Association of compassion fatigue and work context with post-traumatic stress disorder symptoms among care aides in nursing homes.

PURPOSE: This study examined the associations of compassion fatigue and unit-level work environment with post-traumatic stress disorder (PTSD) symptoms among nursing home care aides, a workforce providing essential care yet understudied for mental health risks, particularly during crises like the COVID-19 pandemic.

METHODS

This cross-sectional study used 2021 data from the Translating Research in Elder Care (TREC) program in Alberta, Canada. Participants included 568 care aides from 53 units within 20 nursing homes. PTSD symptoms were assessed using the PTSD Checklist-6 (PCL-6; score ≥ 14 indicating a positive screen). Primary predictors were compassion fatigue (Professional Quality of Life Scale-9 subscale) and seven unit-level work context factors (Alberta Context Tool). Analyses employed three-level multivariable logistic regression.

RESULTS

Of the 568 participating care aides, 127 (22.4%) screened positive for PTSD symptoms. In multivariable three-level logistic regression analyses, a 1-unit increase in compassion fatigue score was associated with a 44% increase in the odds of a positive PTSD screen (adjusted odds ratio [AOR] = 1.44; 95% CI, 1.24-1.68; P < 0.01). None of the seven elements of the unit-level working environment showed a statistically significant association with PTSD symptoms.

CONCLUSIONS

Compassion fatigue was significantly associated with PTSD symptoms among nursing home care aides, while unit‑level work environment did not show statistically significant associations, though these null findings should be interpreted with caution. During systemic crises such as the pandemic, interventions targeting compassion fatigue at the individual level may offer more immediate benefit than broader environmental modifications for this vulnerable frontline workforce.