Vicarious Growth, Traumatization, and Event Centrality in Loved Ones Indirectly Exposed to Interpersonal Trauma: A Scoping Review

Abstract

It is well-known that interpersonal traumatic events can impact the physical and mental health of those indirectly exposed to the events. Less studied are populations of loved ones who have been indirectly exposed to interpersonal trauma. We conducted a scoping review to synthesize literature related to potential consequences of indirect interpersonal trauma exposure, specifically vicarious traumatization (VT) and vicarious posttraumatic growth (VPTG). We used the Joanna Briggs Institute methodology. Inclusion criteria included: (1) participants were indirectly exposed to the interpersonal trauma of a loved one in adulthood, (2) discussion of VT, VPTG, or related terms, (3) published peer-reviewed empirical journal articles, and (4) available in English. We used a three-step search strategy to find relevant articles. Keywords found from the first two steps were entered into PsycINFO, PsycArticles, PubMed, Scopus, and Web of Science databases. Reference lists of the included articles were also examined. The identified articles were then screened using the inclusion and exclusion criteria. Twenty-eight articles met inclusion and exclusion criteria. Twenty-six articles referenced VT or related terms, one referenced VPTG, and one referenced vicarious trauma keywords. Results of this scoping review are summarized by definitions, measures, key findings, and knowledge gaps. Future research should focus on vocabulary management, diverse samples, and VPTG in this population, including the identification or creation of appropriate measures.

Introduction

Interpersonal traumas are defined as exposure to actual or threatened death, serious injury, or sexual violence due to perpetration by another person (American Psychiatric Association [APA], 2013). It is well-known that interpersonal traumatic events can impact the physical and mental health of survivors (Gatov et al., 2020; López-Martínez et al., 2018) and those indirectly exposed to the events (Cieslak et al., 2014; Cyr et al., 2016, 2018). Indirect exposure to interpersonal trauma occurs when an individual learns about another person’s interpersonal traumatic event (APA, 2013), typically through professional duties or as a part of one’s support network. Researchers examining indirect trauma exposure have primarily focused on helping professionals who interact with traumatized individuals as part of their professional work (Cieslak et al., 2014; McCann & Pearlman, 1990). Less studied are populations of loved ones who have been indirectly exposed to interpersonal traumas (Gregory et al., 2021). We conducted a scoping review to synthesize the literature related to potential consequences of indirect interpersonal trauma exposure, specifically vicarious traumatization (VT) and vicarious posttraumatic growth (VPTG).

One unfortunate impact of indirect trauma exposure is VT. VT was first used by McCann and Pearlman (1990) to describe the psychological impact of listening to the descriptions of traumatic events when working with trauma survivors as a therapist. Since that time, the use of VT has been applied to populations of loved ones indirectly exposed to interpersonal traumas (Bux et al., 2016) and is used interchangeably with terms such as secondary traumatic stress (STS; see e.g., Gregory et al., 2017), secondary traumatization (see e.g., Manion et al., 1996; Manion et al., 1998), posttraumatic stress disorder (PTSD; see e.g., Burgess et al., 1990; Cyr et al., 2018), and posttraumatic stress (PTS) symptoms (see e.g., Davies, 1995; Vilvens et al., 2021). VT and related terms describe negative psychological symptoms such as intrusive imagery/memories, negative affect, arousal, avoidance behaviors, and negative changes to cognitions that follow indirect trauma exposure (Mangold et al., 2021; Sparks & Stoppa, 2022).

Another possible outcome related to indirect trauma exposure is VPTG. Posttraumatic growth was first described by Tedeschi and Calhoun (2004) as the positive changes in one’s life domains (e.g., appreciation of life, priorities, and possibilities, relationships, spirituality, and personal strength) due to cognitive processing and emotional engagement after a traumatic event. VPTG originated from researchers extending the definitions of posttraumatic growth (Tedeschi & Calhoun, 2004) to individuals who have experienced indirect trauma exposure and experience growth thereafter (Arnold et al., 2005; Manning-Jones et al., 2015). Instead of VPTG, other researchers use the term vicarious growth to describe the positive changes to oneself and worldviews following indirect trauma exposure (McCormack et al., 2011). Overall, VPTG and vicarious growth are defined as the positive changes that occur cognitively, emotionally, interpersonally, and/or spiritually because of indirect trauma exposure (Arnold et al., 2005; Cummings, 2018; Manning-Jones et al., 2015; McCormack et al., 2011). Nonetheless, it appears to be understudied in loved ones indirectly exposed to interpersonal trauma.

No reviews have collated and summarized the research on loved ones’ experiences of VT and VPTG following indirect interpersonal trauma exposure. Accordingly, a scoping review examining these outcomes was needed to fully understand and summarize these experiences among loved ones. Our scoping review mapped the relevant empirical literature on this topic guided by the question: what has been found in the published scholarly literature examining indirect exposure to interpersonal traumatic events among loved ones regarding VT and VPTG? Identifying the available information related to these outcomes was key to (1) clarifying the definitions in the literature, (2) examining how research is conducted on this topic, (3) identifying key findings related to the concepts, and (4) identifying knowledge gaps (Munn et al., 2018).

Method: A-Priori Protocol

We used the Joanna Briggs Institute (JBI) methodology (Peters et al., 2015, 2017) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Scoping Reviews checklist for reporting guidelines (Tricco et al., 2018), both of which are considered “gold standard” approaches for scoping reviews. The JBI methodology begins with the development of an a-priori protocol which provides a plan for the review and reduces reporting bias (Peters et al., 2015). The protocol outlined the pre-defined objectives and research question(s), topic background, inclusion and exclusion criteria for articles, search strategy, data charting, and results presentation. We searched for, selected, extracted, charted, and then summarized the evidence gathered regarding the scoping review objectives and questions (Peters et al., 2017). Consultation with other researchers and librarians occurred throughout the scoping review process. For example, our disciplinary librarian reviewed the scoping protocol before it was finalized and assisted with decisions related to databases to search. We conducted a preliminary search for existing scoping reviews on this topic using the following databases: PsycINFO, PubMed, APA PsycArticles, Scopus, and Web of Science. We found no evidence to suggest that a scoping review on this topic had previously been conducted.

Inclusion and Exclusion Criteria

Types of Participants

Participants were adults (age 18+) who had been indirectly exposed to the trauma of a loved one in adulthood, regardless of sex or gender. The participants must have known about (i.e., been exposed to) an interpersonal traumatic event that happened to a loved one (i.e., a family member, partner, spouse, child, or friend) to be included.

Concept

The core concepts were the outcomes of loved ones who have been indirectly exposed to an interpersonal traumatic event that happened to a friend, partner, or family member. Any studies focusing on war-, terrorism-, or intergenerational-traumas and any non-interpersonal traumas (e.g., accidents, natural disasters) were excluded. The focus had to be on the impact of the indirect interpersonal trauma exposure, specifically VT, secondary traumatization, STS, PTSD, PTS, VPTG, posttraumatic growth, and/or event centrality. The original data collection was a part of a larger project, and thus event centrality was present in the search terms. The articles looking at VT had to discuss posttraumatic symptoms such as intrusive imagery/memories, negative affect, arousal, avoidance behaviors, and negative changes to cognition; articles that solely focused on distress or stress were excluded.

Context

This scoping review excluded previously published evidence that was based on populations of individuals who experienced trauma through their profession (i.e., occupational traumas), including mental health workers, health care workers, military personnel, journalists, first-responders, and any other professionals that appeared in the search.

Types of Sources

Our scoping review included published peer-reviewed empirical (qualitative and/or quantitative) journal articles and excluded gray literature. This decision ensured that only high-quality, peer-reviewed research was included (Felthous & Wettstein, 2014). Reviews were excluded but were examined for relevant articles. Treatment outcome studies were also excluded.

Search Strategy

We used a three-step search strategy (Peters et al., 2015, 2017). The first step was a limited search of two online databases appropriate for the scoping review topic (PsycINFO and Scopus). This initial search examined the title, abstract, and index terms of articles related to the topic. This helped identify keywords and index terms then used in the second search strategy step. The second step involved entering the identified keywords and index terms into PsycINFO, PsycArticles, PubMed, Scopus, and Web of Science databases. The third step involved examining the reference lists of the included articles for additional studies.

We first screened the identified articles by examining the title and abstracts; the articles that did not meet the inclusion and exclusion criteria or were duplicates were removed. The remaining articles were then subjected to a full-text screening. The screening process was primarily undertaken by the first author, with the oversight of the second author until a consensus was reached on the included articles. Articles from which the full text could not be retrieved online or through the [redacted for blind review] library (including interlibrary loan) were excluded.

