“Humanizing Work” -- Psychosocial Risk and Resilience Model for Burnout and Psychological Distress among Humanitarian Aid Workers in Bangladesh: A Mixed Methods Study

Most studies on the mental health of humanitarian aid workers have concentrated on sociodemographic variables or trauma exposure as predictors of psychopathological outcomes. However, less is known about the psychosocial and organizational factors contributing to occupational stress-related disorders in this high-risk occupation group. This mixed-methods, cross-sectional study sought to establish a psychosocial model for burnout and psychological distress among humanitarian staff that comprehensively tested the psychological effects of common adversities and workplace psychosocial stressors in combination. The model further investigated the potential mediating role of individual coping styles and the protective role of organizational psychological safety climate. N=111 full-time aid workers from 52 organizations in Bangladesh completed an online survey, and n=13 participants were followed-up with virtual individual interviews between December 2020 and May 2021. A stepwise model building process with path analysis established an integrated conceptual model with overlapping but distinct pathways from common adversities and workplace stressors to burnout. While greater exposure to both types of stressors was associated with higher levels of burnout and distress, workplace psychosocial stressors had a greater total effect on psychological outcomes than common adversities (β = .52, 95% CI [0.42, 0.90], p = < .001 vs. β = .20, 95% CI [0.03, 0.59], p = .032). Both types of stressors had indirect effects on burnout through negative emotion-focused coping (β = .12, 95% CI [0.30, 2.14], p = .007). However, only workplace stressors and not common adversities directly affected psychological distress (β = .45, 95% CI [0.09, 0.24], p = < .001 vs. β = -.01, 95% CI [-0.09, 0.09], p = .927). Expanded path models indicated that specific domains of stressors, namely, deployment-related interpersonal stressors, work-life interface, and work organization and communication stressors, significantly influenced psychological outcomes. Conditional process analysis showed that higher perceived levels of psychological safety climate buffered the adverse indirect effects of deployment-related interpersonal stressors via negative emotion-focused coping on burnout (β = -.21, 95% CI [-0.08, -0.01], p = .008) and distress (β = -.23, 95% CI [-0.03, -0.01], p = .005). Contrary to findings from the extant literature, sociodemographic variables (except psychiatric history), task-focused coping, and avoidance-focused coping were not significant exogenous variables. Thematic analysis of qualitative data yielded themes that largely converged with and elaborated on statistical results. Qualitative results offered additional insights about the “chronic emergency” organizational culture and professional attitudes of “martyrdom” unique to humanitarian aid workers, which may normalize and reinforce a high-stress work environment and minimized recognition of staff’s mental health needs. The psychosocial model, complemented with qualitative elaboration, can inform the development of evidence-based interventions for staff care. Reducing workplace stressors, improving adaptive coping, and enhancing the psychosocial safety climate of organizations may prevent and alleviate occupational stress-related disorders in humanitarian aid workers and other first responders

Psychosocial model of burnout among humanitarian aid workers in Bangladesh: role of workplace stressors and emotion coping

Abstract Background While trauma exposure is an established predictor of poor mental health among humanitarian aid workers (HAWs), less is known about the role of psychosocial work-related factors. This study aims to establish a psychosocial model for burnout and psychological distress in HAWs that tests and compares the effects of adversity exposure and workplace stressors in combination, and explores the potential mediating role of individual coping styles. Methods Path analysis and model comparison using cross-sectional online survey data were collected from full-time international and local HAWs in Bangladesh between December 2020 and February 2021. HAWs self-reported on exposure to adversities, workplace psychosocial stressors (Third Copenhagen Psychosocial Questionnaire), coping styles (Coping Inventory for Stressful Situations), burnout (Maslach Burnout Inventory—Human Services Survey), and psychological distress (Kessler-6). Results Among N = 111 HAWs, 30.6%, 16.4%, 12.7%, and 8.2% screened positive for moderate psychological distress (8 ≤ Kessler-6 ≤ 12), emotional exhaustion (EE ≥ 27), depersonalization (DP ≥ 13), and severe psychological distress (K-6 ≥ 13), respectively. 28.8% reported a history of mental disorder. The preferred model showed distinct pathways from adversity exposure and workplace stressors to burnout, with negative emotion-focused coping and psychological distress as significant intervening variables. While greater exposure to both types of stressors were associated with higher levels of burnout and distress, workplace stressors had a stronger association with psychological outcomes than adversity exposure did (β = .52, p ≤ .001 vs. β = .20, p = .032). Workplace stressors, but not adversities, directly influenced psychological distress (β = .45, p ≤ .001 vs. β = −.01, p = .927). Demographic variables, task-focused and avoidance-focused coping were not significantly associated with psychological outcomes. Conclusions Compared to exposure to adversities, workplace stressors primarily influenced occupational stress syndromes. Reducing workplace stressors and enhancing adaptive coping may improve psychological outcomes in humanitarian staff

Efficacy of Solution-Focused Brief Therapy versus case management for psychological distress in help-seeking adolescents and young adults in Singapore: protocol for a randomised controlled trial

Introduction: There are insufficient scalable, evidence-based treatments to meet the increasing mental health needs of young persons in Singapore. Offering interim, brief interventions for distressed treatment-seekers can improve care access and mitigate adverse effects of long waiting times. This study proposes to test the efficacy of Solution-Focused Brief Therapy (SFBT), a strengths-based, goal-directed intervention, for psychological distress in help-seeking adolescents and young adults. Methods: We will conduct a fully-powered, randomised, single-centre, two-armed, parallel, superiority, controlled trial. From September 2023 to March 2025, the study will recruit 124 participants (ages 16-30) presenting at a national youth mental health service in Singapore (CHAT, Centre of Excellence for Youth Mental Health) with clinically-assessed non-specific psychological distress, subthreshold or prodromal symptoms, or a first episode of a mood disorder. Participants will be excluded if they have high suicidal risk, psychosis, cognitive impairments, or current psychological treatments. Participants will be randomised in a 1:1 ratio to receive six-session, case manager-delivered SFBT or treatment as usual (TAU), case management. Participants receiving SFBT are hypothesized to have greater improvements in self-reported psychological distress, from baseline to eight weeks, compared to the control group. Secondary outcomes are self-reported depression and anxiety symptoms, and functional impairment. The study will additionally explore if SFBT is associated with: 1) increased self-efficacy and decreased hopelessness; 2) decreased downstream referrals at post-intervention; and 3) sustained clinical gains at three months post-intervention, compared to TAU. Significance: Results have implications for expanding capacity of mental health services and enhancing capabilities of frontline case managers to provide timely and low-intensity evidence-based interventions to improve the mental health of young persons in Singapore