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. 2025 May 19;32(3):e70084. doi: 10.1002/cpp.70084

Secondary Traumatization Among Mental Health Officers Who Treat Patients With Non‐Suicidal Self‐Injury and Suicidal Behaviour

Shir‐ly Moryosef 1, Orit Taubman – Ben‐Ari 1,✉
PMCID: PMC12088860  PMID: 40389259

ABSTRACT

Objective

Military mental health officers (MHOs) often encounter soldiers who express distress through threats or attempts of self‐injury or suicide. Research shows that working with such cases is highly stressful and can be traumatic for therapists, potentially leading to secondary traumatization (ST)—a condition that affects both personal well‐being and professional performance. This study explores how event centrality, rumination, and self‐compassion influence the development of ST in MHOs exposed to self‐injurious behaviour in their patients. We hypothesized that higher exposure to self‐harm would be associated with greater ST, especially when MHOs perceive these experiences as highly central to their lives. Additionally, we hypothesized that self‐compassion would have a protective effect, reducing ST.

Method

The study involved 130 MHOs (social workers, psychologists, and psychiatrists) serving in the Israeli army, representing roughly half of all such professionals. Participants completed self‐report questionnaires.

Results

No significant association was found between exposure to self‐harm and ST. However, a curvilinear relationship (where the effect rises at moderate levels but decreases at higher levels) also emerged, with moderate exposure linked to the highest levels of ST. Notably, this curvilinear effect was observed only among MHOs with high self‐compassion, whereas those with lower self‐compassion did not show the same pattern.

Conclusions

This study enhances our understanding of how therapists respond to the challenges of self‐injury and suicide in their patients. It highlights the complex role of exposure and self‐compassion in ST, suggesting that fostering self‐compassion in MHOs could be key to developing effective stress‐reduction programs.

Keywords: mental health officers, secondary traumatization, self‐compassion, self‐injury, suicidal behaviour

Summary.

  • Military mental health officers (MHOs) frequently encounter cases of self‐injury and suicide among soldiers, which can contribute to secondary traumatization (ST).

  • This study examined the roles of event centrality, rumination, and self‐compassion in the development of ST among MHOs exposed to self‐injurious behaviours.

  • A curvilinear relationship emerged, where moderate exposure was linked to the highest levels of ST.

  • Self‐compassion may play a complex role in moderating ST, highlighting the potential benefits of self‐compassion‐focused interventions for MHOs.

  • Further research is needed to explore strategies for mitigating ST and enhancing resilience among MHOs.

1. Introduction

Military mental health officers (MHO) meet with soldiers contending with a strict hierarchical system at an age when the soldiers are struggling to achieve independence. Moreover, the possibility of support from family and friends is greatly limited (Bodner et al. 2007). The mental stress on this population puts them at high risk of self‐injury, suicidal behaviors, and suicide (Yacobi et al. 2013). Working with patients in so much distress that they display self‐harming or suicidal behaviors is characterized by a high level of stress and has emotional effects on the therapist (McAdams and Foster 2000). Indeed, therapists coming face to face with the distress of their patients are likely to develop secondary traumatization )ST( (Figley 2002).

1.1. Secondary Traumatization

The DSM defined the distress of therapists stemming from exposure to stories of their patients' trauma as a form of post‐traumatic stress disorder (PTSD; American Psychiatric Association, DSM‐5 Task Force 2013). This was the first recognition that the effect of trauma can also be felt as a result of exposure to the trauma, suffering, and distress of another person. In recent decades, there has been growing awareness of the negative personal and professional impact that exposure to the stressful or traumatic life events of their patients may have on therapists (McDonald 2017; Ondrejkova and Halamova 2022). The terms most commonly used in the literature to describe this phenomenon are ST, compassion fatigue, and vicarious traumatization.