Results

Search Strategy Results

The keywords identified in the first search strategy step can be found in Table 1. Outcome terms were searched with population terms, and the relevant articles were scanned for their keywords. A list was compiled until saturation was reached (i.e., no more relevant keywords were found; see Table 2). These keywords were entered into the selected databases and the abstract, title, and citation for the articles were exported. Operators “OR”, “AND”, and “AND NOT” were used to broaden and narrow the search in their appropriate places. This created more accurate results that pertained to the outcomes and only the populations of interest (e.g., vicarious trauma AND parents). For two databases, we were able to enter all search terms together and export the abstracts. For three databases, we had to conduct four separate searches (i.e., one for indirect trauma exposure keywords, one for VT keywords, one for VPTG keywords, and one for vicarious event centrality keywords) and export the abstracts for each. The latter exporting method was necessary due to the size limitation for exporting files for these databases. We acknowledged that this resulted in additional duplicates.

Table 1.

Initial Search Terms Entered Into PsycINFO and Scopus.

Type of Keyword	Entered Keywords
Outcome	Vicarious trauma*
	Indirect trauma*
	Secondary trauma*
	Vicarious posttraumatic growth
	Vicarious event centrality
Population	Loved ones
	Parents
	Significant others
	Child*
	Spouse
	Partner
	Family
	Friend
	Dependents

^*An asterisk was used to truncate words to their root.

Table 2.

Final Search Terms Entered into All Databases.

Type	Entered Keywords
Indirect trauma exposure keywords	indirect trauma exposure, vicarious trauma, vicarious trauma exposure, child disclosures, domestic violence disclosure, extrafamilial child sexual abuse disclosure, dual traumatic exposure, indirect trauma, secondary trauma, trauma transmission, vicarious experience, vicarious experiences, vicarious exposure, vicarious victimization
Vicarious/secondary traumatization keywords	Vicarious traumatization, vicarious traumatization, secondary traumatization, secondary traumatization, Secondary traumatic stress, STS, secondary trauma stress, secondary trauma symptoms, caregiver burden, caretaker distress, compassion fatigue, interpersonal distress, systemic traumatic stress, systemic traumatology
Vicarious posttraumatic growth keywords	vicarious posttraumatic/post traumatic/post-traumatic growth, vicarious psychological growth, vicarious growth, secondary growth, secondary post-traumatic growth, secondary psychological growth
Vicarious event centrality keywords	vicarious event centrality, vicarious memory
Loved ones keywords	loved ones, parent*, significant other*, child*, sibling*, spouse*, partner*, friend*, dependent*, adult disclosers, brother*, sister*, caregiver*, carer*, caretaker*, caregiver*, partner*, couple*, dyads, family*, families*, father*, interpersonal relationship*, wives, husbands, mother*, offspring*, secondary survivor*,
Exclusion keywords	counselor, worker, mental health worker, therapist, first responder, firefighter, provider, health care worker, nurse, professional, transgenerational, patient

^*An asterisk was used to truncate words to their root.

Overall, a total of 11,591 abstracts were initially collected. During the screening process, we noted that the “AND” function had not worked for the PsycINFO database; thus, the search was not limited to the population of interest. The decision was made to continue screening with the PsycINFO dataset. This resulted in the collection of more irrelevant abstracts than intended; PsycINFO comprised almost 43% of the total abstracts. After the initial screening, 179 articles potentially met inclusion and exclusion criteria. After reviewing the full texts, eight articles were deemed eligible for the scoping review. The reference lists of these articles were examined, and an additional 15 studies met inclusion and exclusion criteria. The reference lists were examined, and two more articles were found. Additionally, three articles from our previous knowledge on this topic met the inclusion and exclusion criteria. The reference lists of these were examined. No further articles were found. The final sample for the scoping review was 28 articles.

Descriptive Summaries

The 28 included articles were published between the years 1990 and 2022. The median year was 2016, when six articles were published. Studies were conducted in the USA (12/28), Canada (5/28), South Africa (3/28), the United Kingdom (2/28), Denmark (1/28), the Netherlands (1/28), Norway (1/28), Australia (1/28), the Republic of Ireland (1/28), and one was not specified. In total, 12 articles (12/28; ~43%) used qualitative research methods, and 16 articles used quantitative methods (16/28; ~57%; see Table 5). Most studies focused on parents/caregivers of individuals who had experienced an interpersonal trauma (22/28; ~79%) and on individuals indirectly exposed to child sexual abuse (CSA; 21/28; 75%; see Table 3). Unexpectedly, 50% of the studies did not comment on the ethnicity of participants. Of those reporting ethnicity, participants were predominantly White/Caucasian (see Table 4 for demographics).

Table 5.

Data Summary.

