Investigation of Secondary Traumatic Stress, Altruism and Psychological Resilience Levels of National Medical Rescue Team Personnel Working in Disaster Areas

Investigation of Secondary Traumatic Stress, Altruism and Psychological Resilience Levels of National Medical Rescue Team Personnel Working in Disaster Areas | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigation of Secondary Traumatic Stress, Altruism and Psychological Resilience Levels of National Medical Rescue Team Personnel Working in Disaster Areas Songül DURAN, Yüksel CAN ÖZ, Büşra KELEŞ This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7691854/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : This study aims to examine the levels of secondary traumatic stress, altruism, and psychological resilience among personnel of the national medical rescue team operating in disaster areas. Methods : This descriptive and cross-sectional study included 126 national medical rescue team personnel. Participants completed a demographic information form, the Altruism Scale, the Secondary Traumatic Stress Scale, and the Brief Resilience Scale. Data were collected through an online platform and analyzed using SPSS 25 software. Statistical significance was set at α = 0.05. Findings : The mean scores for the participants were as follows: STS Scale, 43.45 ± 12.38 (high); Altruism Scale, 56.07 ± 8.84 (high); and Brief Resilience Scale, 20.96 ± 4.76 (high). Male participants scored significantly higher than females on STSS (p=0.001), Avoidance (p=0.016), Intrusion (p=0.000), Arousal (p=0.001), and Brief Resilience Scale (p=0.001). Single participants had statistically higher BRS scores compared to married individuals (p<0.05). Additionally, a positive correlation was found between age, altruism, and professional experience, whereas STSS and BRS scores exhibited a significant negative correlation. Conclusion/Application to Practice : The findings suggest that rescue teams working in disaster zones are at risk of experiencing secondary trauma and require appropriate support. Targeted interventions for at-risk groups are recommended. Healthcare Worker Trauma Psychological Resilience Altruism Background Various professionals tasked with assisting people who have experienced injuries, accidents, violence, or severe, life-threatening illnesses are at risk of indirect exposure to trauma (1). In recent years, there has been growing awareness that professionals indirectly exposed to traumatic events may exhibit post-traumatic stress responses (2). In addition to disaster victims, rescue workers are also at risk of developing adverse mental and physical health outcomes; this situation involves secondary trauma for individuals participating in rescue activities in disaster zones (3). The fact that rescue workers involved in disaster response operations face significant physical and psychological challenges is often overlooked (4). Seondary trauma is defined as the behavioral and emotional consequences experienced by an individual upon learning about another person’s stressful experiences (5). Secondary traumatic stress (STS) includes symptoms similar to post-traumatic stress disorder (PTSD), such as intrusive symptoms, avoidance, and hyperarousal, as well as depressive and anxiety symptoms. These symptoms are considered a natural consequence of the working environment for first response teams (6). Professionals working with trauma-exposed populations have been reported to have a higher risk of developing secondary traumatic stress (7). Healthcare personnel serving as part of rescue teams appear to be more prone to psychological crises (8). A study conducted among disaster response teams following the February 2023 earthquake in Eastern Türkiye/Syria found that 46% of the responders experienced physical or mental health problems during or after their mission (9). Gustavsson and colleagues noted in their interviews with individuals providing healthcare during disasters that altruism served as a protective factor (10). Rescue workers are motivated to work in disaster zones through feelings of volunteerism and altruism (3). Humans tend to exhibit cooperation and social cohesion behavioral patterns and act altruistically when faced with existential threats (11). From a behavioral perspective, altruism refers to an action that benefits others without any expectation of reward (12). Köksal and colleagues found in their study that altruistic behaviors positively and significantly influence employee job performance (13). Another study revealed that individuals working in healthcare exhibited higher levels of altruism compared to those in engineering and self-employed professions (14). In this context, altruism may serve as a motivating factor for individuals to work in the field. Among professions, critical risk factors for secondary trauma include gender, previous trauma, the number of work-related traumatic events, lack of social support, and dysfunctional coping strategies. On the other hand, resilience, a sense of coherence, and self-efficacy may serve as protective factors (15). Resilience is inversely proportional to stress sensitivity and reflects the capacity to overcome chronic stress (16). Given the increasing prevalence of disasters worldwide, the capacity to adapt to and cope with traumatic events is crucial for enabling individuals and communities to recover effectively and timely after a crisis-either by returning to their pre-trauma state or by positively adapting to new circumstances (17). Resilience acts as a significant buffer for individuals facing adverse events such as disasters by alleviating or preventing psychological distress (18). Additionally, resilience is considered one of the protective factors against occupational burnout (19). Resilience is also defined as the absence of negative psychological outcomes, such as PTSD symptoms, among rescue workers following a disaster (18). There is limited research in the literature addressing the health problems of personnel working in disaster zones (3,18). Conducting a situational analysis is important in terms of determining preventive measures. This study aims to examine the levels of secondary traumatic stress, altruism, and psychological resilience among members of the national medical rescue team working in disaster zones. Methods Study Design and Participants This study is descriptive and cross-sectional in nature. Research data were collected online between October 2023 and 2024. The sample size was determined using the G-Power power analysis method, with an effect size of 0.68, α = 0.05, and a power value of 0.95, resulting in a sample size of 96. Considering potential data loss, the study was completed with 126 participants. Inclusion criteria for the study included being a national medical rescue team employee and voluntarily agreeing to participate. Exclusion criteria included incomplete questionnaire responses. Questionnaire For this research, a demographic information form, the Altruism Scale, the Secondary Trauma Stress Scale, and the Brief Psychological Resilience Scale were used. The demographic information form collected data on participants' age, gender, occupation, and related details. Altruism Scale: This scale was developed by Ersanlı and Doğru Çabuker (2015) to determine individuals' levels of altruism.(20) In the Altruism Scale, the two identified factors (selflessness and selfishness) explain 43% of the total variance. The reliability analysis results for the selflessness and selfishness factors are 0.87 and 0.77, respectively. The Cronbach’s alpha value for the entire scale is 0.76. The lowest possible score on the Altruism Scale is -10, and the highest is 70. Secondary Trauma Stress Scale: This scale, originally developed by Bride and colleagues in 2004(21), was adapted into Turkish by Yıldırım, Kıdak, and Yurdabakan in 2018.