposure to trauma. Seven items were included in the scale ('My capacity to deal with my emotions (anger, sadness, depression, anxiety) related to working with these people'). The responses were given on a 7-point Likert-like scale, ranging from 1 (very incapable) to 7 (very capable). The STSE Scale consists of a single factor and obtained good internal consistency, with a Cronbach's alpha score of 0.87. 40
Internal Security, January-June Table 1 . STS symptoms were not significantly associated with age (r=0.04) or the weekly number of hours devoted to working with trauma victims (r=0.06) but were correlated, although rather weakly, with work experience as a police officer assisting trauma victims (r=0.19, p<0.001).
The results presented in Table 2 indicate that symptoms of STS are positively correlated with four dimensions of personality: positively with neuroticism and negatively with extraversion, agreeableness and conscientiousness. The strongest correlation was found for neuroticism. STS is also positively associated with both types of ruminations, with a stronger relationship observed for intrusive ruminations. Self-efficacy is negatively related to STS and all of its criteria.
Four personality traits were included in the regression analysis, excluding openness to experiences, which did not correlate with STS. Similarly, due to the lack of any correlation, it did not include the weekly number of hours devoted to helping trauma victims. Overall, eight explanatory variables were included in the regression model. Of these, six entered the regression equation, of which four appeared to play a predictive role for STS. The results are presented in Table 2. Intrusive ruminations on the situations experienced by clients were found to be the main predictor of STS; this factor had the greatest influence on the variance of the general STSI result, explaining 45%. A higher toward intrusive rumination was associated with a higher intensity of STS symptoms. The remaining variables explained no more than 5% of the variance of the dependent variables. Almost all of them (except agreeableness) seem to favour the occurrence of STS. Neither secondary trauma self-efficacy nor work experience as a police officer assisting trauma victims played any predictive role for the negative consequences of secondary exposure to trauma.
Separate analyses were also carried out for the individual criteria of STS. The findings confirm that intrusive ruminations play an essential role in the occurrence of STS symptoms. Four predictors were revealed for Intrusion: intrusive ruminations (Beta=0.54; R 2 =0. 40

Discussion
Polish police officers working with trauma victims demonstrate a rather low intensity of secondary traumatic stress symptoms. The mean STS score for the policemen examined was lower than that obtained from a previous study on other professionals working with trauma survivors (using the same measurement tool), including therapists, social workers, probation officers, medical rescuers and nurses (M=24.14, SD=16.11). 42 Only 13.9% of policemen present a high risk of secondary trauma stress disorder (STSD) and most (86.1%) present a low risk. This data is largely consistent with results obtained in other countries 43 . It is also in line with previous research indicating a relatively low level of PTSD symptoms in policemen who were directly exposed to traumatic events. A meta-analysis of 28 studies collected from Asia, Europe and North America found that the prevalence of PTSD among representatives of the emergency services does not exceed 10% 44 . Police officers seem to show a greater 42 Ogińska-Bulik, N, Juczyński Z, Kiedy trauma innych..., op. cit., pp. 125-195. 43  ability to cope with the trauma experienced by others compared with representatives of other professionals exposed to secondary trauma, such as paramedics, social workers or probation officers 45 . It can be assumed that they are well-prepared for practising their profession.
Neither age, sex, police division nor weekly number of hours devoted to working directly with trauma victims were associated with STS symptoms. Only the years of experience working with trauma victims as a police officer correlated positively with negative consequences of secondary exposure to trauma.
STS symptoms correlated more strongly with ruminations, especially intrusive ones, than with personality traits and secondary trauma self-efficacy. Intrusive ruminations appeared to be the main predictor of STS and all its factors. The results confirm the significant role of cognitive trauma processing in the form of ruminations in the prevalence of STS symptoms and risk of STS. These results are also consistent with data indicating a positive relationship between ruminations and the symptoms of STS among other professionals working with victims of trauma, such as medical personnel 46 or probation officers 47 . They are also consistent, at least partly, with data obtained by other studies on various negative effects of experienced stress. 48 Ruminations may contribute to the maintenance of STS symptoms because abstract thinking resulting from traumatic experiences leads to the persistence of negative mood and arousal. Our findings confirm that specific methods of emotional regulation and coping with stress, mainly maladaptive ones, expressed as intrusive ruminations, may favour the development of adverse effects of indirect trauma exposure. Moreover, they indicate that the Ehlers and Clark model created for PTSD 49 can also be applied to secondary trauma. Personality traits and secondary trauma self-efficacy seem to play a minor role in the occurrence of STS symptoms. Among the dimensions of personality, neuroticism displays the strongest relationships with STS; this trait seems to predominantly favour negative changes in cognition and mood. Data indicates that police officers with a high level of neuroticism are more likely to experience the negative impact of secondary trauma exposure. Similarly, a positive relationship was also 45 Ogińska-Bulik, N, Juczyński Z, Kiedy trauma innych..., op. cit., pp. 125-195. 46  Internal Security, January-June demonstrated between STS and neuroticism among investigators dealing with the problem of online child abuse 50 and in medical personnel 51 .
A negative association was found between secondary trauma self-efficacy and STS, which is consistent with previous studies. 52 Secondary trauma self-efficacy was expected to play a stronger role as a factor preventing STS. Self-efficacy is regarded as a proximal determinant of health-related outcomes after a traumatic event. 53 However, our present findings did not confirm that it has a predictive role for STS, and neither did those of a previous study on a group of forensic interviewers from children's advocacy centers in the USA, in which only weak associations were found and only 1% of STS variance was explained by self-efficacy 54 .