The concept of ST was proposed by Figley (1983) to describe the emotional and behavioural implications of exposure to a traumatic event experienced by someone else and the stress aroused by the desire to help them cope. It depicts the therapist as a person suffering from post‐traumatic symptoms similar to those of their patient, such as arousal, invasiveness, and avoidance (Figley 1995), as well as anxiety and depression (Hodgkinson and Shepherd 1994). Exposure to a patient's trauma, along with empathy on the part of the therapist, are major risk factors for ST (Figley 1995; Lai et al. 2021 Exposure to trauma has a cumulative effect on the development of secondary traumatization (ST). Unlike direct trauma, which is typically linked to a specific event, secondary traumatization usually results from repeated exposure to traumatic content rather than from a single distressing incident (Baird and Kracen 2006).

The psychological processes underlying secondary traumatization share conceptual similarities with those described in post‐traumatic growth (PTG) theories. Tedeschi and Calhoun (2004) argue that trauma exposure can significantly alter cognitive schemas, worldviews, and personal identity, which are also key components of secondary traumatization (Figley 1995). Whereas PTG is typically examined in relation to direct trauma, research indicates that therapists and caregivers exposed to chronic traumatic narratives may undergo profound cognitive and emotional shifts (Linley and Joseph 2007).

Previous studies have identified a curvilinear association between trauma exposure and post‐traumatic growth (PTG) (e.g., Bhat and Rangaiah 2016; Kleim and Ehlers 2009); however, to the best of our knowledge, no previous study has examined the possibility of similar associations between level of exposure and ST among therapists working with patients displaying self‐harming or suicidal behaviours.

Studies examining the exposure of medical personnel to daily instances of death or dying found that they report symptoms of ST (Abu‐Sharkia et al. 2020; Taubman ‐ Ben‐Ari and Weintroub 2008). These findings, as well, indicate that the exposure of therapists to suicidal patients or those with a tendency to self‐harm may have multiple negative consequences, an issue that therefore warrants further investigtion.

1.2. Therapeutic Work With Self‐Harming and Suicidal Behaviours

Suicidal and self‐harming behaviours range from suicidal thoughts, self‐destructive behaviour, suicidal gestures, and attempts at suicide at varying degrees of severity, to actual suicide (Apter et al. 2008). Self‐injury refers to any deliberate behaviour that is destructive to the individual and is a risk factor for future suicide (Nock et al. 2006). The suicide of a patient or working with patients exhibiting self‐harming or suicidal behaviours are major stressors for therapists (Baker 2016; Norheim et al. 2013). Clinicians often experience negative emotional responses when treating patients at risk for suicide (Barzilay et al. 2018). Indeed, suicidal behaviours and the suicide of a patient are ranked among their greatest stressors, similar in intensity to a traumatic life event (Sandford et al. 2021) or the loss of a family member, arousing responses such as shock, grief, guilt (Ellis and Patel 2012), anger, sorrow (De Lyra et al. 2021; Sandford et al. 2021), stress, anxiety (McAdams and Foster 2000), fatigue, and depression (Foley and Kelly 2007).

Thus, the considerable exposure of MHO to such behaviours is likely to affect their mental state and world view. This raises the question of the factors that may contribute to this response. The current study examines three possible factors: the perceived centrality of the event, rumination, and self‐compassion.

Centrality of the event refers to the degree to which the individual attributes major importance to an event in their life and its influence on their identity. When a traumatic event is seen as a turning point in their personal narrative, it may affect their identity and the way in which they view themselves afterwards (Boals 2010; Steinberg et al. 2021). Perceived centrality of the event may also predict future mental disorders, such as depression or PTSD (Groleau et al. 2013).

Rumination, or repetitive thoughts, is a cognitive process that may appear after coping with stressful events (Calhoun et al. 2000). Two types of rumination have been defined: intrusive rumination, reflecting repeated thoughts that appear unwillingly and uncontrollably, and deliberate rumination, in which the individual purposely raises the thoughts to their conscious in order to better understand the event and its ramifications (Cann et al. 2011). Although it has been suggested that intrusive rumination plays an important role in indicating that the event has psychological effects (Taku et al. 2015; Tedeschi and Calhoun 2004), it is commonly perceived as negative. Coping with intrusive thoughts has been associated with increasing or prolonged distress and difficulty in dealing effectively with stress, as they compel the individual to continuously focus on the event and the emotions and thoughts it arouses (Shigemoto 2022; Taku et al. 2015). In contrast, deliberate rumination indicates processes of comprehending the event and finding solutions to the consequent problems (Cann et al. 2011; Platte et al. 2022), offering an opportunity to examine, consider, and reconstruct one's world view after a stressful event (Cann et al. 2011). At the same time, however, the very act of prolonged deliberate rumination may solidify the presence of the event and lead to distress (Zhou and Wu 2015).