(22) It consists of 17 items rated on a 5-point Likert scale. The scale has three subdimensions: avoidance, arousal, and emotional intrusion. The minimum possible score on the scale is 17, and the maximum is 85. Each of the 32 items is structured into three subdimensions (emotional intrusion, avoidance, and arousal) based on DSM-5 PTSD criteria B (re-experiencing), C (avoidance), and D (hyperarousal). Bride and colleagues reported the internal consistency coefficient of the STSS as 0.94 for the entire scale, 0.83 for emotional intrusion, 0.89 for avoidance, and 0.85 for arousal. Brief Resilience Scale: This scale was developed by Smith et al. (2008) to measure resilience levels.(23) The Turkish adaptation of the scale and its psychometric properties were examined by Doğan (2015).(24) The factor loadings of the scale items range between 0.63 and 0.79. The item-total correlation values range between 0.49 and 0.66. The scale consists of six items prepared in a 5-point Likert format, with response options ranging from "Not at all appropriate" (1) to "Completely appropriate" (5). Items 2, 4, and 6 are reverse-scored. A higher score on the scale indicates a higher level of psychological resilience. The internal consistency coefficient of the scale was found to be 0.83. Statistical Analysis The analysis of the data was conducted using the SPSS 25 software package (IBM Corp., Armonk, NY, USA). The significance level for all results was set at α = 0.05. Descriptive statistics (number, percentage, mean, standard deviation) were used to analyze socio-demographic characteristics. The relationship between socio-demographic characteristics and scale scores was calculated using independent group t-tests and one-way ANOVA. The relationships between the scales were determined using Pearson correlation analysis. Results Socio-demographic Characteristics of Participants Of the individuals who participated in the study, 52.4% were male. Among the personnel, 73% had a bachelor’s degree or higher level of education, while 27% had an education level of a bachelor's degree or lower. Half of the participants were married, while the other half were single. Of the respondents, 4.6% had previously been in a disaster zone, and 15.9% had lost a relative during a disaster. The average age of the participants was 34.56±8.01 years, and their average duration of professional experience was 2.80±1.47 years (Table 1). Mean Scores for Secondary Traumatic Stress, Altruism, and Brief Resilience Scales Table 2 presents the mean scores obtained from the scales. The mean score for the Secondary Traumatic Stress Scale was 43.45±12.38. Subscale scores were as follows: Avoidance, 17.26±5.20; Intrusion, 12.83±4.32; and Arousal, 13.34±3.79. The Altruism Scale mean score was 56.07 ± 8.84, and the Brief Resilience Scale mean score was 20.96±4.76. Sociodemographic Factors Influencing Scale Scores Table 3 demonstrates the sociodemographic factors affecting scores on the Secondary Traumatic Stress Scale, Altruism Scale, and Brief Resilience Scale. Male participants scored significantly higher than females on STSS (p=0.001), Avoidance (p=0.016), Intrusion (p=0.000), Arousal (p=0.001), and the Brief Resilience Scale (p=0.001). Single participants had significantly higher BRS scores (21.92±4.62) compared to married participants (20.01±4.74). Gender and education level did not significantly impact scale scores. Correlations Between Secondary Traumatic Stress, Altruism, and Brief Resilience Scales Table 4 also displays correlations between the scales. A positive correlation was found between age and both altruism (r=0.476, p=0.000) and professional experience (r=0.476, p=0.000). A statistically significant negative correlation was observed between STSS and BRS (r=-0.693, p=0.000) (Table 4). Discussion It is crucial to identify the psychological problems experienced by national medical rescue team personnel, who are among the first responders to disaster areas and establish initial contact with victims, as well as to consider protective factors in this context. In this study, which examined the levels of secondary traumatic stress (STS), altruism, and psychological resilience among members of the national medical rescue team working in disaster zones, participants’ STS levels were found to be high, with a mean score of 43.45±12.38. Disasters have significant adverse effects on the mental well-being of medical responders (25). A study conducted in Türkiye with volunteer search and rescue workers who participated in earthquake response operations reported that some participants continued to exhibit post-traumatic symptoms over time, negatively impacting their lives (26). Another study with healthcare professionals working in earthquake zones found that the mean total score on the Secondary Traumatic Stress Scale was 55.6±12.3 (27). Service providers indirectly exposed to trauma can exhibit the same PTSD symptoms as individuals directly exposed to trauma (28). A meta-analysis revealed that the prevalence of PTSD among healthcare workers involved in earthquake responses was 16.37% (29). An analysis of 266 studies focusing on medical aid workers deployed to provide assistance during natural disasters found that 40% of these workers experienced significant challenges related to general mental well-being (30). Establishing peer support groups is recommended to help rescue workers connect with others who have had similar experiences, providing emotional support and coping mechanisms (31). Signs of stress in individuals exposed to traumatic events should not be overlooked by team members and professionals, even if these individuals appear to maintain functionality. Timely interventions should be implemented to prevent functional impairment (32). In this study, the participants' altruism level was determined to be high, with a mean score of 56.07±8.84. Altruistic behavior within organizations refers to the actions of employees voluntarily assisting others in overcoming difficulties and challenges related to organizational duties, without any obligation (33). When an individual engages in an act of help solely for the benefit of another, it is considered altruistic behavior (34). The willingness of individuals working in disaster zones to engage in helping behaviors cannot be solely attributed to the professional obligations of their roles but also reflects their altruistic characteristics. The high scores observed in this study support this perspective. The participants' BRS (Brief Resilience Scale) score was found to be 20.96±4.76, indicating a high level of resilience. During the Israel-Hamas conflict, the resilience level among mental health professionals was reported to be moderate (35). In a study conducted in Türkiye following a 7.7 magnitude earthquake, the resilience levels of nursing students were found to be moderate (36). During the COVID-19 pandemic, healthcare workers reported lower levels of distress and higher levels of resilience compared to the general population (37). Another study determined that the BRS scores of nurses providing care to earthquake survivors were 17.40±3.61 (Cobanoğlu & Oğuzhan, 2024). The high level of psychological resilience observed among the participants in this study positively influences their ability to cope with trauma. Male participants scored higher on the STSS, Avoidance, Intrusion, and Arousal subscales, as well as the Brief Resilience Scale, compared to female participants. Selvi and Aslan (2024) reported that female healthcare workers in earthquake-affected regions exhibited higher post-traumatic stress levels compared to their male counterparts (38). Similarly, Ediz and Yanik (2024) in their study with nurses following the 2023 Great Türkiye Earthquake, found that women had lower psychological resilience levels (39). The findings of this study suggest that while women are more emotionally affected by trauma, their higher resilience levels may be associated with superior