Compassion Fatigue and Adopted Coping Strategies of Mental Health Service Providers Working In A Regional Psychiatric Hospital In Nigeria

Background: Mental health service providers sometimes suffer burden resulting from their care of mentally ill individuals, and this burden could be modulated by the coping mechanisms they adopt. Objective: This study aimed to investigate the relationships between gender, coping strategy and compassion fatigue of mental health service providers in a mental health facility in Nigeria Method: This was a cross-sectional study which recruited 234 mental health service providers working in a mental health facility in Nigeria, and they completed questionnaires (the Coping Strategy Inventory modified by Addison, Campbell-Jenkins & Sarpong and the Compassion Fatigue subscale of the Professional Quality of Life developed by Stamms. Results: majority of the mental health service providers surveyed were at risk of compassion fatigue (75.2%), gender did not significantly impact on compassion fatigue (t =-0.111; p>0.05), and coping strategies jointly predicted compassion fatigue (F = 11.927; p<0.05; r=0.417). However, when analyzed separately, only the subgroup of emotional focused engagement coping and emotional focused disengagement coping strategies independently predicted compassion fatigue, (β =0.246, t= 3.3.511, p<0.05) and (β =0.226, t= 3.698, p<0.05) respectively. Conclusion; Mental health service providers have high risk of compassion fatigue and the emotional based coping strategies are associated with this. Measures are suggested to mitigate compassion fatigue among this professionals, to reduce the effect on them and their patients. DOI : 10.14302/issn2474-9273.jbtm-16-1195 Corresponding Author: Omoaregba Joyce, Federal Neuropsychiatric Hospital, Benin city, Nigeria, Email: jomoaregba@yahoo.com