Self‐compassion consists of three components: Kindness, that is, a non‐judgmental and non‐critical attitude, toward oneself; common humanity, or recognizing that everyone makes mistakes and has to deal with the challenges of life; and mindfulness, referring to the individual's willingness to be aware of their feelings and thoughts at stressful times (Neff 1995). It has been found that therapists with higher self‐compassion display more compassion, kindness, and humanity toward their patients (Gerber and Anaki 2021; Heffernan et al. 2010). Moreover, therapists with higher levels of self‐compassion cope better with work‐related stress (Boellinghaus et al. 2014), adapt better, tend to have a more balanced assessment of situations and difficulties (Finlay‐Jones et al. 2015), and have a lower risk of ST or burnout (Gerber and Anaki 2021; Thompson et al. 2014). Thus, self‐compassion appears to be a resource that protects therapists from the stress that derives from their work (Braehler and Neff 2020), and may therefore moderate the link between their exposure to stories of stressful events and its consequences, such as ST.

1.3. The Current Study

As previous research indicates that dealing with the distress of their patients may lead to the ST of therapists, this study investigates, for the first time, the connection between exposure to self‐harming and suicidal behaviours and ST among MHO, who frequently encounter these issues in their work with soldiers. It also examines the contribution of the two kinds of ruminations and the perceived centrality of the event as independent variables, as well as the possible moderating role of self‐compassion.

In view of the literature, the following hypotheses and research question were formulated:

  1. A positive linear association or a will be found between exposure to self‐harming and suicidal behaviours and ST, so that the higher the exposure, the higher the ST, or alternatively, moderate levels of exposure will be associated with the highest levels of ST.

  2. Is there a curvilinear relationship between exposure to self‐harming and suicidal behaviours and secondary traumatization (ST)?

  3. A positive association will be found between perceived centrality of instances of exposure to self‐harming and suicidal behaviours and ST, that is, the higher the perceived centrality of the event, the higher the ST.

  4. A positive association will be found between rumination, both intrusive and deliberate, over instances of self‐harming and suicide in the MHO's unit and ST, so that the higher the rumination, the higher the ST.

  5. A negative association will be found between self‐compassion and ST, so that the higher the self‐compassion, the lower the ST. In addition, self‐compassion will moderate the association between exposure to self‐harming and suicidal behaviours and the ST of MHO.

2. Method

2.1. Participants and Procedure

The current study is part of broader research study. After receipt of approval from the University's School of Social Work Review Board, data was collected by means of self‐report questionnaires. A previous article focused on the growth of MHO (Moryosef and Taubman – Ben‐Ari 2024). A list of all the MHO currently serving in the Israeli army was obtained from the Mental Health Corps, and messages were sent to all the officers on the list explaining the nature and purpose of the study, along with a link to an online questionnaire. The questionnaire was returned by 185 MHO out of a total of 260. The participants were assured that the data would be used for research purposes alone, that their responses would be kept confidential, and that no identifying details would be saved in the data base. It was explained that participation in the study was voluntary, and that they could cease to complete the questionnaire at any time.

The final sample consisted of 130 MHOs who fully completed the questionnaire. An additional 55 questionnaires were excluded due to partial response, which ranged from 3 to 70% completion. Notably, nearly half (N = 26) of these incomplete responses contained only 3% of the required answers, making them insufficient for drawing conclusions or identifying patterns. Although the sample may seem relatively small, it is highly significant as it represents approximately half of the target population. Before each relevant questionnaire, the MHO was asked to think and reflect on an event of self‐harm or suicide that happened at their unit. The sociodemographic characteristics of the participants appear in Table 1.

TABLE 1.

Sociodemographic characteristics of participants.