Author (Year)	Aim	Method and Analyses	Tool	Terms	Key Findings
Anderson Jacob and McCarthy Veach (2005)	“The present study was designed to qualitatively assess intrapersonal and familial effects of CSA on FPs of male CSA survivors.” p. 285	Qualitative; Interviews; Consensual qualitative research analysis	n/a	Trauma contagion, healing themes	Female partners of male CSA survivors described threatened beliefs and shattered assumptions, chronic stress, and repetition-re-enactment of aspects of the CSA in the relationship, supporting trauma contagion. Female partners of male CSA survivors cited healing themes when discussing the effects of the trauma (e.g., coping techniques, emotional reactions, roles, self-esteem, sexual and emotional intimacy, couple strengths, and family impact).
Burgess et al. (1990)	“The paper seeks to add to the empirical literature by comparing parental response to child sexual abuse by whether or not their child testified in a trial.” p. 396	Quantitative; Questionnaires; Planned comparisons, chi square analyses	IES	PTS, PTSD	Mothers of children who testified compared to mothers of children who did not testify scored significantly higher on the Avoidance and Intrusion subscale of the IES. Fathers of children who testified compared to mothers of children who did not testify scored significantly higher on the Avoidance and Intrusion subscale of the IES.
Bux et al. (2016)	“The objective of this study was to explore the experiences of nonoffending caregivers in order to understand how disclosure impacts their psychological well-being and to document the difficulties and challenges that caregivers face in the aftermath.” p. 90	Qualitative; Semi-structured interviews; Inductive thematic analysis	N/A	VT, PTSD, secondary traumatization	The impacts of VT of child sexual abuse on the caregiver were grouped into five themes: 1. Distress, including physical, emotional, medico-legal and situations distress. 2. Concern for the child, including physical closeness, emotional closeness, HIV status, concern about safety, and the future. 3. Alienation, including community alienation and family alienation. 4. Coping Style, including action coping and emotional coping. 5. Grief, including grieving for what their child endured, their child’s loss of innocence, loss of faith in their worth as a caregiver, and loss in their sense of trust, which was associated with anger, bargaining, despair, and hope.
Christiansen et al. (2012)	“Although the primary focus of this study is on individual reactions, particularly PTSD, we will also examine how the secondary victims experience the support they provide for the PV, as well as how the relationship with the PV is affected by the rape.” p. 248	Quantitative; Questionnaires; Planned comparisons, chi square analyses, ANOVAs, hierarchical linear regression analyses	HTQ	PTSD, secondary traumatization	Twenty-six percent of participants met the three core criteria for a PTSD diagnosis (re-experiencing, avoidance, arousal) and 36% met criteria for subclinical PTSD, falling one avoidance or arousal symptom short of the diagnosis. Additionally, 79% of participants fulfilled re-experiencing criteria and 64% fulfilled arousal criteria. Meeting avoidance criteria was less common (28%).
Cummings (2018)	The purpose of this study was to “develop a cohesive theory of how parenting strategies change following child trauma.” p. 118	Qualitative; Interviews; Grounded theory analysis	n/a	Posttraumatic growth, VTG, thriving recovery	The Protecting and Healing model described how and why parents adjusted their parenting strategies following their child’s trauma through the phases of destabilization, recalibration, and stabilization. In the stabilization phase of the model, parents experienced thriving recovery where negative symptoms were alleviated and posttraumatic gains in communication, intimacy as a family, support, and familial emotional intelligence were seen. Thriving Recovery was consistent with models of posttraumatic growth as parents experienced challenges to schemas about the self and the world, distress caused by a stressor, and cognitive processing that led to positive changes not previously available to them. There were two differences between their model and PTG. First, Protecting and Healing described the purpose of shattered views/schemas, which was to give the parent the energy and motivation to heal the child, and second, that parents did not discuss meaning making.
Cyr et al. (2016)	“The aim of the present study was to assess the mental and physical health of nonoffending parents following disclosure of sexual abuse of one of their children and to determine whether gender differences among parents existed. A second objective was to identify whether other variables (related to CSA, sociodemographic characteristics, parents’ maltreatment history, and life and disclosure event stressors) could predict parents’ mental and physical health.” p. 760	Quantitative; Questionnaires and structured interviews; Analyzed using generalized estimating equations (GEE)	MPSS-SR and SCID	PTSD	Thirty-two percent of mothers met criteria for PTSD related to the CSA disclosure when evaluated by a clinician with the SCID and 13.1% of mothers met criteria based on the MPSS-SR. 7.1% of fathers met criteria for PTSD related to the CSA disclosure with the SCID, and 7.3% of fathers met criteria based on the MPSS-SR. PTSD measured by the SCID was explained partly by gender and post disclosure distress, meaning mothers and those with higher levels of post disclosure distress were significantly more likely to receive a PTSD diagnosis.
Cyr et al. (2018)	“This study pursues three objectives. The first one is to assess the evolution of the psychological and physical health statuses of nonoffending parents of sexually abused children, as well as their use of health care services, throughout the first year that followed their children’s CSA disclosure and 6 months later. . . The second objective is to examine the differential responses of mothers and fathers. . . Finally, the third objective is to verify whether other variables, such as childhood history of maltreatment, stressful life events, sociodemographic variables and characteristics of the CSA and the child, are related to the parent’s health over time.” p. 151	Quantitative; Questionnaires; Analyzed using generalized linear mixed models	MPSS-FC	PTSD, PTS symptoms	The main effect of gender indicated that significantly more mothers displayed a clinical level of PTSD symptoms compared to fathers (15.4% vs. 3.3%), whereas the main effect of time illustrated a significant decrease between 12 months and 18 months after disclosure; 10.2% of mothers still displayed a clinical level of PTSD symptoms at the 18-month assessment compared to 0% of fathers. Factors related to PTSD scores included the past level of PTSD and the time between disclosure and evaluation.
Davies (1995)	“This small-scale exploratory study aims to identify particular areas of difficulties experienced by parents of children who were extra-familial abused.” p. 400	Quantitative; Questionnaires; Exploratory analysis	IES	PTS	Of 30 parents, seven mothers scored above the intrusive subscale cut-off point, no fathers scored above the intrusive subscale cut-off point, seven mothers scored above the avoidance subscale cut-off point and four fathers scores above the avoidance cut-off point. Parents experienced a range of problems following disclosure, including marital dissatisfaction, depression, posttraumatic stress, loss of significant relationships, and unresolved anger.
Dyb et al. (2003)	“The current study aimed to assess parents’ PTSD symptoms and general psychological responses to a national publicized case of alleged CSA at a day care center in Norway 4 years after disclosure.” p. 940	Quantitative; Questionnaires; Analyzed using Mann–Whitney test comparisons, correlations, and multiple stepwise regressions	IES	PTSD, PTS symptoms	Four years after the alleged sexual abuse of their children, 33.3% of 39 parents were classified with high scores, 25.6% with medium scores, and 41.0% with low scores on the intrusion scale. 25.6% of parents were classified with high scores, 46.2% with medium scores, and 28.2% with low scores on the avoidance subscale. General psychological wellbeing was significantly positively correlated with both PTSD intrusion and avoidance scores. Several independent variables were significantly correlated with IES intrusion scores (e.g., locus of control, secondary life changes, abuse severity), whereas other variable were not correlated (e.g., participating in police interviews, media exposure, testifying in court, perceived social support). Several independent variables were significantly correlated with IES avoidance scores (e.g., locus of control, secondary life changes, testifying in court, and participating in police interviews), whereas other variables were not correlated (e.g., abuse severity, media exposure, and perceived social support). The strongest predictors of PTS symptoms were locus of control and secondary life changes, which accounted for 27% and 49% of the variance for intrusion and avoidance, respectively. There were no significant differences between mothers vs fathers, couples vs. single parents, or parents with one vs two children at the day care on the IES.
Fuller (2016)	“This research examines two key aspects of secondary victimization in this context. The first is how CSA impacts the parents of victims, focusing on their emotional responses to the sexual assault. The second is how these responses shape the way parents help their child cope with the sexual assault.” p. 2	Qualitative; Archived database of psychological evaluations; Unspecified analysis	n/a	PTSD	Parents in the short-term felt distress, anger, confusion, numbness, and shock. In the long-term, they described desiring vengeance, expressing anger at the justice system, anxiety, depression, suicidal ideation, feelings of failure, guilt, hopelessness, diminished self-worth, symptoms of PTSD (e.g., intrusive thoughts, images, and nightmares about the abuse). More fathers reacted with anger than mothers. Most parents described that their priority was helping their child cope with the sexual assault post-disclosure (e.g., communicating with survivor about their wishes and needs). Parents also reported overprotection, intrusion into their child’s lives, isolating the family and themselves, mistrusting others, using alcohol, overworking, using counseling, and relocating away from the place of abuse.
Green et al. (1995)	“This paper will present the case histories of four women who developed symptoms of posttraumatic stress disorder (PTSD) following the disclosure of the molestation of their daughters” p. 1275	Qualitative; Case Histories; Descriptive	n/a	PTSD, Delayed PTSD, Complex PTSD	Mothers experienced intrusive memories, re-experiencing, autonomic hyperarousal, and psychic numbing from their own sexual abuse after their daughter’s disclosure, conceptualized as delayed PTSD and consistent with Complex PTSD. The mothers also presented with depression, suicidality, anxiety, impulsivity, somatization reactions, and personality disorders.
Gregory et al. (2017)	“The aim of the research was exploratory, with the following research question: what are the health and well-being impacts on adults who provide informal support to female DV survivors?” p. 1	Qualitative; Semi-structured interviews; Thematic analysis	N/A	STS, PTSD	Anger, fear, sadness, helplessness, disruptions to core beliefs, and disrupted sleep were experienced by participants, reflecting similar symptoms experienced by those directly exposed to trauma. Furthermore, health and well-being impacts of providing informal support to DV survivors included: 1. Impacts following the incidents (shock, horror, fear, and panic). 2. Impacts resulting from the overall strain of the situation (anger and frustration, anxiety and worry, distress and upset, overwhelm and saturation, tension and turmoil, sense of responsibility, feeling disempowered, sadness and depression, confusion and uncertainty, guilt and self-blame). 3. Physical health impacts (physical symptoms and ailments, sleep difficulties, appetite and weight loss).
Jobe-Shields et al. (2016)	“. . .the present study had two aims: (a) to describe rates of clinical depression and clinically significant levels of PTS in a sample of nonoffending caregivers following CSA and (b) to compare self-reported and child-reported parenting practices (positive parenting, poor monitoring, corporal punishment, inconsistent parenting, and caregiver involvement) between four groups of caregivers: those with clinically significant levels of PTS (PTS only), those with clinical depression (depression only), those with both (combined), and those with neither (no condition).” p. 113	Quantitative; Questionnaires; Planned comparisons (ANOVAs) and correlational analyses	PSS-SR	PTS Symptoms, PTSD	Caregivers reported experiencing an average 7.84 PTS symptoms (criteria B, C, and D summed; range 0–16). 14% (n = 13) obtained scores in the clinically significant range. For caregiver report on inconsistent discipline, caregivers with depression only or PTS only had higher scores than caregivers in the no condition group (the combined PTS and depression group did not significantly differ from any groups). For child-reported inconsistent discipline, caregivers in the PTS only group had higher scores than those with no distress or the depression only group. There was no significant difference between the PTS only and combined group, nor among the combined group and the other groups.
Kelley (1990)	“The purpose of this study was to empirically validate parental stress responses to extrafamilial sexual and ritualistic abuse.”	Quantitative; Questionnaires; Planned comparisons (ANOVAs, T-tests) and correlations	IES	PTSD	Mean scores on the IES indicated that parents experienced intrusive thoughts and images as well as conscious avoidance of ideas and emotions related to their child’s abuse. Mothers scored significantly higher than fathers on the intrusion subscale. There was no significant difference found between mothers and fathers on the avoidance subscale. There was no significant difference between parents of sexually abused children without ritualistic abuse and parents of sexually abused children with ritualistic abuse. Parental stress was found to be significantly correlated to the IES intrusion and avoidance subscales.