coping capabilities.In this study, unmarried participants had a significantly higher BRS score (21.92±4.62) compared to married participants (20.01±4.74). A study conducted shortly after the 2020 Malatya-Elazığ earthquake found that married healthcare workers exhibited higher trauma scores (40). Although married individuals may perceive greater social support, the additional responsibility of caring for others might negatively affect resilience in disaster scenarios. However, in-depth interviews with rescue teams could provide more comprehensive insights. This study identified a positive and statistically significant correlation between altruism and both age and years of professional experience (41). found that middle-aged individuals exhibited higher levels of altruism compared to other age groups. The positive influence of age and professional experience on altruism suggests that individuals may develop greater compassion and altruistic tendencies as they age and gain experience. The literature indicates that secondary trauma may influence resilience (42). In this study, a statistically significant negative correlation was identified between STSS and BRS scores. Roden-Foreman et al. (2017) found a positive association between low resilience, personal trauma, and higher STS severity scores. A study conducted with psychologists working in disaster zones in Türkiye revealed that psychological resilience negatively predicts secondary traumatic stress (43). Similarly, Selvi and Aslan (2024) found that healthcare workers with higher levels of psychological resilience exhibited lower levels of post-traumatic stress disorder (38). Considering that resilience is regarded as a protective factor, its negative relationship with secondary trauma is an expected outcome. Implementing interventions aimed at enhancing resilience among individuals working in disaster zones may have a positive impact on their well-being. The findings of this study are limited to the sample group and cannot be generalized to the entire population. Conclusion In this study, the level of secondary traumatic stress, altruism and psychological resilience of the National Medical Rescue Team personnel working in the disaster area were determined at high levels. The STSS score of men is higher than that of women. Single people had higher BRS scores than married people and men had higher BRS scores than women. A statistically significant positive correlation was found between age and The Altrusim and working time in the profession, while a statistically significant and negative correlation was found between STSS and BRS. Since men may be at risk in terms of STSS, it is thought that they should be supported. In addition, since STSS and BRS are negatively correlated, it is thought that interventions to increase psychological resilience may positively affect secondary trauma. Implications for Occupational Health Practice Determining the secondary trauma, altruism and psychological resilience levels of National Medical Rescue Team Personnel Working in Disaster Zones is important in terms of precautions that can be taken. Interventions that support these individuals can increase their psychological resilience and have a positive effect on secondary trauma and altruism. Declarations Ethics approval and consent to participate Ethical approvals were obtained from the Kocaeli University Ethics Committee (Date: 19.10.2023- Number: KÜ GOKAEK-2023/17.26). Ethical approval was obtained for the study in accordance with the Declaration of Helsinki. Participants were informed about their voluntary participation in the online form and those who did not approve the box stating that they would participate voluntarily in the study were not allowed to proceed with the survey questions. The enames of the participants were not included in the scales. Informed consent to participate was obtained from all of the participants. Competing interests Th authors declare that they have no competing interests. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests None. Funding This study had no funding support. 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Tables Table 1 Socio-demographic Characteristics of Participants Variable n % Gender Male 66 52.4 Female 60 47.6 Educational level Bachelor’s degree or lower 34 27 High school and above 92 73 Marital status Single 63 50 Married 63 50 Occupation Nurse 49 38.9 Emergency medical technician 16 12.7 Dentist 12 9.5 Other 49 38.9 Had previously been in a disaster zone Yes 94 74.6 No 32 25.4 Had lost a relative during a disaster Yes 20 15.9 No 106 84.1 Mean SD Age 34.56 8.01 Work experience (year) 2.80 1.47 Table 2 Descriptive statistics of the scale scores of the participants (n = 126) Scales Mean ± SD Secondary Traumatic Stress Scale (STSS) 43.45 ±12.38 Avoidance 17.26 ±5.20 Intrusion 12.83 ±4.32 Arousal 13.34 ±3.79 The Altruism Scale 56.07 ± 8.84 Brief Resilience Scale 20.96 ±4.76 Abbreviations: SD, standard deviation Table 3 Sociodemographic Factors Influencing Scale Scores Characteristics The Altruism Scale STSS Avoidance Intrusion Arousal Brief Resilience Scale Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Gender Male (n = 66) Female (n = 60) 56.62 ± 9.02 55.48± 8.67 46.96±12.48 39.58±11.14 18.33±5.50 16.10±4.62 14.19±4.24 11.33±3.93 14.43±3.65 12.15±3.61 19.62±4.97 12.15±3.61 t / F, p t=0.720 p=0.473 t=3.490 p=0.001 t=2.451 p=0.016 t=3.914 p=0.000 t=3.531 p=0.001 t=-3.474 p=0.001 Education level Bachelor’s degree or lower (34) High school and above (92) 55.64±7.16 56.23±9.41 42.44±11.22 43.82±12.82 16.70±4.53 17.47±5.44 12.73±4.28 12.86±4.37 13.00±3.24 13.47±3.99 20.73±5.48 21.05±4.49 t / F, p t=-0.332 p=0.740 t=-0.556 p=0.579 t=-0.737 p=0.462 t=-0.154 p=0.878 t=-0.626 p=0.532 t=-0.333 p=0.740 Marital status Single (63) Married (63) 56.38±9.35 55.77±8.36 41.84±12.04 45.06±12.60 16.63 ±4.89 17.90 ±5.47 12.12 ±4.27 13.53 ±4.29 13.07 ±3.80 13.61 ±3.79 21.92 ±4.62 20.01 ±4.74 t / F, p t=0.382 p=0.703 t=-1.467 p=0.145 t=-1.373 p=0.172 t=-1.849 p=0.067 t=-0.796 p=427 t=2.282 p=0.024 * p < 0.05, ** p < 0.01 Abbreviations: IGDS9-SF: Internet Gaming Disorder Scale-Short Form, SD, standard deviation Ta ble 4 Variables related to The Altruism scale, STSS, Brief Resilience Scale Variables The Alturism Scale STSS BRS Age r 0.223 ** -0.062 0.047 p 0.012 0.487 0.603 Eork experience r 0.223 ** 0.014 0.015 p 0.012 0.878 0.867 The Alturism Scale r 1 -0.099 0.126 p 0.268 0.122 Brief Resilience Scale r 0.122 -0.693 ** 1 p 0.174 0.000 ** p < 0.01 Additional Declarations No competing interests reported. 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Areas\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eVarious professionals tasked with assisting people who have experienced injuries, accidents, violence, or severe, life-threatening illnesses are at risk of indirect exposure to trauma (1). In recent years, there has been growing awareness that professionals indirectly exposed to traumatic events may exhibit post-traumatic stress responses (2). In addition to disaster victims, rescue workers are also at risk of developing adverse mental and physical health outcomes; this situation involves secondary trauma for individuals participating in rescue activities in disaster zones (3). The fact that rescue workers involved in disaster response operations face significant physical and psychological challenges is often overlooked (4). Seondary trauma is defined as the behavioral and emotional consequences experienced by an individual upon learning about another person\u0026rsquo;s stressful experiences (5). Secondary traumatic stress (STS) includes symptoms similar to post-traumatic stress disorder (PTSD), such as intrusive symptoms, avoidance, and hyperarousal, as well as depressive and anxiety symptoms. These symptoms are considered a natural consequence of the working environment for first response teams (6). Professionals working with trauma-exposed populations have been reported to have a higher risk of developing secondary traumatic stress (7). Healthcare personnel serving as part of rescue teams appear to be more prone to psychological crises (8). A study conducted among disaster response teams following the February 2023 earthquake in Eastern T\u0026uuml;rkiye/Syria found that 46% of the responders experienced physical or mental health problems during or after their mission (9). Gustavsson and colleagues noted in their interviews with individuals providing healthcare during disasters that altruism served as a protective factor (10). Rescue workers are motivated to work in disaster zones through feelings of volunteerism and altruism (3).