Variable M SD
Age (years) 33.6 4.31
Seniority in army (months) 5.13 5.01
N %
Gender M (F) 39 (91) 30.0% (70%)
Marital status Single 24 18.4%
Married 88 67.7%
Divorced 5 3.8%
In a stable relationship 13 10%
Profession Social worker 108 83.1%
Psychologist a 20 15.4%
Psychiatrist 2 1.5%
Education B.A. 37 28.5%
M.A./M.A. studies 88 67.7%
Ph.D. 5 3.8%
Army unit Combat 36 27.7%
Combat support 18 13.8%
Non‐combat 76 41.5%
Exposure to threats of suicide and self‐injury Less than once a week 54 41%
Once a week 40 31%
More than once a week 36 27%
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a

Psychologist—A psychologist in Israel is defined as someone who holds a master's degree in clinical psychology.

2.2. Instruments

Secondary Traumatic Stress Scale (STSS; Bride et al. 2004), a 17‐item scale assessing the frequency of post‐traumatic stress symptoms among people impacted by their work with traumatized clients. The instrument contains three subscales: arousal (five items, e.g. ‘I had trouble sleeping’); intrusion (five items, e.g. ‘I thought about my work with clients when I didn't intend to’); and avoidance (seven items, e.g. ‘I felt emotionally numb’). Responses are marked on a 5‐point Likert scale from 1 (never) to 5 (very often). The authors report an internal reliability of α = 0.93. In the current study, Cronbach's alpha was 0.91. Each participant's responses to all items were averaged to produce a total ST score, with higher scores indicating greater traumatization.

Centrality of Event Scale (CES; Berntsen and Rubin 2006), designed to assess the degree to which a stressful event impacts the individual's identity. The scale consists of seven items (e.g. ‘I feel that this event has become part of my identity’), with responses indicated on a 5‐point Likert scale from 1 (totally disagree) to 5 (totally agree). Since the current study investigated repeated, rather than a single, event, the participants were asked to relate to all instances of exposure to self‐harming and suicidal behaviours. Cronbach's alpha was 0.88 in the original scale and 0.87 in the current scale. Each participant's responses to all items were averaged to produce a centrality of event scale, with higher scores indicating greater perceived centrality of the event.

The Event‐Related Rumination Inventory (ERRI; Cann et al. 2011), designed to assess the frequency of repeated thoughts, both intrusive and deliberate, after a stressful event. The inventory consists of 20 items, half of which relate to intrusive thoughts (e.g. ‘I thought about the event when I did not mean to’), and the other half to deliberate thoughts (e.g. ‘I thought about whether I could find meaning from my experience’). Here, too, participants were asked to relate to instances of suicidal and self‐harming behaviours, indicating the degree to which they experienced the reaction described in each item. Responses were marked on a 4‐point Likert scale from 0 (not at all) to 3 (often). Cronbach's alphas were 0.94 and 0.88 in the original scale, and 0.93, 0.88 in the current scale. For intrusive and deliberate rumination, respectively. The responses in each subscale were averaged to produce two scores, with higher scores indicating greater rumination of the given type.

Self‐compassion Scale‐Short Form (SCS‐SF; Raes et al. 2011), a 12‐item instrument assessing the three dimensions of self‐compassion: self‐kindness (e.g. ‘I try to be understanding and patient toward those aspects of my personality I don't like’); common humanity (e.g. ‘I try to see my failings as part of the human condition’); and mindfulness (e.g. ‘When something painful happens I try to take a balanced view of the situation’). Participants were asked to respond to each item on a 5‐point Likert scale from 1 (almost never) to 5 (almost always). Cronbach's alpha for the original scale was 0.86 and was 0.84 in the current study. After reverse coding the relevant items, each participant's responses to all items were averaged to produce a self‐compassion score, with higher scores indicating greater self‐compassion.

A sociodemographic questionnaire was used to obtain personal and occupational details, including age, sex, profession (psychologist, social worker, psychiatrist), education (BA, MA, doctorate), and seniority. In addition, it tapped the frequency of exposure to cases or threats of self‐harm and suicidal behaviour (less than once a week, once a week, more than once a week), as well as the number of cases of actual self‐injury and suicide in the unit in the preceding 6 months. Only the numerical variable reflecting the number of self‐injury and suicide cases was used for data analysis, while the variable related to the frequency of encounters was included for general descriptive purposes only and was not used in the statistical analysis.

