Secondary traumatic stress among healthcare workers in Egypt and the mediating role of workplace protective factors

Healthcare workers are occupationally exposed to traumatic events, placing them at risk of secondary traumatic stress (STS) a condition characterized by intrusion, avoidance, and arousal symptoms. To determine the prevalence of STS among healthcare workers, identify early warning signs, evaluate the effectiveness of workplace preventive measures, and identify factors associated with STS. A cross-sectional study was conducted from October to December 2025 among 783 healthcare workers in critical care units at Tanta University Hospitals, Egypt. Data were collected using a structured self-administered questionnaire including the Secondary Traumatic Stress Scale (STSS), an early warning signs scale, and a preventive measures scale. Multivariate logistic regression was used to identify associated factors with STS. The frequency of STS was 64.5%, with a total mean score of 58.16 ± 11.18. The most frequent early warning signs were chronic exhaustion (3.43 ± 1.126), increased anxiety about safety (3.18 ± 1.156), and difficulty maintaining work-life boundaries (3.17 ± 1.206). A strong positive correlation was observed between STS score and warning signs score (r = 0.76, p < 0.01). Multivariate logistic regression identified physicians (AOR = 2.14), working > 40 h/week (AOR = 2.07), > 8-night shifts/month (AOR = 2.56), absence of preventive measures (AOR = 2.87), and sick leave history (AOR = 1.89) as significant associated factors of severe STS. Mediation analysis revealed that social support mediated the relationship between occupational stressors and secondary traumatic stress, with a significant indirect effect (0.105, 95% CI: 0.062-0.148) accounting for 23.4% of the total effect. STS is highly prevalent among Egyptian healthcare workers and is significantly associated with modifiable workplace factors. The absence of essential organizational interventions highlights critical gaps in occupational health protection. Routine surveillance, mandatory debriefing, and enhanced organizational support are urgently needed.