Secondary Traumatic Stress: Prevalence in Humanitarian Aid Workers in India Siddharth Ashvin Shah, Elizabeth Garland, and Craig Katz to survivors’ stories of fear, pain, and suffering may develop deleterious emotional, cognitive, and physi- cal consequences (Carbonell & Figley, 1996; Collins & Long, 2003; Danieli, 1996; McCann & Pearlman, 1990; Salston & Figley, 2003). Workers like HAWs, who are not trained clinically but do this work in the course of duty and/or out of compassion, have not been studied adequately. The adverse psychological impact of working directly with people who have experienced trauma has been discussed in the nursing, emergency medicine, and psychotherapist literature (Alexander & Atcheson, 1998; Carson, Leary, de Villiers, Fagin, & Radmall, 1995; Hodgkinson & Stewart, 1991; Melchior, Bours, Schmitz, & Wittich, 1997; Wall et al., 1997). Whether it is disaster work in the field or clinical work in professional settings, the occupational hazards of such work may include episodes of nightmares, sleeplessness, hopelessness, and other forms of STS that appear to be linked to working with psychologi- cal trauma (Figley, 1995). The concept that trauma can occur indirectly is consistent with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) S everal occupations expose their practitioners to victimized individuals or traumatized com- munities. Primary traumatic stress is the term used for individuals who respond with intense fear or helplessness after experiencing a traumatic event firsthand. Secondary traumatic stress (STS) occurs as a result of indirect exposure to trauma through a firsthand account or narrative of a traumatic event (Zimering, Munroe, & Gulliver, 2003). For the pur- poses of this article, humanitarian aid workers (HAWs) are nonclinician employees or volunteers who may (a) ask details of or (b) provide care to those exposed to severe physical or psychological trauma. The pro- fessional literature shows that clinicians who listen Background: Humanitarian aid workers (HAWs) who aid traumatized populations experience emotional, cognitive, and physical consequences. This study documents the extent of secondary traumatic stress (STS) in a group of HAWs in Gujarat, India. Method: A standardized 17-item self-report questionnaire, the STS Scale, evaluated STS symptoms and severity in workers belonging to humanitarian organizations that provided psychosocial aid to traumatized people in India. Results: All the HAWs (N = 76) reported STS as a consequence of their work; 8% met criteria for posttraumatic stress disorder (PTSD). HAWs of lower socioeconomic status (SES) (p < .001) reported higher trauma scores compared with those of higher SES. Conclusion: Substantial STS exists among HAWs 5 months after widespread mass vio- lence. To bolster resilience appropriately, preventive measures must focus on the prevalent types of trau- matic stress in HAWs. Keywords: burnout; compassion fatigue; work stress; humanitarian aid worker self-care; occupational haz- ard; relief worker PTSD; secondary traumatic stress; vicarious traumatization From Psychosocial Assistance Without Borders and the Center for Integrative Medicine at George Washington University, Washington, DC (SAS); Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY (EG); Depart- ment of Psychiatry, Mount Sinai School of Medicine, New York, NY (CK). Address correspondence to: Siddharth Ashvin Shah, Center for Integrative Medicine, 908 New Hampshire Avenue, Suite 200, Washington, DC 20037; e-mail: pawb99@gmail.com. Traumatology Volume 13 Number 1 March 2007 59-70 ©2007 Sage Publications 10.1177/1534765607299910 http://tmt.sagepub.com hosted at http://online.sagepub.com 59