\u003c/p\u003e\n\u003cp\u003eHumans tend to exhibit cooperation and social cohesion behavioral patterns and act altruistically when faced with existential threats (11). From a behavioral perspective, altruism refers to an action that benefits others without any expectation of reward (12). K\u0026ouml;ksal and colleagues found in their study that altruistic behaviors positively and significantly influence employee job performance (13). Another study revealed that individuals working in healthcare exhibited higher levels of altruism compared to those in engineering and self-employed professions (14). In this context, altruism may serve as a motivating factor for individuals to work in the field.\u003c/p\u003e\n\u003cp\u003eAmong professions, critical risk factors for secondary trauma include gender, previous trauma, the number of work-related traumatic events, lack of social support, and dysfunctional coping strategies. On the other hand, resilience, a sense of coherence, and self-efficacy may serve as protective factors (15). Resilience is inversely proportional to stress sensitivity and reflects the capacity to overcome chronic stress (16). Given the increasing prevalence of disasters worldwide, the capacity to adapt to and cope with traumatic events is crucial for enabling individuals and communities to recover effectively and timely after a crisis-either by returning to their pre-trauma state or by positively adapting to new circumstances (17). Resilience acts as a significant buffer for individuals facing adverse events such as disasters by alleviating or preventing psychological distress (18). Additionally, resilience is considered one of the protective factors against occupational burnout (19). Resilience is also defined as the absence of negative psychological outcomes, such as PTSD symptoms, among rescue workers following a disaster (18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere is limited research in the literature addressing the health problems of personnel working in disaster zones (3,18). Conducting a situational analysis is important in terms of determining preventive measures. This study aims to examine the levels of secondary traumatic stress, altruism, and psychological resilience among members of the national medical rescue team \u0026nbsp;working in disaster zones.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy Design and Participants\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is descriptive and cross-sectional in nature. Research data were collected online between October 2023 and 2024. The sample size was determined using the G-Power power analysis method, with an effect size of 0.68, \u0026alpha; = 0.05, and a power value of 0.95, resulting in a sample size of 96. Considering potential data loss, the study was completed with 126 participants. Inclusion criteria for the study included being a national medical rescue team employee and voluntarily agreeing to participate. Exclusion criteria included incomplete questionnaire responses.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuestionnaire\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor this research, a demographic information form, the Altruism Scale, the Secondary Trauma Stress Scale, and the Brief Psychological Resilience Scale were used.\u003c/p\u003e\n\u003cp\u003eThe demographic information form collected data on participants\u0026apos; age, gender, occupation, and related details.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAltruism Scale:\u0026nbsp;\u003c/em\u003eThis scale was developed by Ersanlı and Doğru \u0026Ccedil;abuker (2015) to determine individuals\u0026apos; levels of altruism.(20) In the Altruism Scale, the two identified factors (selflessness and selfishness) explain 43% of the total variance. The reliability analysis results for the selflessness and selfishness factors are 0.87 and 0.77, respectively. The Cronbach\u0026rsquo;s alpha value for the entire scale is 0.76. The lowest possible score on the Altruism Scale is -10, and the highest is 70.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSecondary Trauma Stress Scale:\u003c/em\u003e This scale, originally developed by Bride and colleagues in 2004(21), was adapted into Turkish by Yıldırım, Kıdak, and Yurdabakan in 2018.(22) It consists of 17 items rated on a 5-point Likert scale. The scale has three subdimensions: avoidance, arousal, and emotional intrusion. The minimum possible score on the scale is 17, and the maximum is 85. Each of the 32 items is structured into three subdimensions (emotional intrusion, avoidance, and arousal) based on DSM-5 PTSD criteria B (re-experiencing), C (avoidance), and D (hyperarousal). Bride and colleagues reported the internal consistency coefficient of the STSS as 0.94 for the entire scale, 0.83 for emotional intrusion, 0.89 for avoidance, and 0.85 for arousal.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBrief Resilience Scale:\u003c/em\u003e This scale was developed by Smith et al. (2008) to measure resilience levels.(23) The Turkish adaptation of the scale and its psychometric properties were examined by Doğan (2015).(24) The factor loadings of the scale items range between 0.63 and 0.79. The item-total correlation values range between 0.49 and 0.66. The scale consists of six items prepared in a 5-point Likert format, with response options ranging from \u0026quot;Not at all appropriate\u0026quot; (1) to \u0026quot;Completely appropriate\u0026quot; (5). Items 2, 4, and 6 are reverse-scored. A higher score on the scale indicates a higher level of psychological resilience. The internal consistency coefficient of the scale was found to be 0.83.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of the data was conducted using the SPSS 25 software package (IBM Corp., Armonk, NY, USA). The significance level for all results was set at \u0026alpha; = 0.05. Descriptive statistics (number, percentage, mean, standard deviation) were used to analyze socio-demographic characteristics. The relationship between socio-demographic characteristics and scale scores was calculated using independent group t-tests and one-way ANOVA. The relationships between the scales were determined using Pearson correlation analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics of Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the individuals who participated in the study, 52.4% were male. Among the personnel, 73% had a bachelor\u0026rsquo;s degree or higher level of education, while 27% had an education level of a bachelor\u0026apos;s degree or lower. Half of the participants were married, while the other half were single. Of the respondents, 4.6% had previously been in a disaster zone, and 15.9% had lost a relative during a disaster. The average age of the participants was 34.56\u0026plusmn;8.01 years, and their average duration of professional experience was 2.80\u0026plusmn;1.47 years (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMean Scores for Secondary Traumatic Stress, Altruism, and Brief Resilience Scales\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents the mean scores obtained from the scales. The mean score for the Secondary Traumatic Stress Scale was 43.45\u0026plusmn;12.38. Subscale scores were as follows: Avoidance, 17.26\u0026plusmn;5.20; Intrusion, 12.83\u0026plusmn;4.32; and Arousal, 13.34\u0026plusmn;3.79. The Altruism Scale mean score was 56.07 \u0026plusmn; 8.84, and the Brief Resilience Scale mean score was 20.96\u0026plusmn;4.76.