2.3. Data Analysis

The data was analysed using the SPSS (ver. 28). In a preliminary analysis, t tests were calculated to identify differences by professions (social worker versus psychologists and psychiatrists) and gender. Pearson correlations were then conducted between the study variables to examine the hypotheses. Finally, a six‐step hierarchical regression was performed to determine the contribution of each of the independent variables to ST and examine the possibility that self‐compassion moderates the association between exposure to self‐harming and suicidal behaviours and ST. The background variables were entered in step 1, exposure in step 2, exposure squared in step 3, centrality of the event and the two types of rumination in step 4, and self‐compassion in step 5. In step 6, the interactions between self‐compassion and exposure was entered. Analysis of the source of the significant interaction was performed using PROCESS (Hayes 2013) models 4 and 5 to examine the indirect associations between the variables and the direct association between exposure and ST at different levels of self‐compassion.

3. Results

The t‐tests performed to identify differences in the study variables by gender and profession showed that the only significant gender difference was on ST, with women reporting higher ST than men, t(2.27) = 2,25, p < 01. No other significant differences were found for either gender or profession.

Pearson correlations between the variables appear in Table 2. As can be seen from Table 2, hypothesis 1 was not confirmed, with no significant association found between exposure to self‐harming and suicidal behaviours and ST. Hypothesis 2 was fully confirmed, so that the more central to their lives MHO considered the instances of self‐harming and suicidal behaviours, the higher the ST they reported.

TABLE 2.

Pearson correlations among study variables.

Secondary traumatization Self‐compassion Centrality of event Intrusive rumination Deliberate rumination
Secondary traumatization —
Self‐compassion −.31*** —
Centrality of event 0.34*** −0.03 —
Intrusive rumination 0.45*** 0.05 0.50*** —
Deliberate rumination 0.48*** −0.10 0.55*** 0.55*** —
Exposure 0.03 0.03 −0.15 −0.04 −0.09
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***

p < 0.001.

Hypothesis 3 was also confirmed, so that the more rumination of both types, the higher the ST reported. Hypothesis 4 was confirmed as well, as the more self‐compassion that was evidenced, the lower the ST reported.

The results of the hierarchical regression performed to examine the contribution of the variables to ST appear in Table 3, showing that the variables explained a total of 47.6% of the variance.

TABLE 3.

Results of regression for secondary traumatization.

B Seb β t ΔR 2
Step 1
Gender 0.184 0.114 0.146 1.622 0.66*
Education −0.072 0.059 −0.12 −1.224
Seniority in army −0.011 0.013 −0.083 −0.867
F 2.961*
R 2 0.66*
Step 2—exposure
Exposure to self‐injury 0.101 0.043 0.198 2.341* 0.039
F 5.482*
R 2 0.105**
Step 3—exposure squared
Exposure to self‐injury squared −0.103 0.049 −0.178 −2.116* 0.31
F 4.479*
R 2 0.136**
Step 4—cognitive variables
Centrality of event 0.065 0.074 0.082 0.888 0.218
Intrusive rumination 0.258 0.161 0.151 1.6
Deliberate rumination 0.307 0.091 0.328 3.375***
F 13.62***
R 2 0.354***
Step 5—self‐compassion
Self‐compassion −0.277 0.069 −0.287 −4.042*** 0.077
F 16.336***
R 2 0.432***
Step 6—interactions
Exposure × self‐compassion −0.026 0.058 −0.166 −441 0.044
Exposure squared × self‐compassion −0.208 0.066 −1.211 3.137**
F 5.001**
R 2 0.476***
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*p < 0.05, **p < 0.01, ***p < 0.001.

