ACUTE STRESS AND TRAUMA AT WORK: PREVENTION AND RISK MANAGEMENT IN THE BANKING SECTOR
Creators: name: FATTORI, ALICE
Publisher: name: Universit� degli Studi di Milano
Year: 2016

description: Background
Relevance of the topic and the necessity for scientific investigation
Robberies at the bank branches are potentially traumatic events. Many bank employees experiencing a robbery in their workplace suffer important negative consequences as numerous clinical symptoms of post-traumatic stress, worse physical health, impaired productivity and intention to leave their job, both immediately and up to six months after bank robbery. Despite decreasing in frequency, there is an ongoing risk in the bank branches: such events are difficult to predict, and primary intervention strategies may not completely eliminate the risk. 

Motives for choosing a particular topic
Although bank robberies are potentially traumatic event, little is known about the psychological sequelae of those involved. Post-traumatic stress disorder (PTSD) literature has largely focused on victims of specific traumas, such as sexual violence, natural disaster, and military combat. PTSD in the occupational context is still under-investigated, and research mainly concerns specific occupational groups as emergency service personnel, police officers, firefighters, and health care workers.
Studies concerning the psychological consequences of bank robberies are limited, mostly based on convenience samples, and vary in outcomes measures and design substantially, thus making comparisons difficult. 
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Research problem and why it is worthwhile studying
Since only a minority of subjects experiencing such event in the workplace develop long-term clinically important symptoms and functional impairment, understanding the antecedents of occupational PTSD is a key goal of research. A better understanding of risk factors associated to post-traumatic stress reactions may improve early treatment and preventive intervention, thus reducing PTSD onset and worsening of symptoms.

Research objectives 
The study has three main objectives. The first aim is to evaluate the impact of bank robbery on employees psychological well-being, thus investigating post-traumatic stress reactions. The second one is to better understand risk factors associated to the onset of post-traumatic symptomatology. Consequently, the third aim is to inform the development of new interventions and risk management strategies. 

Research methodology 
Nine hundred twenty-four employees of a primary Italian bank group, victims of 238 different robberies, voluntarily joined an employer-sponsored post-robbery support program:
- a structured and collective support interview (i.e. psychological debriefing) was conducted with robbery victims within 7-15 days after the event (T1) at the bank branch. A self-reported questionnaire collected socio-demographic information, number of bank robberies occurred during participants? working life, detailed description of the last robbery with closed and open-ended questions, assessment of post-traumatic stress reaction (Impact of Event Scale); 
- a follow-up psychological assessment (through structured individual interviews) was conducted 45 days after the first session (T2). Interview investigated victims? general health conditions and self-reported trajectory of post-traumatic symptoms after robbery, victims? evaluation of the intervention, assessment of post-traumatic stress reaction (Impact of Event Scale).
To accomplish with our objectives, the following statistical analysis were adopted:
- Absolute and relative frequencies or means and standard deviations, ?2 and one-way ANOVA for categorical or continuous variables respectively.
- Logistic and linear multilevel regression to estimate the impact of predictive values on post-traumatic symptoms: random intercept mixed-effect regression models to account for subjects? clustering within robberies. Three hierarchical models were adopted (Model 1: pre-trauma risk factors; Model 2: peri-trauma risk factors; Model 3: subjective perception and reaction to robberies).
- Residual pseudo-likelihood test (H0: ? 2 = 0) to assess the significance of unmeasured robbery- related factors; latent variable threshold model approach for the calculation of the variance partition coefficient.

Results
The final sample consisted in 595 subjects, victims of 238 different robberies. Correlates of early post-robbery reactions were age, being female, being cashier, geographical region, perception of robbers as out of control; after including feelings of fear, terror and hopelessness during the robbery, all the other variables lost statistical significance.
IES scores decreased during the follow-up (?T1-T2=15.76; p&lt;.001). At T2, 14% of subjects reported a IES score&gt;34, a cut-off suggestive of Post-traumatic stress disorder (PTSD). In the multivariable model, age, being female, being cashier, presence of arms, being injured, were associated with PTSD diagnosis. After including early subjective reaction, IES score at T1 was the strongest predictor. Unmeasured robbery-related factors explained a significant portion (24%) of IES variance at T1 after excluding small groups (number of colleagues &lt;5).

Limitations
Possible selection bias due to the voluntary participation into the intervention program cannot be excluded. Information on non-occupational traumatic events occurred in subjects? life time and pre-existent psychiatric disorders, as well as perceived support after the event, could not be collected. Assessment of post-traumatic stress symptoms relied on self-report measure without a thorough clinical examination; thus, Impact of Event Scale did not include all criteria for Post-traumatic stress disorder stated by recent DSM-V. 

Originality of the study 
The study gives an original contribution to the existing literature of psychological sequelae following bank robbery: to date, this is the longitudinal study with the largest sample assessing prevalence and predictors of post-traumatic stress symptoms; logistic and linear multilevel regression provided a valuable understanding of risk factors; furthermore, no studies had previous investigated the role of group factor in the aftermath of post-traumatic reaction following bank robbery or acute stress at work.

Conclusion/Practical implication
Our findings showed that bank robbery is a potential traumatizing event associated with both immediate and long-term posttraumatic stress symptoms. Results suggested the weight of subjective variables, such as personal perception of robbery severity and early emotional reaction, in identifying persons at higher risk to develop PTSD. Our findings may help management and prevention of acute stress and trauma in the banking sector, contributing to post-traumatic stress literature. Finally, group factors, an often overlooked dimension in post-traumatic stress literature, might affect the risk of PTSD, thus encouraging further research.