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic Factors Influencing Scale Scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 demonstrates the sociodemographic factors affecting scores on the Secondary Traumatic Stress Scale, Altruism Scale, and Brief Resilience Scale. Male participants scored significantly higher than females on STSS (p=0.001), Avoidance (p=0.016), Intrusion (p=0.000), Arousal (p=0.001), and the Brief Resilience Scale (p=0.001). Single participants had significantly higher BRS scores (21.92\u0026plusmn;4.62) compared to married participants (20.01\u0026plusmn;4.74). Gender and education level did not significantly impact scale scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations Between Secondary Traumatic Stress, Altruism, and Brief Resilience Scales\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 also displays correlations between the scales. A positive correlation was found between age and both altruism (r=0.476, p=0.000) and professional experience (r=0.476, p=0.000). A statistically significant negative correlation was observed between STSS and BRS (r=-0.693, p=0.000) (Table 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIt is crucial to identify the psychological problems experienced by national medical rescue team personnel, who are among the first responders to disaster areas and establish initial contact with victims, as well as to consider protective factors in this context. In this study, which examined the levels of secondary traumatic stress (STS), altruism, and psychological resilience among members of the national medical rescue team working in disaster zones, participants\u0026rsquo; STS levels were found to be high, with a mean score of 43.45\u0026plusmn;12.38. Disasters have significant adverse effects on the mental well-being of medical responders (25). A study conducted in T\u0026uuml;rkiye with volunteer search and rescue workers who participated in earthquake response operations reported that some participants continued to exhibit post-traumatic symptoms over time, negatively impacting their lives (26). Another study with healthcare professionals working in earthquake zones found that the mean total score on the Secondary Traumatic Stress Scale was 55.6\u0026plusmn;12.3 (27). Service providers indirectly exposed to trauma can exhibit the same PTSD symptoms as individuals directly exposed to trauma (28). A meta-analysis revealed that the prevalence of PTSD among healthcare workers involved in earthquake responses was 16.37% (29). An analysis of 266 studies focusing on medical aid workers deployed to provide assistance during natural disasters found that 40% of these workers experienced significant challenges related to general mental well-being (30). Establishing peer support groups is recommended to help rescue workers connect with others who have had similar experiences, providing emotional support and coping mechanisms (31). Signs of stress in individuals exposed to traumatic events should not be overlooked by team members and professionals, even if these individuals appear to maintain functionality. Timely interventions should be implemented to prevent functional impairment (32).\u003c/p\u003e\n\u003cp\u003eIn this study, the participants\u0026apos; altruism level was determined to be high, with a mean score of 56.07\u0026plusmn;8.84. Altruistic behavior within organizations refers to the actions of employees voluntarily assisting others in overcoming difficulties and challenges related to organizational duties, without any obligation (33). When an individual engages in an act of help solely for the benefit of another, it is considered altruistic behavior (34). The willingness of individuals working in disaster zones to engage in helping behaviors cannot be solely attributed to the professional obligations of their roles but also reflects their altruistic characteristics. The high scores observed in this study support this perspective.\u003c/p\u003e\n\u003cp\u003eThe participants\u0026apos; BRS (Brief Resilience Scale) score was found to be 20.96\u0026plusmn;4.76, indicating a high level of resilience. During the Israel-Hamas conflict, the resilience level among mental health professionals was reported to be moderate (35). In a study conducted in T\u0026uuml;rkiye following a 7.7 magnitude earthquake, the resilience levels of nursing students were found to be moderate (36). During the COVID-19 pandemic, healthcare workers reported lower levels of distress and higher levels of resilience compared to the general population (37). Another study determined that the BRS scores of nurses providing care to earthquake survivors were 17.40\u0026plusmn;3.61 (Cobanoğlu \u0026amp; Oğuzhan, 2024). The high level of psychological resilience observed among the participants in this study positively influences their ability to cope with trauma.\u003c/p\u003e\n\u003cp\u003eMale participants scored higher on the STSS, Avoidance, Intrusion, and Arousal subscales, as well as the Brief Resilience Scale, compared to female participants. Selvi and Aslan (2024) reported that female healthcare workers in earthquake-affected regions exhibited higher post-traumatic stress levels compared to their male counterparts (38). \u0026nbsp;Similarly, Ediz and Yanik (2024) in their study with nurses following the 2023 Great T\u0026uuml;rkiye Earthquake, found that women had lower psychological resilience levels (39).\u003c/p\u003e\n\u003cp\u003eThe findings of this study suggest that while women are more emotionally affected by trauma, their higher resilience levels may be associated with superior coping capabilities.In this study, unmarried participants had a significantly higher BRS score (21.92\u0026plusmn;4.62) compared to married participants (20.01\u0026plusmn;4.74). A study conducted shortly after the 2020 Malatya-Elazığ earthquake found that married healthcare workers exhibited higher trauma scores (40). Although married individuals may perceive greater social support, the additional responsibility of caring for others might negatively affect resilience in disaster scenarios. However, in-depth interviews with rescue teams could provide more comprehensive insights.\u003c/p\u003e\n\u003cp\u003eThis study identified a positive and statistically significant correlation between altruism and both age and years of professional experience (41). found that middle-aged individuals exhibited higher levels of altruism compared to other age groups. The positive influence of age and professional experience on altruism suggests that individuals may develop greater compassion and altruistic tendencies as they age and gain experience.\u003c/p\u003e\n\u003cp\u003eThe literature indicates that secondary trauma may influence resilience (42). In this study, a statistically significant negative correlation was identified between STSS and BRS scores. Roden-Foreman et al. (2017) found a positive association between low resilience, personal trauma, and higher STS severity scores. A study conducted with psychologists working in disaster zones in T\u0026uuml;rkiye revealed that psychological resilience negatively predicts secondary traumatic stress (43). Similarly, Selvi and Aslan (2024) found that healthcare workers with higher levels of psychological resilience exhibited lower levels of post-traumatic stress disorder (38). Considering that resilience is regarded as a protective factor, its negative relationship with secondary trauma is an expected outcome. Implementing interventions aimed at enhancing resilience among individuals working in disaster zones may have a positive impact on their well-being.