The background variables in step 1 contributed 6.6% to the explained variance, with no one specific variable significantly linked to ST. In step 2, the linear association between exposure and ST added another 3.9% to the explained variance, with higher exposure significantly associated with higher ST. The squared (curvilinear) term of exposure in step 3 contributed a further 3.1% to the explanation of the variance, showing that at moderate levels of exposure, the association between the variables was weak, whereas at high and low levels of exposure it was stronger. In step 4, the cognitive variables of centrality of the event and the two types of rumination added 21.8% to the explained variance, with a significant positive effect for deliberate rumination, so that the higher the deliberate rumination, the higher the ST. Self‐compassion in step 5 contributed a further 7.7% to the explanation of the variance, revealing a significant negative association: the higher the self‐compassion the lower the ST. In order to examine the possibility that self‐compassion might moderate the association between exposure and ST, that is, whether the linear and curvilinear links between exposure and ST might change in the presence of different values of self‐compassion, the interaction between them was entered in step 6 and added 4.4% to the explained variance. The PROCESS procedure (Hayes 2013) was used to examine the source of this interaction. The results appear in Table 4.

TABLE 4.

Source of interaction effect between exposure and self‐compassion on secondary traumatization.

B Seb t
Association between exposure and secondary traumatization
Self‐compassion 0.07 0.05 1.28
Moderate 0.04 0.003 1.15
High 0.02 0.05 0.33
Association between exposure squared and secondary traumatization
Self‐compassion
Low 0.07 0.06 1.27
Moderate −0.07 0.04 −1.77
High −0.19 0.06 −3.39**
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**

p < 0.01.

As can be seen from Table 4, only the interaction between the curvilinear term of exposure and self‐compassion was significant, indicating that the association between the curvilinear term of exposure and ST changed at different values of self‐compassion. Figure 1 presents the curvilinear association between exposure and ST at three levels of self‐compassion: low (mean less that one SD), moderate, and high (mean over one SD).

FIGURE 1.

FIGURE 1

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Curvilinear association between exposure and secondary traumatization at different levels of self‐compassion.

As Figure 1 shows, when self‐compassion was low, a negative association emerged between exposure and ST for lower levels of exposure. However, the direction of the association was reversed at levels of exposure above 2.5. That is when self‐compassion is low, and the level of exposure is higher than 2.5, the association becomes positive. In contrast, at moderate or high levels of self‐compassion, a hyperbolic curvilinear association was found, indicating a rise in ST in response to relatively low exposure, up to approximately 2.5. From this point on, the association became negative, so that ST lessened in response to increased exposure. More precisely, the reversal in direction was expressed mainly in the presence of high levels of self‐compassion (above the mean plus full SD). That is, the curvilinear connection was strongest at high levels of self‐compassion. Put differently, at low (1) to moderate (2.50) levels of exposure, the correlation with ST rose from 2.0 to 2.40, whereas between 2.50 to maximum exposure, the correlation with ST fell from 2.40 to 2.0. To conclude, the curvilinear relationship between exposure and ST appeared only at high levels of self‐compassion, but not at lower levels of self‐compassion.

4. Discussion

The current study examined the link between the exposure of MHO to self‐harming and suicidal behaviours and ST, investigating the contribution of cognitive variables (centrality of the event, and intrusive and deliberate rumination) and an internal resource (self‐compassion).

The findings confirmed our hypothesis regarding a positive correlation between centrality of the event and ST, so that the more central the exposure was perceived, the higher the ST. This is consistent with the results of previous studies showing the effect of centrality of the event following a stressful event (Brooks et al. 2017; Greenblatt‐Kimron et al. 2021; Groleau et al. 2013). Research indicates that instances of self‐harming and suicidal behaviours by their patients are stress‐inducing and disturbing for therapists (Gutin et al. 2011; Tillman 2006). In such cases, the space of the clinic is compressed to a life and death experience, significantly intensifying the therapist's stress.

The hypothesis concerning a positive association between both intrusive and deliberate rumination and ST was also confirmed, in line with the results of previous studies (Blackburn and Owens 2016; Zhou and Wu 2015). Intrusive rumination has been associated with distress probably because of the compulsion to focus repeatedly on the stressful event and the thoughts and feelings it arouses (Ehlers and Clark 2000; Taku et al. 2015), while prolonged deliberate rumination may also engender distress because it continues to give active presence to the event. In the case of MHO, ongoing preoccupation with their exposure may be reflected not only in spontaneous intrusive rumination, but also in deliberate rumination, as they undergo regular training and clinical learning. These frameworks invite cognitive thinking about given events, including instances of self‐harming and suicidal behaviours. The demands of the system and profession to delve deeper and look inside oneself may actually increase the distress of health officers treating soldiers in their units and bearing responsibility for their mental health.