Kilroy et al. (2014)	“Thus, qualitative research exploring the impact parents experience in this context is crucial, and the overall aim of this study is just that. By examining the pathways through which a child’s abuse impacts on parental well-being, including that of fathers, this can only serve to further inform best-practice interventions in this area.” p. 484	Qualitative; Semi-structured interviews; Grounded theory analysis	n/a	Systemic trauma, relational PTSD	Eight categories emerged as the pathways to distress in parents whose children have experienced sexual abuse: family context, abuse characteristics, emotional impact, cognitions, support systems, impact on daily life, coping, and family dynamics. Overall, the core broad experience of having a child who was sexually abused was conceptualized as “systemic trauma”. This encompasses the fact that a trauma occurred that caused great distress and disruption to systems within and outside the person.
Mangold et al. (2021)	“The purpose of this research was to expand upon previous research and examine additional factors that may influence levels of STS in NOCs of children with trauma histories. . . As a secondary objective, this research examined the interactions between children’s self-reports of their own posttraumatic stress disorder (PTSD) symptomatology, NOCs’ estimates of their children’s PTSD” p. 554	Quantitative; Questionnaires; Point-biserial correlation coefficients (PBC), ANCOVAs, Independent linear regression analyses	PCL-5	STS, PTSD symptomatology	Twenty-four percent of 150 nonoffending caregivers (NOC) were identified as having STS based on the clinical cut-off of 33 on the PCL-5. Their self-reported PCL-5 scale scores (except for intrusion) were significantly related to their relationship with the abuser. No relationship was found between NOCs scores on the PCL-5 and child self-reported PTSD symptoms on the CPSS. NOC self-reported STS scores were significantly related to NOC reported child PTSD symptoms. NOC reported child scores significantly predicted all NOC self-reported STS symptomatology. Child reported PTSD scores did not predict NOC self-report STS symptomology. There were significant relationships between NOC PCL-5 scores and their own trauma history, elapsed time since disclosure, and gender of children. Discrepancy scores between NOC and child reported PTSD symptomology were impacted by children’s ages and genders.
Manion et al. (1996)	“First, the study attempted to answer the following key questions: Does ESA have an impact on parent functioning? To what extent can the objective aspects of the abusive incident(s) and the subjective experience of the abuse predict parents’ initial adjustment? Second, the study attempted to overcome methodological limitations in current literature” p. 1097	Quantitative; Questionnaires; Planned comparisons (e.g., MANCOVAs), regressions	IES, BSI	Secondary traumatization, PTSD	Mothers of children who had been sexually abused experienced significantly more IES intrusive and avoidant symptoms than did fathers. Mothers were at significantly greater risk of clinical levels of distress compared to case fathers on the BSI subscales of psychoticism, phobias, and hostility. Total PTSD symptoms were not significantly related to the severity of the child’s sexual abuse, maternal perceptions of the child’s functioning, or maternal abuse history. Additional analyses regarding distress, family functioning, marital functioning, and parenting were conducted.
Manion et al. (1998)	“This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.” p. 1287	Quantitative; Longitudinal; Questionnaires; Planned comparison (e.g., MANOVAs, MANCOVAs), regressions	IES, BSI	Secondary Traumatization, PTSD	Mothers of abused children had significantly higher levels of avoidant and intrusive symptoms on the IES than did fathers. Parents combined had higher levels of intrusive and avoidant symptoms at 3 months compared to 1 year post disclosure. Mothers’ satisfaction in the parenting role, perceived total support, and mothers’ intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, mothers’ perception of internalizing problems in their child, and mothers’ initial emotional distress were significant predictors of longer-term emotional functioning. Additional analyses regarding emotional distress, family functioning, and parenting were conducted.
Masilo and Davhana-Maselesele (2016)	“The purpose of this study was to explore and describe the experiences of mothers of SAC post disclosure, with the aim of developing recommendations.” p. 2	Qualitative; Unstructured interviews and field notes; Exploratory, descriptive, and contextual qualitative analysis	n/a	PTSD	Mothers’ exhibited symptoms of depression and PTSD post-disclosure. Overall, their experiences post-disclosure were summarized into three themes: 1. Reaction of participant to disclosure of CSA. This included emotional and psychological reactions, socio-economic reaction, and spiritual reactions. 2. Effects of child abuse on a child as viewed by mothers. This included physical and psychological trauma observations and feelings for revenge on perpetrators. 3. Experiences regarding support. This included experiences regarding medical support, experiences related to legal support, and experiences related to societal support.
Nelson & Wampler (2002)	“This study addressed the effects of childhood sexual abuse (CSA) on the individual trauma survivor (primary partner), the spouse/partner (secondary partner), and their relationship by comparing these couples to a clinical control sample of couples with no CSA reported by either partner” p. 88	Quantitative; Questionnaires; Comparisons using ANOVAs and MANOVAs	PPTSD-R, BSI	Secondary trauma, secondary traumatization, PTS symptoms, PTSD	On the PPTSD-R, females reported significantly more trauma symptoms than males, and couples in the CSA group reported significantly more trauma symptoms than couples in the control group. On the three PPTSD-R subscales (re-experiencing, avoidance, and arousal) there was no significant differences between groups, but females reported significantly more avoidance and arousal symptoms than males. Comparisons between groups on the BSI subscales and relationship functioning were also examined. The results indicated that CSA survivor partners experienced higher stress and trauma symptoms compared to clinical controls, and that this provided support for the theory of secondary trauma.
Newberger et al. (1993)	“The course of mothers’ psychological symptomatology over the year following disclosure of their children’s sexual abuse will be examined, as will relationships between mothers’ emotional well-being and their children’s emotional states.” p. 93	Quantitative; Questionnaires; Longitudinal, planned comparisons (T-tests), linear regressions, and correlations	Brief Symptom Inventory (BSI)	PTSD	At the initial interview, mothers had significantly higher overall emotional stress scores (GSI) than the normal populations, and all nine specific symptom subscales were elevated. Twelve months later, mothers’ GSI scores significantly declined, but one-third of mothers had scores in the clinical range. Each symptom dimension had significantly decreased except for anxiety at the follow-up. However, hostility, phobic anxiety, paranoid ideation, psychoticism, and anxiety remained significantly higher than the normal population. These elevations were seen as consistent with the diagnostic criteria for PTSD. The relationships between GSI scores and various factors (e.g., financial status, therapy participation, children’s treatment contacts, and children’s perceived and self-report symptoms) were examined.
Runyon et al. (2014)	“The purpose of the present study was to examine the relationship between abuse-specific cognitions with symptoms in maternal caregivers.” p. 149	Quantitative; Questionnaires; Correlations and hierarchical regression analyses	IES-R	Traumatic stress symptoms, PTSD	Depression (as measured by the BDI-II) scores were significantly related to traumatic stress scores (as measured by IES-R). Abuse specific cognitions and negative general attributional style were not significantly related to traumatic stress scores after controlling for depression.
Smith (2005)	“The present study sought to understand the MSO [male significant other]’s meaning of the sexual assault and the emotional impact it had on him”	Qualitative; Interviews; Existential-phenomenological method of analysis	n/a	PTSD	Men were found to experience similar psychological and interpersonal difficulties as the survivor, including depression, guilt, self-blame, loss of trust, withdrawal from others, sleep disturbances, and PTSD symptoms. Specifically, themes for the impact on males whose female significant others were sexually assaulted included: 1. Immediate thoughts and feelings, including denial, anger, guilt, depression, need for justice, assigning blame, and a sense of betrayal. 2. Relationship with the survivor, including negative changes to the relationship. 3. Worldview on male attitudes, including seeing males as being untrustworthy. 4. Long term effects of the trauma, including guilt, protectiveness, depression, powerlessness, and anger.
Sparks & Stoppa (2022)	“The current study explored the experiences of two sets of parents soon after their adult sons’ disclosure of CSA by a common perpetrator.” p. 2	Qualitative; Interviews; Thematic narrative analysis	n/a	Systemic trauma, secondary traumatization	Parents had intrusive thoughts and images about the trauma, re-experiencing of the imagined abuse, intense emotional responses, hyperarousal, and negative thoughts and emotions. These descriptions were noted as consistent with previous discussions of secondary traumatization. Overall, three themes arose for the experiences of parents of adult disclosers of CSA, this included: 1. Emotional impact of the disclosure, including bewilderment and disbelief, hyperarousal, anger, sadness, and grief. 2. Cognitive impacts of the disclosure, including ongoing self-assessments and changing views of others. 3. Parents purposeful responses to the experience, including parents believing, supporting, and empowering their children.
Timmons-Mitchell et al. (1996)	“In the present study, mothers who reported a history of child sexual abuse were compared with mothers who did not report such a history on two measures of functioning.” p. 464	Quantitative; Questionnaires; Analyzed with planned comparisons (T-tests)	PPTSD-R; SCL-90-R	PTSD	Women whose children recently reported sexual abuse experienced significantly higher scores for PTSD total, re-experiencing, arousal, and avoidance symptoms, compared with the normative sample for the PPTSD-R. Mothers with their own CSA history had significantly higher scores for total PTSD, re-experiencing, and arousal (but not avoidance) compared to the normative sample. Mothers without their own CSA history had significantly higher scores from the norm on only arousal. On the Crime Related PTSD scale on the SCL-90-R, the total group of mothers and mothers with CSA history displayed PTSD symptoms based on the cut-off score of .89. The mothers with CSA history had significantly higher overall distress, somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, paranoia, and PTSD compared to mothers without CSA history. There were no significant differences between the groups on hostility, phobic anxiety, and psychoticism on the SCL-90-R.
Van Delft et al. (2016)	“Our first aim was to examine whether pathogen, sexual, and moral disgust sensitivity were associated with maternal PTS symptoms. . . Our second aim was to examine whether disgust sensitivity would be associated with PTS symptoms over and above the maternal history of CSA and biological relatedness of the perpetrator. . . The final aim of this study was to examine the possible moderating effect of biological relatedness with the perpetrator on association between disgust sensitivity and PTS symptoms.” p. 238	Quantitative; Questionnaires; Descriptive, correlational, and hierarchical regression analyses	IES-R	PTS symptoms, STS	The percentage of mothers that scored above the suggested cut-off for high levels of PTS symptoms was 38.9%. A mother’s history of CSA herself and biological relatedness with the perpetrator were not related to PTS symptoms. Sexual disgust sensitivity was significantly positively associated with PTS symptom severity. When the perpetrator was biologically related to the child, mothers’ PTS symptoms were similarly high regardless of maternal levels of sexual disgust sensitivity. However, mothers with high levels of sexual disgust sensitivity showed significantly higher levels of PTS symptoms when the perpetrator was biologically unrelated to the child.
Van Wijk et al. (2014)	“The aim of the study was to explore, analyze and interpret the lived experiences of MIPs of female rape victims and the meaning of these experiences in the six months following the partner’s rape.” p. 2	Qualitative; Interviews; Longitudinal hermeneutic phenomenological study	n/a	Secondary victims, secondary trauma, vicarious trauma	Significant others were seen as no less affected than primary victims as the trauma shattered their assumptions about themselves, their relationships, and the world around them, leading to negative consequences such as negative self-image, feelings of guilt, helplessness, and fear, and relationship difficulties. Overall, two themes emerged as the main lived experiences of MIPs of female rape victims: (1) being-in-the-world as a secondary victim of rape, including feeling their life had changed and feelings of frustration, powerlessness, humiliation, and horror. It included the subthemes of (a) violation of one’s intimate property, (b) guilt and helplessness, and (c) being in the world with their partner (e.g., effects on relationship). (2) living in multiple worlds, including two subtheme of (a) being in the world with others (e.g., important of receiving support from others and reactions of others to disclosure) and (b) outward adjustment (e.g., feeling overwhelmed in their adjustment to new routines, their relationship, and their own feelings, and methods of coping).
Vilvens et al. (2021)	“Given the significant role of the nonoffending parent in the recovery of the sexually abused child, the purpose of this study was to gain a deeper understanding of how nonoffending parents recover from a CSA event in order to improve programs and services.” p. 2691	Qualitative; Semi-structured interview; Inductive thematic analysis	n/a	PTS, recovery	Five themes were related to the healing process of parents of children who experienced CSA: (1) a variety of emotions are present; (2) family context influences recovery; (3) coping is different for everyone; (4) navigating the justice system is frustrating; and (5) healing is a process. Some parents described feeling “stuck” in their recovery and they described anxiety, depression, posttraumatic stress, an inability to forgive the perpetrator, and that the event identifies them as a parent. Non-offending parents who described less chaos in their family unit, processed their emotions, employed positive coping strategies, felt the perpetrator was served justice, and could accept a new normal were further along in the healing process.