\u003c/p\u003e\n\u003cp\u003eThe findings of this study are limited to the sample group and cannot be generalized to the entire population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, the level of secondary traumatic stress, altruism and psychological resilience of the National Medical Rescue Team personnel working in the disaster area were determined at high levels. The STSS score of men is higher than that of women. Single people had higher BRS scores than married people and men had higher BRS scores than women. A statistically significant positive correlation was found between age and The Altrusim and working time in the profession, while a statistically significant and negative correlation was found between STSS and BRS. Since men may be at risk in terms of STSS, it is thought that they should be supported. In addition, since STSS and BRS are negatively correlated, it is thought that interventions to increase psychological resilience may positively affect secondary trauma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Occupational Health Practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDetermining the secondary trauma, altruism and psychological resilience levels of National Medical Rescue Team Personnel Working in Disaster Zones is important in terms of precautions that can be taken. Interventions that support these individuals can increase their psychological resilience and have a positive effect on secondary trauma and altruism.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approvals were obtained from the Kocaeli University Ethics Committee (Date: 19.10.2023- Number: K\u0026Uuml; GOKAEK-2023/17.26). Ethical approval was obtained for the study in accordance with the Declaration of Helsinki. Participants were informed about their voluntary participation in the online form and those who did not approve the box stating that they would participate voluntarily in the study were not allowed to proceed with the survey questions. The enames of the participants were not included in the scales. \u0026nbsp;Informed consent to participate was obtained from all of the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTh authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study had no funding support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Concept: SD, YC\u0026Ouml;, BK; Design: SD, YC\u0026Ouml;, BK; \u0026nbsp;onsulting/Supervision: SD, YC\u0026Ouml; Data collection and/or processing: BK ; Data analysis and/or interpretation: SD, YC\u0026Ouml;; Literature search: SD, YC\u0026Ouml;, BK ; Article writing: SD, YC\u0026Ouml; Critical review: SD, YC\u0026Ouml;, BK.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors appreciate all the participants who took part in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOgińska-Bulik N, Juczyński Z. 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Prevalence and predictors of secondary traumatic stress symptoms in health care professionals working with trauma victims: A cross-sectional study. PLoS One. 2021;16(2):e0247596. \u003c/li\u003e\n\u003cli\u003eGreinacher A, Derezza-Greeven C, Herzog W, Nikendei C. Secondary traumatization in first responders: a systematic review. Eur J Psychotraumatol [Internet]. 2019;10(1):1562840. Available from: https://doi.org/10.1080/20008198.2018.1562840\u003c/li\u003e\n\u003cli\u003eTessitore F, Caffieri A, Parola A, Cozzolino M, Margherita G. The role of emotion regulation as a potential mediator between secondary traumatic stress, burnout, and compassion satisfaction in professionals working in the forced migration field. Int J Environ Res Public Health. 2023;20(3):2266. \u003c/li\u003e\n\u003cli\u003eHuang W, Li L, Zhuo Y, Zhang J. Analysis of resilience, coping style, anxiety, and depression among rescue nurses on EMTs during the disaster preparedness stage in Sichuan, China: A descriptive cross-sectional survey. Disaster Med Public Health Prep. 2023;17(e268):1\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eHugelius K, Murphy J, Blomberg K. Health problems among disaster responders to the 2023 Turkey-Syria earthquake: a cross-ectional study. BMC Emerg Med. 2024;24(226):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eGustavsson ME, Juth N, Arnberg FK, von Schreeb J. Dealing with difficult choices: a qualitative study of experiences and consequences of moral challenges among disaster healthcare responders. Confl Health [Internet]. 2022;16(24):1\u0026ndash;19. Available from: https://doi.org/10.1186/s13031-022-00456-y\u003c/li\u003e\n\u003cli\u003eIshfaq A, Ahmad G. Impact of altruism, heroism, and psychological distress on quality of life among social workers during COVID-19. Pakistan J Psychol Res. 2023;38(2):329\u0026ndash;47. \u003c/li\u003e\n\u003cli\u003eBerber Z. \u0026Ouml;zgeciliğin ortaya \u0026ccedil;ıktığı durumların değerlendirilmesi [Evaluation of situations where altruism occurs]. Elektron Sos Bilim Derg. 2024;23(92):1685\u0026ndash;97. \u003c/li\u003e\n\u003cli\u003eK\u0026ouml;ksal K, G\u0026uuml;rsoy A, Yapar H. \u0026Ouml;zgecilik ve \u0026ccedil;alışan performansı arasındaki ilişki: Kamu sekt\u0026ouml;r\u0026uuml;nde bir inceleme [The relationship between altruism and employee performance: An application in the public sector]. T\u0026uuml;rkiye Sos Araştırmalar Derg. 2018;22(3):783\u0026ndash;96. \u003c/li\u003e\n\u003cli\u003eDoğru \u0026Ccedil;abuker N, Ersanlı K. Bireylerin meslekleri̇ne g\u0026ouml;re di̇ğerk\u0026acirc;mlık d\u0026uuml;zeyleri̇ [Altruism level of individulas by professions]. 19 Mayıs Sos Bilim Derg. 2021;2(2):522\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eSoravia LM, Schwab S, Walther S, M\u0026uuml;ller T. 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Developing a tool for measuring the disaster resilience of healthcare rescuers: A modified Delphi study. Scand J Trauma Resusc Emerg Med. 2020;28(4):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eErsanlı K, Doğru \u0026Ccedil;abuker N. Diğerk\u0026acirc;mlık \u0026Ouml;l\u0026ccedil;eği\u0026rsquo;nin psikometrik \u0026ouml;zellikleri [Psychometr,c properties of the altruism scale]. Elektron Sos Bilim Derg. 2015;14(52):43\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eBride BE, Robinson MM, Yegidis B, Figley CR. Development and validation of the Secondary Traumatic Stress Scale. Res Soc Work Pract. 2004;14(1):27\u0026ndash;35. \u003c/li\u003e\n\u003cli\u003eYıldırım G, Kidak LB, Yurdabakan I. İkincil travmatik stres \u0026ouml;l\u0026ccedil;eği: Bir uyarlama \u0026ccedil;alışması [Secondary Traumatic Stress Scale: an adaptation study]. Anadolu Psikiyatr Derg. 2018;19(1):45\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eSmith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: Assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194\u0026ndash;200. \u003c/li\u003e\n\u003cli\u003eDoğan T. Kısa Psikolojik Sağlamlık \u0026Ouml;l\u0026ccedil;eği\u0026rsquo;nin T\u0026uuml;rk\u0026ccedil;e uyarlaması: Ge\u0026ccedil;erlik ve g\u0026uuml;venirlik \u0026ccedil;alışması [Adaptation of the Brief Resilience Scale into Turkish: A validity and reliability study]. J Happiness Well-Being. 2015;3(1):93\u0026ndash;102. \u003c/li\u003e\n\u003cli\u003eNaushad VA, Bierens JJLM, Nishan KP, Firjeeth CP, Mohammad OH, Maliyakkal AM, et al. A Systematic Review of the Impact of Disaster on the Mental Health of Medical Responders. Prehosp Disaster Med. 2019;34(6):632\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eK\u0026ouml;se A. Voluntary search-and-rescue workers\u0026rsquo; experiences after witnessing trauma in the earthquake field. OPUS J Soc Res. 2023;20(51):56\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eTopkara FN, Reyhan FA, Dağli E, Bakir E. Deprem b\u0026ouml;lgesinde g\u0026ouml;rev yapan sağlık \u0026ccedil;alışanlarının merhamet yorgunluğu ve ikincil travmatik stres d\u0026uuml;zeyleri arasındaki ilişkinin belirlenmesi [Determination of the relationship between compassion fatigue and secondary traumatic stress levels of healthcar. J TOGU Heal Sci. 2024;4(2):152\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eTominaga Y, Goto T, Shelby J, Oshio A, Nishi D, Takahashi S. Secondary trauma and posttraumatic growth among mental health clinicians involved in disaster relief activities following the 2011 Tohoku earthquake and tsunami in Japan. Couns Psychol Q [Internet]. 