Secondary Traumatic Stress and Post-Traumatic Stress Symptoms in Nurses: Mediating Role of Psychological Distress and Moderating Role of Emotional Support

Abstract

Aim: This study aimed to investigate whether psychological distress mediates the relationship between secondary traumatic stress (STS) and post-traumatic stress symptoms (PTSS) among clinical nurses, and whether perceived emotional support moderates this mediating effect. Design: A cross-sectional study. Methods: A total of 205 clinical nurses who had direct patient contact and trauma-related experience were included. Data were collected using validated instruments: the Secondary Traumatic Stress Scale (STSS), Depression Anxiety Stress Scale-12 (DASS-12), Impact of Event Scale-Revised (IES-R), and the Multidimensional Scale of Perceived Social Support (MSPSS). All scales demonstrated high internal consistency (Cronbach's α = 0.88–0.97). Results: Psychological distress significantly mediated the relationship between STS and PTSS. Perceived emotional support moderated the path from STS to psychological distress, such that higher emotional support amplified the association. However, emotional support did not significantly moderate the relationship between psychological distress and PTSS. Conclusion: Psychological distress plays a central role in translating STS into PTSS among clinical nurses. Although emotional support may buffer early psychological distress, it does not attenuate PTSS development once distress is established. Implications for the Profession and/or Patient Care: Early detection and management of psychological distress can prevent STS from progressing to PTSS. Nurses frequently exposed to trauma require timely psychological support. We recommend implementing routine screening and early interventions focused on distress, along with peer-support programmes and supervisory encouragement to enhance resilience. Trauma-informed care training and organisational awareness should also be strengthened to foster a supportive environment. Impact: This study shows that managing early emotional symptoms is critical in preventing PTSS among nurses exposed to secondary trauma. Findings can inform global policies, peer-support initiatives, and early screening systems to enhance resilience and safeguard patient care. Reporting Method: The study adhered to the STROBE checklist for cross-sectional studies. Patient or Public Contribution: No patient or public contribution.