Note. ANOVA = Analysis of variance; BSI = Brief Symptom Inventory; CSA = child sexual abuse; HTQ = Harvard Trauma Questionnaire; IES = Impact of Event Scale; MANOVA = Multivariate analysis of variance; PTS = posttraumatic stress; PTSD = posttraumatic stress disorder; PPTSD-R = Purdue Posttraumatic Stress Disorder, Revised; SCL-90-R = Symptom Checklist 90-Revised; VPTG = Vicarious posttraumatic growth; VT = vicarious traumatization.

Table 3.

Type of Loved One and Interpersonal Trauma.

Author (Year)	Type of Loved One**	Type of Interpersonal Trauma
Anderson Jacob and McCarthy Veach (2005)	Partners (female partners of male survivors)	CSA
Van Wijk et al. (2014)	Partners (male partners of female survivors)	Sexual assault
Nelson and Wampler (2002)	Partners (male partners of female survivors)	CSA
Smith (2005)	Partners (male partners of female survivors)	Sexual assault
Burgess et al. (1990)	Parents/Caregivers (mothers and fathers of child survivors)	CSA
Bux et al. (2016)	Parents/Caregivers (mothers and one sister of child survivors)	CSA
Cummings (2018)	Parents/Caregivers (mothers and fathers of child survivors)	Sexual abuse, witnessing domestic violence, physical abuse, or bullying
Cyr et al. (2016)	Parents/Caregivers (mothers, stepmothers, father, and stepfathers of child survivors)	CSA
Cyr et al. (2018)	Parents/Caregivers (mothers, stepmothers, father, and stepfathers of child survivors)	CSA
Davies (1995)	Parents/Caregivers* (parents and stepparents of child survivors)	Extra-familial CSA
Van Delft et al. (2016)	Parents/Caregivers (mothers of child survivors)	CSA
Dyb et al. (2003)	Parents/Caregivers (mothers and fathers of child survivors)	Sexual abuse, physical abuse, or threats
Fuller (2016)	Parents/Caregivers (mothers, fathers, and stepfathers of child survivors)	CSA
Green et al. (1995)	Parents/Caregivers (mothers of child survivors)	CSA
Jobe-Shields et al. (2016)	Parents/Caregivers* (biological/adoptive parents, stepparents, legal guardians, and other custodial guardians of child survivors)	CSA
Kelley (1990)	Parents/Caregivers (mothers and fathers of child survivors)	CSA with and without ritualistic abuse
Kilroy et al. (2014)	Parents/Caregivers (biological mothers and fathers of child survivors)	CSA
Mangold et al. (2021)	Parents/Caregivers* (caregivers of child survivors)	Physical or sexual abuse
Manion et al. (1996)	Parents/Caregivers (parents/mothers/fathers, stepparents, and foster parents of child survivors)	Extra-familial CSA
Manion et al. (1998)	Parents/Caregivers (parents/mothers/fathers, stepparents, and foster parents of child survivors)	Extra-familial CSA
Masilo and Davhana-Maselesele (2016)	Parents/Caregivers (any maternal stepparent, caregiver, foster parent, adoptive parent, grandparent, or biological parent of child survivors)	CSA
Newberger et al. (1993)	Parents/Caregivers (mothers, custodial stepmothers, and custodial grandmothers of child survivors)	CSA
Runyon et al. (2014)	Parents/Caregivers (biological and nonbiological maternal caregivers of child survivors)	CSA
Sparks and Stoppa (2022)	Parents/Caregivers (mothers and fathers of child survivors disclosing as adults)	CSA
Timmons-Mitchell et al. (1996)	Parents/Caregivers (mothers of child survivors)	CSA
Vilvens et al. (2021)	Parents/Caregivers (biological mothers and one biological father of child survivors)	CSA
Christiansen et al. (2012)	Close Others (mothers, fathers, sisters, friends, partners, and colleagues of survivors)	Sexual assault
Gregory et al. (2017)	Close Others (mother, father, sister, niece, daughter-in-law, current partner, friend, and work colleague to a woman who had experienced domestic violence)	Domestic violence

Note. CSA = child sexual abuse.

^*No data on gender of parents.

^**All loved ones are nonoffending.

Table 4.

Demographics.