2020;33(4):427\u0026ndash;47. Available from: https://doi.org/10.1080/09515070.2019.1639493\u003c/li\u003e\n\u003cli\u003eTahernejad S, Ghaffari S, Ariza-Montes A, Wesemann U, Farahmandnia H, Sahebi A. Post-traumatic stress disorder in medical workers involved in earthquake response: A systematic review and meta-analysis. Heliyon [Internet]. 2023;9(1):e12794. Available from: https://doi.org/10.1016/j.heliyon.2023.e12794\u003c/li\u003e\n\u003cli\u003eEin N, Plouffe RA, Liu JJW, Gervasio J, Baker C, Carleton RN, et al. Physical and psychological challenges faced by military, medical and public safety personnel relief workers supporting natural disaster operations: a systematic review. Curr Psychol [Internet]. 2024;43(2):1743\u0026ndash;58. Available from: https://doi.org/10.1007/s12144-023-04368-9\u003c/li\u003e\n\u003cli\u003ePatwary MM, Ashraf S, Swed S, Beaglehole B, Shoib S. Natural disaster and mental health of emergency rescue workers: Lessons learned from Turkey-Syria earthquake. Ann Work Expo Heal. 2023;67(8):1018\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eKahve AC, Aydın S, Er DG. Travmaya maruz kalan bireyler ve sağlık \u0026ccedil;alışanlarında deprem sonrası ortaya \u0026ccedil;ıkan ruhsal sorunlara yaklaşım [Approach to psychological problems arising after the earthquake in individuals exposed to trauma and healthcare workers]. TOTBİD Derg. 2023;22(6):642\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eKa\u0026ccedil;an H, Karakulle İ, Aydın E. \u0026Ouml;rg\u0026uuml;tsel vatandaşlık davranışının yordacıları olarak duygusa zeka ve kişilik \u0026ouml;zlelikleri: Hemşireler \u0026uuml;zerinde kesitsel bir \u0026ccedil;alışma [Emotional intellgence and personal characteristics as anticident of organizational citizenship behaviour: A sectional study. Int J Econ Adm Stud. 2023;(39):170\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eD\u0026uuml;zg\u0026uuml;ner S. Pro-sosyal davranışlarda di̇ğerk\u0026acirc;mliğin (\u0026ouml;zgeci̇li̇k) tanımı ve konumu [The definition and location of altruism among pro-social behaviours]. Bilim XL [Internet]. 2019;4:351\u0026ndash;73. Available from: http://dx.doi.org/10.28949/bilimname.595847\u003c/li\u003e\n\u003cli\u003eDahan S, Bloemhof-Bris E, Segev R, Abramovich M, Levy G, Shelef A. Anxiety, post-traumatic symptoms, media-induced secondary trauma, post-traumatic growth, and resilience among mental health workers during the Israel-Hamas war. Stress Heal. 2024;40:e3459. \u003c/li\u003e\n\u003cli\u003eSirin Gok M, Aydin A, Baga Y, Ciftci B. The relationship between the psychological resilience and general health levels of earthquake survivor nursing students in Kahramanmaras earthquakes, the disaster of the century. J Community Psychol. 2024;52(3):498\u0026ndash;511. \u003c/li\u003e\n\u003cli\u003ePink J, Gray NS, O\u0026rsquo;Connor C, Knowles JR, Simkiss NJ, Snowden RJ. Psychological distress and resilience in first responders and health care workers during the COVID-19 pandemic. J Occup Organ Psychol. 2021;94(4):789\u0026ndash;807. \u003c/li\u003e\n\u003cli\u003eSelvi D\u0026Ouml;, Aslan A. 6 Şubat 2023 Maraş depreminde g\u0026ouml;rev yapan sağlık \u0026ccedil;alışanlarının travma sonrası stres ve psikolojik dayanıklılık ilişkilerinin değerlendirilmesi [Evaluation of post-traumatic stress and psychological resiligence levels of health workers who worked in the M. Middle Black Sea J Commun Stud. 2024;9(June):1\u0026ndash;18. \u003c/li\u003e\n\u003cli\u003eEdiz \u0026Ccedil;, Yanik D. Disaster preparedness perception, pyschological resiliences and empathy levels of nurses after 2023 Great Turkiye earthquake: Are nurses prepared for disasters: A risk management study. Public Health Nurs. 2024;41(1):164\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eCansel N, Ucuz İ. Post-traumatic stress and associated factors among healthcare workers in the early stage following the 2020 Malatya-Elazığ earthquake. Konuralp Tıp Derg. 2022;14(1):81\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eXiao Y, Wong K, Cheng Q, Yip PSF. Understanding the better than average effect on altruism. Front Psychol. 2021;11:562846. \u003c/li\u003e\n\u003cli\u003eMaran D, Dolce V, L C. Editorial: Secondary traumatic stress: Risk factors, consequences, and coping strategies Daniela. Front Psychol. 2023;(14):1148186. \u003c/li\u003e\n\u003cli\u003eDemirel B. Kahramanmaraş merkezli depremde g\u0026ouml;rev alan psikologların psikolojik dayanıklılık ve ikincil travma analizi [An analysis of psychological resilience and secondary trauma among psychologists involved in the earthquake response in Kahramanmaraş]. Adli tıp B\u0026uuml;lteni. 2024;29(3):230\u0026ndash;5. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Socio-demographic Characteristics of Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree or lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHigh school and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEmergency medical technician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDentist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHad previously been in a disaster zone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e74.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHad lost a relative during a disaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e84.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eWork experience (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Descriptive statistics of the scale scores of the participants (n = 126) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"570\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScales\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary Traumatic Stress Scale (STSS)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e43.45\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026plusmn;12.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e17.26 \u0026plusmn;5.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eIntrusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e12.83 \u0026plusmn;4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eArousal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e13.34 \u0026plusmn;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Altruism Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e56.07\u003cstrong\u003e\u0026nbsp;\u0026plusmn;\u003c/strong\u003e 8.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrief Resilience Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 258px;\"\u003e\n \u003cp\u003e20.96 \u0026plusmn;4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 570px;\"\u003e\n \u003cp\u003eAbbreviations: SD, standard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSociodemographic Factors Influencing Scale Scores\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Altruism Scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eAvoidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eIntrusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eArousal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrief Resilience Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMale (n = 66)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFemale (n = 60)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.62 \u0026plusmn; 9.02\u003c/p\u003e\n \u003cp\u003e55.48\u0026plusmn; 8.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46.96\u0026plusmn;12.48\u003c/p\u003e\n \u003cp\u003e39.58\u0026plusmn;11.