Journal of Traumatic Stress April 2015, 28, 83–91 Meta-Analysis of Risk Factors for Secondary Traumatic Stress in Therapeutic Work With Trauma Victims Jennifer M. Hensel, 1,2,3 Carlos Ruiz, 1 Caitlin Finney, 1 and Carolyn S. Dewa 1,2 1 Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada 2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada 3 Department of Psychiatry at Women’s College Hospital, Toronto, Ontario, Canada Revisions to the posttraumatic stress disorder (PTSD) diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) clarify that secondary exposure can lead to the development of impairing symptoms requiring treatment. Historically known as secondary traumatic stress (STS), this reaction occurs through repeatedly hearing the details of traumatic events experienced by others. Professionals who work therapeutically with trauma victims may be at particular risk for this exposure. This meta-analysis of 38 published studies examines 17 risk factors for STS among professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Small significant effect sizes were found for trauma caseload volume (r = .16), caseload frequency (r = .12), caseload ratio (r = .19), and having a personal trauma history (r = .19). Small negative effect sizes were found for work support (r =−.17) and social support (r =−.26). Demographic variables appear to be less implicated although more work is needed that examines the role of gender in the context of particular personal traumas. Caseload frequency and personal trauma effect sizes were moderated by year of publication. Future work should examine the measurement of STS and associated impairment, understudied risk factors, and effective interventions. Professionals who work therapeutically with victims of trauma are at risk for what has historically been called sec- ondary traumatic stress (STS). STS occurs as a reaction to secondary or indirect exposure to traumatic events experienced by another (Bride, Radey, & Figley, 2007). Recent revisions to the diagnostic criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) have made explicit that repeated exposure to the aversive details of a traumatic event during the course of one’s professional duties qualifies as a Criterion A stressor (American Psychiatric Association, 2013).Therefore, here we have treated STS, if appropriately severe, as a form of PTSD where the exposure is listening repeatedly to the details of a client’s traumatic experience and the symptoms are characterized by intrusive imagery related to the client’s trauma, avoidance, physiological arousal, distressing emotions, and functional impairment (Bride, Robinson, Yegidis, & Figley, Funding support was provided courtesy of Carolyn S. Dewa’s Canadian Insti- tutes of Health Research Applied Public Health Chair. Correspondence concerning this article should be addressed to Jennifer M. Hensel, Department of Psychiatry, Women’s College Hospital, 7 th floor, Rm 7122, 76 Grenville St, Toronto, Ontario, Canada, M5S 1B2. E-mail: Jennifer.hensel@wchospital.ca Copyright C  2015 International Society for Traumatic Stress Studies. View this article online at wileyonlinelibrary.com DOI: 10.1002/jts.21998 2004). These symptoms impact the personal and working lives of those affected, and extend to the quality of care delivered (Bride, Radey, et al., 2007; Choi, 2011; Salston & Figley, 2003; Sexton, 1999). Various conceptually overlapping terms including STS, compassion fatigue (CF), vicarious traumatization (VT), and burnout have been used to refer to the effects of secondary trauma exposure. Only STS and CF, however, will be used in this review as they most closely reflect the symptoms of PTSD. VT relates more to the transformation of the helper’s inner ex- perience resulting from empathic engagement with a client’s trauma and the resultant shift in cognitive schemas about one- self, others, and the world (Bride, Radey, et al., 2007). Burnout, on the other hand, is not specific to exposure to traumatic ma- terial and can affect individuals in any professional role as it develops in the setting of prolonged exposure to stressful de- mands at work (Cieslak et al., 2014). In a meta-analysis of published studies, Cieslak et al. (2014) has shown a high corre- lation between burnout and STS (weighted r = .69) suggesting that there may be a common predisposition or that one condition may be a risk factor for the other. Although some suggest that professionals may experience mild STS symptoms not of clinical significance (Elwood, Mott, Lohr, & Galovski, 2011; Ortlepp & Friedman, 2002), other studies report moderate to high levels of STS, or PTSD, result- ing from indirect exposure only. For example, a diagnosis of STS was reported in 34% of child protective services workers 83