Author (Year)	Sample Size	Age Range in Years, Mean Age	Reported Ethnicity
Anderson Jacob and McCarthy Veach (2005)	10 partners	27–51, 36.2	Caucasian (100%)
Van Wijk et al. (2014)	9 partners	25–54, —	South African (100%)
Nelson and Wampler (2002)	32 couples total, 17 in control group	21–62, 38	European American (% unspecified)
Smith (2005)	5 partners	19–43, —	Caucasian (80%), Asian (20%)
Burgess et al. (1990)	111 caregivers	Mothers: 26–43, 34.05; Fathers: 30–45, 36.5	—
Bux et al. (2016)	16 caregivers	22–61, 42	Black African (100%)
Cummings (2018)	15 caregivers	44–73, —	Caucasian (93.3%), First Nations (6.7%)
Cyr et al. (2016)	152 caregivers	Mothers: —, 27.4; Fathers: —, 41.7	French Canadian (82.4%), Other (17.6%)
Cyr et al. (2018)	124 caregivers	27–61, 37.9 (mothers), 41.2 (fathers)	French Canadian (84.3%), other (15.7%), n = unspecified
Davies (1995)	30 caregivers	—	—
Van Delft et al. (2016)	72 caregivers	—	Dutch (91.7%), 8.3% unspecified
Dyb et al. (2003)	39 caregivers	—, 39.2	—
Fuller (2016)	26 caregivers	—	—
Green et al. (1995)	4 caregivers	—	—
Jobe-Shields et al. (2016)	96 caregivers	—	—
Kelley (1990)	230 caregivers total: 57 in experimental group 1, 54 in experimental group 2, and 119 in comparison group	Group 1 mothers: 26–42, 33.5; Group 1 fathers: 30–45, 36; Group 2 mothers: 25–55, 34.6; Group 2 fathers: 26–55, 37; Group 3: —, —	—
Kilroy et al. (2014)	13 caregivers	33–51, —	Caucasian (92.3%), African (7.7%)
Mangold et al. (2021)	150 caregivers	—, 37.87	—
Manion et al. (1996)	229 caregivers total; 93 caregivers in case group (CG) and 136 in comparison group	CG fathers: —, 38.21; CG mothers: —, 34.87; Comparison group fathers: —, 41.31; Comparison group mothers: —, 38.53	—
Manion et al. (1998)	228 total; 92 caregivers in CG and 136 in comparison group	—, —	—
Masilo and Davhana-Maselesele (2016)	17 caregivers	23–59, —	—
Newberger et al. (1993)	46 caregivers	—, 33	White (76%), African American (17%), and Hispanic (7%)
Runyon et al. (2014)	68 caregivers	23–53, 33.5	Caucasian (61.8%), African American (19.1%), Hispanic (13.2%), and Biracial (5.9%).
Sparks and Stoppa (2022)	4 caregivers	40s–70s, —	—
Timmons-Mitchell et al. (1996)	28 caregivers; 14 with a history of CSA and 14 without	21–45, 33.8	—
Vilvens et al. (2021)	16 caregivers	—, —	White (50%), Black (31%), Other/Didn’t Specify (19%)
Christiansen et al. (2012)	107 close others	16–86, 39	—
Gregory et al. (2017)	23 close others	“Mid-20s-80”, —	Predominantly White (% unspecified)

Note. CSA = child sexual abuse.

^*Unclear if the percentages came from the sample of parents and children, or just the sample of parents.

—Unspecified.

There were 26 articles that referenced outcomes of VT and related terms in populations of loved ones following indirect interpersonal trauma exposure that met inclusion and exclusion criteria. These 26 articles used terms such as trauma contagion, PTS/PTSD, VT, secondary traumatization, STS, and systemic trauma to describe the negative sequela of being indirectly exposed to a loved one’s interpersonal trauma (see Table 5 for key findings related to outcomes). Although trauma contagion was not an original key search term for VT, it was decided that this term was likely overlooked when gathering search terms (Anderson Jacob & McCarthy Veach, 2005). There was one article that used indirect trauma keywords but did not use any VT keywords to describe their findings (Van Wijk et al., 2014), despite citing similar findings to other studies. As their participants exhibited similar symptoms to VT, the article was included. There was only one article that discussed VPTG, although one other article referenced “healing” themes. The definitions, tools, and knowledge gaps are highlighted below.

Definitions

Trauma Contagion

Anderson Jacob and McCarthy Veach (2005) were the only researchers to use the term “trauma contagion”. Specifically, Anderson Jacob and McCarthy Veach (2005) cited that this term came from Maltas and Shay’s (1995) trauma contagion model, which describes trauma contagion as consisting of (1) threatened beliefs and shattered assumptions, (2) chronic stress, and (3) repetition and re-enactment of facets of the vicarious trauma. Overall, the researchers concluded that their qualitative study supported the trauma contagion model, as female partners of male CSA survivors described each of the three aspects of trauma contagion.

Posttraumatic Stress/Posttraumatic Stress Disorder

PTS and PTSD were the most common terms used to describe the effect of exposure to a loved one’s interpersonal trauma. However, the definition of PTS/PTSD varied between articles. Moreover, despite noting that participants experienced PTSD symptoms, some researchers failed to define this (e.g., Masilo & Davhana-Maselesele, 2016; Smith, 2005; Vilvens et al., 2021).

Many researchers conceptualized PTS/PTSD in line with a Diagnostic Statistical Manual of Mental Disorders (DSM). For example, Newberger et al. (1993) referenced the DSM-III-R (APA, 1987) and reported that their findings were consistent with the diagnostic criteria for PTSD. Newberger et al. (1993) reported that their participants demonstrated avoidance (e.g., avoidance of trauma reminders), arousal (e.g., irritability), and diminished responsiveness (e.g., isolation). More recently, researchers referenced the DSM-IV (APA, 2000) definition of PTSD to describe participants’ symptoms of re-experiencing, avoidance, and arousal (Christiansen et al., 2012; Cyr et al., 2016; Timmons-Mitchell et al., 1996).

Other researchers defined PTS/PTSD in line with their measure of choice. This included defining PTSD/PTS as involving symptoms of intrusions and avoidance (Burgess et al., 1990; Cyr et al., 2018; Davies, 1995; Dyb et al., 2003; Kelley, 1990) or intrusions, avoidance, and hyperarousal (Jobe-Shields et al., 2016; Runyon et al., 2014; Van Delft et al., 2016). Although Fuller (2016) did not use any quantitative measures, they similarly discussed symptoms of intrusions as indicating the presence of PTSD.

Green et al. (1995) differed from other studies as they primarily referenced delayed PTSD. Green and colleagues conceptualized the parent’s experience of hyperarousal, intrusive memories and affect, and “psychic numbing” (undefined in the article) as delayed PTSD from their sexual abuse, which was catalyzed by their child’s abuse. In the discussion, Green et al. (1995) report that their findings are consistent with Herman’s (1992) definition of complex PTSD. This included having alterations in (1) affect regulation, (2) consciousness (e.g., amnesia, re-living experiences), (3) self-concept (e.g., feelings of guilt, shame, helplessness), (4) perception of the perpetrator, (5) relationships (e.g., withdrawal, distrust), and (6) systems of meaning (e.g., hopelessness, loss of faith).

Vicarious Traumatization

Bux et al. (2016) highlighted a previous definition of VT from Pearlman and Mac Ian (1995) that described it as the exhaustion and dysfunction that results from empathic engagement with another’s traumatic experience. In their discussion, however, Bux et al. (2016) described VT as the disruption of participant’s beliefs/representations about trust, control, sense of self-worth, and sense of safety.

Secondary Traumatization

Manion et al. (1996, 1998) primarily used the term secondary traumatization. They first highlight that they modified the “developmental lifespan model” (Newberger & De Vos, 1988) of child sexual victimization to create the framework from which they understood secondary traumatization. This model recognized that the trauma experience begins with the abuse event, continues throughout the disclosure, and integrates individual, cognitive, and familial variables to predict parental functioning (Manion et al., 1996, 1998). In each article’s discussion, secondary traumatization was represented as the emotional distress parents experienced following the disclosure of their child’s sexual abuse (Manion et al., 1996, 1998). Bux et al. (2016) parallel VT to Manion et al. (1996) definition of secondary traumatization. Sparks and Stoppa (2022) gave a more specific definition of secondary traumatization, referencing that it involves participants’ re-experiencing of the abuse, hyperarousal, and negative thoughts and emotions. Lastly, other researchers mention secondary traumatization (e.g., Christiansen et al., 2012) without defining it.

Secondary Traumatic Stress

Four studies mentioned STS. First, Gregory et al. (2017) referenced STS but did not define it; however, in their discussion, they described that their participants experienced anger, fear, sadness, helplessness, disruptions to sleep, and disruptions to core beliefs. They suggested that this supports that individuals providing informal support to survivors of DV are at risk for STS. Mangold et al. (2021) also researched STS, specifically with nonoffending caregivers of children who endured sexual or physical abuse. They defined it as a “set of psychological symptoms that mimic posttraumatic stress disorder” (p. 553) in the parents. Third, Nelson and Wampler (2002) vacillated in their study between the terms theory of secondary trauma, secondary traumatization, and STS, where each term was used to describe the intrapersonal and interpersonal problems suffered by partners of trauma survivors. Finally, Van Delft et al. (2016) mentioned STS, but they did not define it.