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18.33\u0026plusmn;5.50\u003c/p\u003e\n \u003cp\u003e16.10\u0026plusmn;4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14.19\u0026plusmn;4.24\u003c/p\u003e\n \u003cp\u003e11.33\u0026plusmn;3.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14.43\u0026plusmn;3.65\u003c/p\u003e\n \u003cp\u003e12.15\u0026plusmn;3.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19.62\u0026plusmn;4.97\u003c/p\u003e\n \u003cp\u003e12.15\u0026plusmn;3.61\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et / F, p\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=0.720 p=0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003et=3.490 \u003cstrong\u003ep=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003et=2.451 \u003cstrong\u003ep=0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003et=3.914\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003et=3.531\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003et=-3.474 \u003cstrong\u003ep=0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree or lower\u0026nbsp;(34)\u003c/p\u003e\n \u003cp\u003eHigh school and above\u0026nbsp;(92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55.64\u0026plusmn;7.16\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.23\u0026plusmn;9.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42.44\u0026plusmn;11.22\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43.82\u0026plusmn;12.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16.70\u0026plusmn;4.53\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17.47\u0026plusmn;5.44\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.73\u0026plusmn;4.28\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.86\u0026plusmn;4.37\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.00\u0026plusmn;3.24\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.47\u0026plusmn;3.99\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20.73\u0026plusmn;5.48\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21.05\u0026plusmn;4.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et / F, p\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=-0.332 p=0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003et=-0.556 p=0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003et=-0.737\u003c/p\u003e\n \u003cp\u003ep=0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003et=-0.154\u003c/p\u003e\n \u003cp\u003ep=0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003et=-0.626\u003c/p\u003e\n \u003cp\u003ep=0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003et=-0.333\u003c/p\u003e\n \u003cp\u003ep=0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSingle (63)\u003c/p\u003e\n \u003cp\u003eMarried (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.38\u0026plusmn;9.35\u003c/p\u003e\n \u003cp\u003e55.77\u0026plusmn;8.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41.84\u0026plusmn;12.04\u003c/p\u003e\n \u003cp\u003e45.06\u0026plusmn;12.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16.63 \u0026plusmn;4.89\u003c/p\u003e\n \u003cp\u003e17.90 \u0026plusmn;5.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12.12 \u0026plusmn;4.27\u003c/p\u003e\n \u003cp\u003e13.53 \u0026plusmn;4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.07 \u0026plusmn;3.80\u003c/p\u003e\n \u003cp\u003e13.61 \u0026plusmn;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21.92 \u0026plusmn;4.62\u003c/p\u003e\n \u003cp\u003e20.01 \u0026plusmn;4.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et / F, p\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003et=0.382 p=0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003et=-1.467 p=0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003et=-1.373\u003c/p\u003e\n \u003cp\u003ep=0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003et=-1.849 p=0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003et=-0.796\u003c/p\u003e\n \u003cp\u003ep=427\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003et=2.282\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep=0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003ep \u0026lt; 0.05, \u003csup\u003e**\u003c/sup\u003ep \u0026lt; 0.01\u003c/p\u003e\n\u003cp\u003eAbbreviations: IGDS9-SF: Internet Gaming Disorder Scale-Short Form, SD, standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTa\u003c/strong\u003e\u003cstrong\u003eble 4\u0026nbsp;\u003c/strong\u003eVariables related to The Altruism scale, STSS, Brief Resilience Scale\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Alturism Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBRS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.223\u003csup\u003e**\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e-0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEork experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.223\u003csup\u003e**\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe Alturism Scale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e-0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 219px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrief Resilience Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;-0.693\u003csup\u003e**\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e**\u003c/sup\u003ep \u0026lt; 0.01\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Healthcare Worker, Trauma, Psychological Resilience, Altruism","lastPublishedDoi":"10.21203/rs.3.rs-7691854/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7691854/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eThis study aims to examine the levels of secondary traumatic stress, altruism, and psychological resilience among personnel of the national medical rescue team operating in disaster areas.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eThis descriptive and cross-sectional study included 126 national medical rescue team personnel. Participants completed a demographic information form, the Altruism Scale, the Secondary Traumatic Stress Scale, and the Brief Resilience Scale. Data were collected through an online platform and analyzed using SPSS 25 software. Statistical significance was set at α = 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eThe mean scores for the participants were as follows: STS Scale, 43.45 ± 12.38 (high); Altruism Scale, 56.07 ± 8.84 (high); and Brief Resilience Scale, 20.96 ± 4.76 (high). Male participants scored significantly higher than females on STSS (p=0.001), Avoidance (p=0.016), Intrusion (p=0.000), Arousal (p=0.001), and Brief Resilience Scale (p=0.001). Single participants had statistically higher BRS scores compared to married individuals (p\u0026lt;0.05). Additionally, a positive correlation was found between age, altruism, and professional experience, whereas STSS and BRS scores exhibited a significant negative correlation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion/Application to Practice\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e The findings suggest that rescue teams working in disaster zones are at risk of experiencing secondary trauma and require appropriate support. Targeted interventions for at-risk groups are recommended.\u003c/p\u003e","manuscriptTitle":"Investigation of Secondary Traumatic Stress, Altruism and Psychological Resilience Levels of National Medical Rescue Team Personnel Working in Disaster Areas","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-25 17:57:03","doi":"10.21203/rs.3.rs-7691854/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b03f277-f8d7-49d6-8793-a3750e40d9b9","owner":[],"postedDate":"November 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T14:41:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-25 17:57:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7691854","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7691854","identity":"rs-7691854","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}