In respect to self‐compassion, the results show a negative association with ST, which is also consistent with previous studies (Dahm et al. 2015; Jaber et al. 2016; Leary et al. 2007; Wong and Yeung 2017), as well as with evidence that self‐compassion is a protective resource that promotes resilience in the face of stressful events and trauma (Beaumont et al. 2015; Zeller et al. 2015),

The current study also investigated the possibility that the relationship between exposure and ST is dependent on the level of self‐compassion. It was found that self‐compassion only moderates the curvilinear assciation between exposure and traumatization, indicating that the curvilinear relationship between exposure and ST appears at high levels of self‐compassion, but not at lower levels of self‐compassion. In other words, when self‐compassion is low, exposure to a limited number of self‐harm or suicide cases results in lower secondary trauma (ST), as these events do not play a significant enough role in their life to trigger symptoms of PTSD. This may stem from the fact that the other problems they deal with are more central to their work. Moreover, they are less urgent and leave more room for consideration. This is in line with a study comparing ST among social workers involved in child protection and those working in social services. Those in social services were found to have lower levels of ST as they deal with a broader range of clients and issues. On the other hand, those involved in child protection have to make difficult decisions, work under pressure, and bear huge responsibiity for the lives of children at risk (Dagan et al. 2016). Similarly, the higher the exposure the MHO in the current study to cases of self‐harming and suicidal behaviours, the more ST they reported. It might be that at low levels of self‐compassion, there is nothing to shield them from the negative effects of exposure.

In contrast, at moderate and high levels of self‐compassion, a curvilinear link was found between exposure and ST, so that at moderate levels of exposure this association was positive, while at high or low levels of exposure it was negative. That is, MHO who displayed higher self‐compassion were better able to cope with exposure to the difficulties of their patients. At low or high levels of exposure, they reported less ST. Only when the exposure was within the moderate range, was higher exposure associated with higher ST. At these levels, the officers were apparently still able to process their feelings despite the negative implications of exposure. In other words, at high levels of exposure, self‐compassion appears to play a protective role, allowing adaptation to and processing of their patients' difficulties, and therefore they experience less ST. Thus, those evidencing less self‐compassion do not enjoy this protection. Another possible explanation for the findings may lie in the fact that MHO with high exposure to self‐harming and suicidal behaviours are intensely involved in risk assessment, perhaps increasing their knowledge and experience in regard to these issues, so that along with the difficulties aroused by meeting with suicidal or self‐harming soldiers, self‐compassion allows them to respond in a more professional manner. This could make their work more rewarding and significant, shielding them from the negative consequences of the content they encounter in the clinic (Baird and Jenkins 2003).

Finally, the only gender difference in the variables was found for ST, showing that women reported experiencing more negative implications on their life from their exposure to the self‐harming and suicidal content of their patients. This is consistent with the literature that systematicallly indicates that women report more ST than men in a variety of contexts (Arpacioglu et al. 2021; Baum 2016; Baum et al. 2014). No significant differences were found here on any of the variables for profession (social workers, psychologists, psyciatrists). In line with the results of previous studies (Abu‐Sharkia et al. 2020; Taubman ‐ Ben‐Ari and Weintroub 2008), this supports Figley's (1995) contention that the most important factor in ST is not background variables or amount of exposure, but the very exposure to events with traumatic characteristics.