Systemic Trauma

Kilroy et al. (2014) defined systemic trauma as the experience of going through an event that causes disruption and distress to systems within and outside the person that experienced the trauma. For instance, they conceptualized that “systemic trauma” means that family context, abuse characteristics, emotions, cognitions, support systems, daily life, coping, and family dynamics are all either impacted by or are moderators of having your child experience sexual abuse. Similarly, Sparks and Stoppa (2022) reference Kilroy et al. (2014) findings on systemic trauma in their discussion.

Vicarious Posttraumatic Growth

Cummings (2018) was the only researcher to define VPTG. Cummings (2018) suggested that the last stage of their model, Thriving Recovery, is consistent with models of posttraumatic growth (e.g., Arnold et al., 2005; Tedeschi & Calhoun, 2004) as parents met the three necessary qualities: (1) challenges to schemas, (2) distress caused by a stressor, and (3) cognitive processing. Additionally, Cummings (2018) noted two differences between their model of parental recovery and posttraumatic growth. First, their model described the purpose of shattered views/schemas, which was to give the parent the energy and motivation to heal the child. Second, parents did not discuss meaning-making, which is typically a component of posttraumatic growth. Vilvens et al. (2021) and Anderson Jacob and McCarthy Veach (2005) described recovery and healing, respectively, but did not mention VPTG.

Measures

The measures used to examine the terms were the Impact of Event Scale (IES; Horowitz et al., 1979), Impact of Event Scale-Revised (IES-R; Weiss & Marmar, 1997), Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), Modified PTSD Symptom Scale-Self-Report (MPSS-SR; Falsetti, et al., 1993), French-Canadian Modified PTSD Symptom Scale (MPSS-FC; Stephenson et al., 2000), Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR; Foa et al., 1993), Purdue Posttraumatic Stress Disorder, Revised (PPTSD-R; Lauterbach & Vrana, 1996), Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1977), Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982), Structured Clinical Interview for DSM-IV (SCID; First et al., 1995), and Posttraumatic Stress Disorder Checklist for the DSM‑5 (PCL-5; Blevins et al., 2015). The most frequently used measure was the IES.

Knowledge Gaps

There were several knowledge gaps identified in this scoping review. These included: (1) unified definitions of trauma contagion, systemic trauma, secondary traumatization, STS, PTS/PTSD, and VT, (2) clarification on the differences, if any, between each of the terms, (3) quantitative research on VPTG in this population, including identification or creation and validation of an appropriate measure, (d) samples that focus on paternal parents, LGBTQIA+ partners, siblings, and friends, and (e) samples, particularly in the USA and Canada, that focus on the experience of Black, Indigenous, and People of Color (BIPOC).

Discussion

To our knowledge, this is the first scoping review on VT and VPTG in loved ones indirectly exposed to interpersonal trauma. Scoping reviews do not evaluate the quality or conclusions of the literature; rather, they provide a novel inventory of the research on a topic. Thus, this scoping review is an easily accessible catalog of literature on experiences of VT and VPTG for loved ones indirectly exposed to interpersonal trauma. This resource may be used to transfer knowledge to researchers and clinicians and illustrate areas needing further elucidation, cohesiveness, or future research. Specifically, our scoping review aimed to map the definitions, methods, tools/measures, demographics, key findings, and knowledge gaps related to the outcomes of interest. Tables 3, 4, 5, and 6 summarize our data and illustrate that there was a variety of research on VT in loved ones indirectly exposed to interpersonal trauma, which also meant variability in the terms, definitions, tools, and key findings related to VT. On the other hand, there was a paucity of research on VPTG and samples with diverse demographics. Provided below is an overview of the key findings and the associated recommendations. Table 7 summarizes these key findings.

Table 6.

Implications for Research, Practice, and Policy.

	Implications
Demographics	Further research needed with the following demographics: (1) Siblings, friends, paternal caregivers, and partners (2) Gender- and sexuality-diverse individuals (3) Black, Indigenous, and People of Color
Terms and definitions	Vocabulary management for VT and related term is needed. Indicates the need for a consensus by expert panel and stakeholders. This is necessary to: (1) Delineate the terms’ definitions. (2) Operationalize the terms. (3) Halt the interchanging of terms. (4) Allow for easy access by researchers and clinicians of pertinent information in these areas.
Measures	Creation and validation of a measure for VT and VPTG in loved ones. Assess the psychometric properties of the measure for STS and VT in loved ones.
Outcomes	Loved ones may experience VT and require services that address PTSD symptoms. Further research on VPTG in loved ones is needed. Future research on VT in a variety of demographics is needed.

Note. STS = secondary traumatic stress; VPTG = Vicarious posttraumatic growth; VT = vicarious traumatization.

Table 7.

Summary of Major Findings.

	Major Findings
Demographics	Majority of research studies examine parents/caregivers. Minimal research has been conducted on siblings, friends, partners, and paternal caregivers. Most studies use predominantly White/Caucasian samples. No studies with gender- or sexuality-diverse samples.
Terms and definitions	Variable vocabulary is used to describe traumatization of loved ones. Terms include trauma contagion, PTS/PTSD, VT, secondary traumatization, STS, and systemic trauma. Researchers using similar terms often used different definitions.
Measures	No study used specific measures of VT, despite available measures. No quantitative studies examined VPTG; thus, no measures were highlighted.
Outcomes	VT is possible for loved ones indirectly exposed to trauma across populations of caregivers, significant others, friends, and other close individuals. Quantitatively, VT involved examining intrusions/re-experiencing, avoidance, and/or arousal symptoms. Qualitatively, outcomes of VT included cognitive, relational, emotional, spiritual, behavioral, and physical domains.

Note. PTS = posttraumatic stress; PTSD = posttraumatic stress disorder; STS = secondary traumatic stress; VPTG = Vicarious posttraumatic growth; VT = vicarious traumatization.

Key Findings and Recommendations

Demographics

Majority of the studies examined samples of parents/caregivers (22 articles or 79%), with minimal research on siblings (2 articles), friends (2 articles), partners (4 articles), and paternal caregivers (14 articles). This is surprising, considering that siblings, partners, and friends are often disclosed to for interpersonal traumatic events (Dworkin et al., 2016; Orchowski & Gidyca, 2012). This indirect interpersonal trauma exposure then leaves them at risk for VT, yet we found limited research on VT and VPTG for these populations. Furthermore, most studies had samples that were predominantly White/Caucasian, and there were no studies with gender- or sexuality-diverse samples. This leaves gaps in certain demographics that should be studied in future research. Research with individuals identifying as LGBTQIA+ and BIPOC is particularly important considering that individuals with these identities are at an increased risk of experiencing violence (Statistics Canada, 2020, 2021a, 2021b). This means that family, partners, and friends of these individuals, who may also be a part of the same communities, are at an increased risk of being indirectly exposed to interpersonal trauma. There may also be important cultural differences in the experiences of VT and VPTG that will not be elucidated if there is no research in these populations.

Definitions

One finding was the variable vocabulary used to describe the traumatization of a loved one after indirect interpersonal trauma exposure. For example, the terms trauma contagion, PTS/PTSD, VT, secondary traumatization, STS, and systemic trauma were used. Even further, researchers who used similar terms often had variability in their definitions. This variance in the indirect trauma literature has been noted previously by Branson (2019), although their literature review focused on clinicians being affected by their clients’ trauma(s).

Furthermore, the symptom profiles for VT terms were relatively similar: most described some variation of PTSD symptoms. Hence, should there be different definitions based on how the symptoms were acquired? Wies and Coy (2013) argued that the difference between vicarious trauma and PTSD was that the former involved the traumatic event being acquired indirectly while the latter involved firsthand experience. However, the DSM-5 (APA, 2013) includes indirect exposure to a loved one’s trauma in criterion A of PTSD rather than giving a separate diagnosis based on exposure. Consequently, it may neither be necessary to have a separate term that delineates the timeline nor type of exposure if the pathology remains the same. This then raises the question of whether using PTS/PTSD alone is sufficient in the literature. However, there is utility in the quick access to research in the population of interest when terms such as VT are used, as PTS/PTSD is likely to bring up research on primary trauma survivors.