In turn, Cieślak et al. found that self-efficacy, measured with the STSE Scale, explains 23%-39% of the variance in STS. These findings indicate that the role of self-efficacy in the occurrence of STS varies and that it may be influenced by the choice of study group. In the case of Cieslak et al., the participants were clinical psychologists, counselors and social workers providing services for a military population, whose work differed from that of police officers. 55 In the case of the policemen participating in the present study, it should be taken into account that helping trauma victims was only one of their many professional duties and that the time devoted to working with people who suffered traumatic experiences varied greatly. Moreover, it should not be forgotten that the police officers surveyed demonstrated a relatively low intensity of STS and such conditions do not require the involvement of secondary trauma self-efficacy.
It is also possible that in a group of police officers exposed to secondary trauma, a greater role in the occurrence of STS is played by generalised self-efficacy than secondary trauma self-efficacy, which measures beliefs about the ability to deal with barriers associated with secondary exposure to trauma. However, self-efficacy beliefs related to specific stressful situations should closely reflect the demands related to these situations. 56 Nevertheless, it should also be taken into account that the intensity of STS symptoms may influence self-efficacy in coping with secondary trauma, particularly since self-efficacy may fluctuate over time due to mastery experiences in environmental and intrapersonal challenges. 57 It is also possible that secondary trauma self-efficacy may promote positive post-traumatic changes, 50  expressed as secondary post-traumatic growth, rather than prevent the negative outcomes of secondary exposure to trauma. Indeed, a positive relationship was revealed between secondary trauma self-efficacy and secondary post-traumatic growth in a study on clinical psychologists, counselors and social workers providing services for a military population. 58 Generally, however, the above data indicate that the role of secondary trauma self-efficacy is ambiguous and requires further exploration. The present study does, however, have certain limitations. Due to its cross-sectional character, unequivocal conclusions cannot be drawn with regard to causality. In addition, the group of participants was not characterised by homogeneity: most were men and the group was dominated by police officers from the Criminal Division, with few representatives of the Support Services; furthermore, the participants were restricted to those receiving vocational training for university graduates. Moreover, the study did not attempt to make any association between STS symptoms in police officers and the type of traumatic event experienced by their clients, mostly because it was multiple events in most cases, nor did it examine the traumatic events experienced by police officers. It is possible that the relationship between ruminations, personality or secondary trauma self-efficacy and STS would differ depending on whether the police officers themselves experienced a trauma or not. It is important to emphasise that it is difficult to clearly separate the occurrence of PTSD symptoms from STS in this professional group.
Another important consideration is that ruminations are highly similar to intrusions: symptoms of both STS and PTSD. However, as indicated by Ehring and Ehlers, these concepts are not identical: 'intrusive memories are sensory experiences of short duration that represent the experience of the trauma itself, whereas rumination is described as a train of thoughts of longer duration that elaborate on the experience' 59 .
Despite the limitations given above, our findings provide new information regarding the predictors of adverse effects of exposure to secondary trauma in police officers. It is also important to highlight that little research has been carried out so far on police officers who experience secondary exposure to trauma and that the present study employed a new tool, the Secondary Traumatic Stress Inventory, which was developed according to the DSM-5 criteria.
The study may inspire further research addressing other factors determining the negative consequences of secondary exposure to trauma, including many different indexes of cognitive processing of trauma like disruption in core beliefs or personal resources; factors such as a sense of coherence, dispositional optimism or resiliency may protect police officers from these negative consequences. It would also be interesting to establish the role of social support both in and outside the work environment. Moreover, a longitudinal approach would be desirable in future studies to capture the changes in the intensity of the adverse effects of secondary trauma exposure over time. Future research should also consider the possibility of positive secondary post-traumatic changes, in the form of secondary/vicarious post-traumatic growth, which may coexist with STS symptoms.
Internal Security, January-June The conducted research may also have some practical implications, especially for the development of preventive activities aimed at reducing the symptoms of STS and lowering the risk of STSD among police officers exposed to secondary trauma. The importance of interventions directed against STS symptoms was underlined by Molnar et al. and Ogińska-Bulik and Juczyński. 60 Such interventions should include the development and fostering of self-efficacy to improve control over the environment and develop the competencies associated with coping with trauma, including reducing maladaptive ruminations and encouraging the use of more adaptive coping strategies, such as resolution, acceptance or positive cognitive restructuring. It is also desirable to encourage police officers to express negative emotions related to secondary trauma. Wider use of self-care practices (e.g., leisure time) may also be useful, particularly since they are a very popular method of providing support among police officers. 61

Conclusions
Police officers working with trauma victims are prone to develop STS symptoms. These symptoms are positively related to both types of ruminations, with a stronger relationship observed for intrusive ruminations. They are also associated with four traits from the Big Five personality model, with neuroticism showing a positive and stronger correlation than the other personality traits and ruminations. STS symptoms are also negatively correlated with secondary trauma self-efficacy. Intrusive ruminations serve as the main predictor of the occurrence of STS. It is important to include police officers working with trauma victims in the actions aimed at the prevention and reduction of STS symptoms and risk of STSD.