Introduction
Offering help or being involved in the care of traumatized patients usually places health professionals at risk of developing psychological problems, which could be related to their helping profession (Figley, 1995) [14]. When exposed, these professionals are not immune to psychological harms, but are just as likely to develop psychological complications. A body of literature reveals that frontline mental health service providers (such as psychiatrists, psychiatric nurses, psychiatrist trainees, clinical psychologists, and clinical social workers) occasionally feel burdened from the efforts they put into helping their patients, (Figley, 1995, Huggard & Dixon, 2011, Yoder, 2008. [14,21,22 ] This burden primarily arises from their care of traumatized individuals and may be symptomatically expressed as feelings of depression, fatigue, worthlessness, disillusionment and emotional exhaustion (Figley, 1995;Stamm, 2010). [14,34]; These problems can be detrimental to the health of these professionals by reducing their ability to sustain focus, increasing selfdoubt and incompetence, a gradual lessening of compassion over time and eventually leading to a decrease in productivity (Adams, Boscarino, & Figley, 2006)1. These range of symptoms in these health professionals have been sometimes referred to as Compassion Fatigue. Compassion fatigue is a syndrome consisting of depletion in carers' emotional, physical and spiritual states and is in association with their role of taking care of patients in considerable physical and emotional pain (Anewalt, 2009;Figley, 1995). [4,14] Compassion fatigue is two-tiered into Burnout and Secondary traumatic stress. Burnout is a condition of unhappiness or a sense of disconnection from work because the professional helpers feels bogged down, overwhelmed or overloaded about working conditions. Similarly, Secondary traumatic stress is described as psychological duress which arises in health professional as a result of their exposure to the firsthand experiences of trauma by the patient, and can be characterized by symptoms similar to that of PTSD such as fear, sleep difficulties, intrusive images or avoiding reminders of the traumatic experience, (Stamm, 2010). 34 Compassion fatigue is an occupational hazard which has been found to affect about 50% of physicians and one-third of other cancer care professionals, (Grunfeld, 2000 [22,23,41]in their study of 61 professional therapist in Kenya observed that 70% of professional therapists presented with compassion fatigue and that professional therapist with high levels of compassion fatigue had almost four times increased risk of having their performances affected compared to their counterpart with average composition fatigue. Worldwide, there is an increasing trend of natural and man-made violence and so mental health service providers are at increasing risk of developing compassion fatigue. and overly conscientious, perfectionistic, and self-giving individuals. Another factor identified to modulate compassion fatigue in health professionals is the coping strategies employed by the professional helpers. Coping strategy is a process, either internal or external, of responding to a stressor. It comprises of the disbursement of conscious effort in the resolution of personal and interpersonal problems, and involves an attempt to minimize, master or tolerate conflict or stress. ( Weiten & Lloyd 2008, Snyder 1999, Zeiden & Endler 1996. [44,41,36] In other words, it is a process of adopting a strategy in executing a response to a perceived threat, (Lazarus, 1996). Folkman & Lazarus (1985) [15,25] distinguished between problem-focus coping strategy and emotion-focus coping strategy. While the former employs a problem-solving strategy or doing something to change the stressor, the latter is aimed at reducing the emotional distress related to the stressor. Problemfocus coping reduces stress more than emotion-focus coping (Endler, 1997) 13because people using problemfocused strategies try to deal with the cause of their problem or eliminate the source of their stress either by obtaining information or obtaining better skills to manage the problem.
Emotion-focused coping strategies involve an attempt at alleviating distress by reducing, minimizing, or preventing, the emotional components of a stressor (Carver, 2011). 6 Folkman and Lazarus (1988)16 identified five emotion-focused coping strategies namely escape-avoidance, disclaiming, exercising self-control, accepting responsibility or blame, and positive reappraisal.
Coping strategy can also be divided into Engagement (approach) strategy which is targeted at reducing stress by confronting it, -which has been found to work better for long-term physiological or psychological presentations of stressors-and Disengagement (avoidance) strategy which is employed in order to limit exposure to the stressors -which has also been found to be effective as a short-term coping strategy- ( [3,18] This could result in increased compassion fatigue among the available mental health service providers and could subsequently lead to a reduction in their desire to help mentally ill individuals. It is desirable to ascertain the experiences of compassion fatigue amongst mental health service providers, the coping strategies adopted by these professionals, as well as the relationship between the two. The results of this would provide a template for the development of preventive as well as curative programmes to curtail the effects of compassion fatigue on these set of professionals so that they, and by extension, their patients would enjoy better psychological health.

Methods:
This study adopted the definition of coping strategy similar to that of ( Table 2.

Discussion
This study aimed to investigate the relationships between gender, coping strategy and compassion in medical line in another study (Zeidner, et al, 2013

Conclusion and Implication
It can be concluded from the study that there is a report of risk of compassion fatigue in the mental health service providers surveyed and coping strategies are significantly related to compassion fatigue. The implication of this on these professionals could include exhaustion, absenteeism, reduced happiness previously derived from their job, reduced ability to make decisions etc. There would also be a spillover effect on the patients that they care for, resulting in a reduction in the quality of services provided for these patients. This calls for proactive measures on a two-level basis which may involve an organizational effort to encourage the recognition of compassion fatigue by staff, debriefing, reduction in workloads for these professionals, peer support, and more promotion opportunities. In addition, these professionals should be encouraged to set only realistic goals about their patient's outcomes, utilize breaks within work periods, get a colleague with whom they can ventilate emotions. Relaxation techniques and connecting with higher being, as well as being emotionally intelligent could also be beneficial to these professionals.

Limitation
Our research design calls for caution in the interpretation of our results. The study was a crosssectional study which considers actions retrospectively and does not provide causal explanation for phenomena.
There will be a lot to gain in the understanding of the construct of compassion fatigue if future studies utilize a study. Further study that will encourage equality in the gender of the participants will be of good use. A country -wide study will be more scientifically beneficial to the generalization of the results for a study of this nature.
The present single site consideration for this study raises a caveat on the use of its result.