4.1. Limitations of the Study

Several limitations of the current study should be noted. First, it is a cross‐sectional study, that is, the data was collected at a single point in time. Consequently, causal relationships cannot be determined. A longitudinal investigation of new MHO from the time they assume their post and at several additional points in time might shed further light on the specific cognitive, internal, and environmental factors that contribute to the ST of this population. Secondly, MHOs face additional pressures, including meeting the demands of their commanders, addressing the severe distress of non‐suicidal soldiers, and managing other challenges inherent to the military environment, such as adjusting to the system and frequent transfers between units. Although these factors may also play a role in the ST of these officers, it was impossible to examine them individually in the current study. In addition, despite our efforts to reach the entire population of MHO in the Israeli army, only about half of them responded to our request to participate in the study. The final sample size limited the number of statistical models we were able to examine. It is important to note that the decision to focus on this relatively small population was driven by its unique characteristics. This group consists of therapists operating within a hierarchical system, treating predominantly young patients who are frequently express suicidal and self‐harm behaviour. Additionally, these therapists regularly undergo training and supervision. However, future studies with a larger sample size could yield further significant insights. Comparing MHOs with professionals outside the military could also enhance understanding of the topic in subsequent research. Furthermore, the study is based on self‐report questionnaires, which may lead to a social desirability bias, so that the responses may only partially reflect the participants' attitudes, feelings, and experience. However, since all the variables relate to the personal feelings and attitudes of the respondents, there was no other way to assess them. Finally, a future study might distinguish between suicidal behaviours and self‐injury, which does not always indicate suicidal intent, as well as between suicidal thoughts, intentions, and actual attempts. Examination of these distinctions could also increase our knowledge of the distress experienced by therapists in general, and MHO in particular.

4.2. Implications of the Study

Notwithstanding these limitations, the current study makes both a theoretical and practical contribution to the literature on the encounter with traumatic events. On the theoretical level, it sheds light on factors that contribute to the distress of MHO working with patients displaying self‐harming and suicidal behaviours.

On the practical level, no other challenges and crises that MHO contend with are as serious or urgent as suicidal events. Thus, the findings may help instructors and other professionals to understand the implications of the officers' exposure to self‐harming and suicidal content, to identify their use of available resources, and to encourage their self‐compassion, which was found here to buffer the consequences of stress. It may be assumed that reducing ST will improve not only the MHO's own well‐being, but also the treatment they offer their patients.

In addition, recognizing the critical role of self‐compassion, as demonstrated in this study, may guide the development of training programs designed to strengthen MHOs' resilience. Such programs should incorporate techniques that foster self‐compassion, which could enhance coping mechanisms, support continued professional functioning, and promote personal and professional growth.

The findings of the current study underscore the critical importance of addressing secondary traumatization (ST) among military mental health officers (MHOs). Given their unique occupational context, MHOs face distinctive stressors not commonly encountered by civilian therapists. Specifically, MHOs operate within a strict hierarchical structure, bearing considerable responsibility for the mental well‐being of soldiers. This structural dynamic introduces an additional layer of stress and accountability, compounding the effects of exposure to suicide‐related stigma (Ammerman et al. 2022). Therefore, interventions aimed at reducing ST among MHOs must consider both the hierarchical pressures inherent in military systems and the stigma surrounding suicide. Effective training, ongoing supervision, and targeted psychological support interventions tailored to this context could mitigate these risks and ultimately enhance the professional quality of life and effectiveness of MHOs. Addressing these factors is essential not only for the well‐being of MHOs themselves but also for maintaining the mental health readiness of military units as a whole.

Another important aspect that may assist MHOs is increased awareness of factors contributing to or mitigating secondary traumatization, as well as deeper understanding of their own emotional responses when working with suicidal or self‐harming soldiers. Future research should explore the expanded use of countertransference and therapists' awareness of their emotional reactions when treating suicidal patients or individuals prone to self‐harm (Barzilay et al. 2018). Additionally, to enhance coping strategies, subsequent studies could investigate the effectiveness of implementing tools derived from trauma‐based approaches (Reynolds 2024).

Ethics Statement

The study was conducted in compliance with ethical standards.

Conflicts of Interest

The authors declare no conflicts of interest.

Funding: The authors received no specific funding for this work.

This study is part of the MA thesis submitted to the School of Social Work, Bar‐Ilan University, by the first author and was carried out under the supervision of the second author.

Data Availability Statement

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets generated during the current study are available from the corresponding author on reasonable request.

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