Overall, vocabulary management is a necessary step forward in this area of research, potentially through the collaboration of an expert panel of researchers and stakeholders in this area. Clearly delineating the definitions of each term, operationalizing them, using the correct terms in future research, and halting the interchanging of terms is necessary for researchers and clinicians to easily find applicable research. Without it, researchers may be overlooking relevant articles in their literature reviews or unnecessarily duplicating previous research.

Measures

We found no studies in this scoping review that used specific measures of VT. This is despite 16 quantitative studies of VT where researchers used measures originally developed for direct trauma survivors. This was surprising considering there are measures that assess VT in the literature. For example, the STS Scale, a 17-item self-report scale whose items correspond to the 17 PTSD symptoms on the DSM-IV-TR (APA, 2000), was developed by Bride et al. (2004). Another measure in the literature on professionals indirectly exposed to trauma is the Vicarious Trauma Scale (Aparicio et al., 2013). However, neither of these measures were used by researchers in this scoping review. If terms apart from PTSD/PTS continue to be used for research on loved ones, researchers should apply the above measures to this population and assess the psychometric properties.

There were no quantitative studies that examined VPTG in this scoping review, and thus there were no measures of VPTG highlighted. The lack of validated measures for VPTG seems to be similar in populations beyond loved ones. For example, Manning-Jones et al.’s (2015) review of 28 articles on VPTG in working professionals, and Tsirimokou et al.’s (2023) review of 15 articles on VPTG in mental health professionals both noted that there were no validated quantitative measures on VPTG. These results indicate that it would be worthwhile for researchers to develop and validate measures of VPTG in populations of loved ones indirectly exposed to an interpersonal trauma.

Outcomes

Overall, there were 26 articles involving VT and related terms in this scoping review. Although analyzing the outcomes of these studies was beyond the scope of this review, the key findings ranged from quantifying VT (e.g., PTS symptoms), qualitatively describing the experience of VT, and examining variables related to VT (Table 5). These studies illustrated that VT is possible for loved ones indirectly exposed to trauma across populations of caregivers, significant others, friends, and other close individuals. For example, the prevalence of meeting criteria for PTSD across studies ranged from 13.1% to 32% for mothers, 7.1% to 7.3% for fathers, and 26% for close others (Christiansen et al., 2012; Cyr et al., 2016). Likewise, when researchers discussed high or clinically significant PTS/PTSD symptom scores, the prevalence ranged from 0% to 3.3% for fathers, 10.2% to 38.9% for mothers, and 14% to 24% for caregivers overall (Cyr et al., 2018; Jobe-Shields et al., 2016; Mangold et al., 2021; Van Delft et al., 2016). Other studies used similar classifications to look at prevalence rates for specific symptoms (Davies, 1995; Dyb et al., 2003). Quantitatively, VT commonly involved examining intrusions/re-experiencing, avoidance, and/or arousal symptoms (Burgess et al., 1990; Christiansen et al., 2012; Cyr et al., 2016, 2018; Davies, 1995; Dyb et al., 2003; Jobe-Shields et al., 2016; Manion et al., 1996, 1998; Nelson & Wampler, 2002; Runyon et al., 2014; Timmons-Mitchell et al., 1996; Van Delft et al., 2016), which differs from the current DSM-5 criteria of intrusion symptoms, avoidance, negative alterations to cognitions and mood, and changes to arousal and reactivity (APA, 2013). Only Mangold et al. (2021) using the PCL-5 reported on all DSM-5 PTSD symptoms. Qualitatively, outcomes of VT spanned cognitive, relational, emotional, spiritual, behavioral, and physical domains for participants (Anderson Jacob & McCarthy Veach, 2005; Bux et al., 2016; Fuller, 2016; Green et al., 1995; Gregory et al., 2017; Kilroy et al., 2014; Masilo & Davhana-Maselesele, 2016; Smith, 2005; Sparks & Stoppa, 2022; Van Wijk et al., 2014; Vilvens et al., 2021).

Furthermore, there were a variety of variables examined for their relationship to VT. These included, but are not limited to, testifying in court (Burgess et al., 1990; Dyb et al., 2003), time since disclosure (Cyr et al., 2018; Mangold et al., 2021; Manion et al., 1998), gender of participants (Cyr et al., 2016; Dyb et al., 2003; Kelley, 1990; Mangold et al., 2021; Manion et al., 1996, 1998; Nelson & Wampler, 2002), parental discipline (Jobe-Shields et al., 2016), stress (Cyr et al., 2016; Kelley, 1990), general psychological well-being (Dyb et al., 2003), depression (Runyon et al., 2014), locus of control (Dyb et al., 2003), secondary life changes (Dyb et al., 2003), perceived child symptomology (Mangold et al., 2021; Manion et al., 1996), sexual disgust sensitivity (Van Delft et al., 2016), abuse characteristics (Dyb et al., 2003; Kelley, 1990; Manion et al., 1996; Van Delft et al., 2016), and parental trauma history (Mangold et al., 2021; Manion et al., 1996; Timmons-Mitchell et al., 1996; Van Delft et al., 2016).

There was minimal research on VPTG in this population; VPTG was only discussed by Cummings (2018). In a systematic literature review by Manning-Jones et al. in 2015, they found 28 articles related to VPTG. However, family members of direct trauma survivors were excluded from this review, as their experience was seen as direct rather than indirect trauma exposure. Therefore, it could be the case that researchers were not using the term VPTG to describe positive changes to cognitions, emotions, relationships, and spirituality following loved ones’ indirect interpersonal trauma exposure or that loved ones are an overlooked population in the field of VPTG research. Furthermore, because there is minimal research on VPTG in the population of interest, there is not yet literature that describes the relation of VPTG to other factors (e.g., STS). Consequently, this current study further emphasized the need for more research in this area.

Limitations

A limitation of this scoping review was the narrow definition of interpersonal trauma at an individual level. Research on intergenerational trauma, community-, war-, and terrorism-based traumas were therefore excluded from this study as they represent collective traumas (Hirschberger, 2018). Further, majority of the articles were identified from the string search; this may indicate that the search terms were not broad enough. As well, the limitation of the overrepresentation of articles from Canada and the USA may be due to the English language inclusion criteria. Another limitation was that research discussing experiences such as improved relationships without using the terms of interest (e.g., VPTG) were excluded. For that reason, these outcomes may be discussed in research that captures them under other constructs. Lastly, scoping reviews do not evaluate the collated research, nor do they perform thematic analyses of the collected data; thus, a higher-level analysis of the data beyond the presentation of what is known and needs to be known was beyond the scope of this review.

Implications

The major implications for practice, policy, and research are outlined in Table 6. Overall, this scoping review informs future research to fill necessary knowledge gaps to further this area of study. In terms of practical implications, this scoping review validates that loved ones are a population deserving of attention and intervention following indirect trauma exposure, as they experience VT and could benefit from direct services to address PTSD symptoms. This is particularly important given that loved ones are often the people that survivors turn to for support following interpersonal trauma. Previous research has demonstrated that caregivers of children who have experienced trauma are often met with blame by professionals who are meant to help the family recover (Plummer & Eastin, 2007). By mapping the literature, practitioners can be informed of target areas for intervention such as PTSD. Our scoping review indicates that siblings, friends, paternal caregivers, and partners are particularly overlooked in this area. In addition, there is a paucity of research involving gender- and sexuality-diverse participants as well as BIPOC.

Our scoping review also reveals implications for using terms and definitions within this subfield, as researchers used various terms to refer to the same constructs. It is necessary to delineate the terms’ definitions and operationalize them. In addition, halting the interchanging of terms will streamline research in this area and allow for easier access by researchers and clinicians seeking information in this area.

Our results also have implications for measuring vicarious experiences after interpersonal trauma. Two priorities emerge from our results: creating and validating a measure for VT and VPTG in loved ones and assessing the psychometric properties of existing measures for STS and VT in loved ones.

Conclusion

This scoping review was the first study to compile and summarize the literature on VT and VPTG of loved ones indirectly exposed to interpersonal trauma. It clarified the variety of definitions, methods, tools/measures, demographics, and key findings in these areas. By doing so, important knowledge gaps and issues pertaining to these constructs were illuminated. Further discussed were areas warranting future research related to these knowledge gaps and practical implications for those working with families who have experienced interpersonal trauma.

Author Biographies

Whitney Willcott-Benoit, Ph.D., obtained her doctorate in Clinical Psychology at the University of Saskatchewan.

Jorden A. Cummings, Ph.D., is a Professor in the Department of Psychology & Health Studies at the University of Saskatchewan and Director of RESOLVE SK. Their research focuses on the influence of trauma on families.