The Relationship between Professional Identity Statuses, Religious Identity Statuses and Secondary Traumatic Stress amongst Workers in the Emergency Room

Emergency room (ER) workers face frequent trauma exposure, placing them at risk of developing secondary traumatic stress (STS). Despite the recognized importance of identity commitments for psychological well-being, the relationship between identity statuses and secondary traumatic stress in this context remains unexplored. This study aimed to examine the relationships between professional identity statuses, religious identity statuses and secondary traumatic stress among ER staff. 

Building upon Erikson's theoretical framework, Marcia's identity status model (1966) is built from two dimensions: exploration and commitment. Marcia (1993) defined exploration as the degree to which individuals engage in a personalized search for different values, beliefs, and goals; commitment was defined as adhering to a specific set of convictions, goals, and beliefs. By combining these two dimensions, Marcia derived four identity statuses: achievement (commitment following exploration), moratorium (being in the process of exploration), foreclosure (commitment without previous exploration), and diffusion (an absence of exploration and commitment).

Grounded in Marcia's identity status model, we hypothesized that professional identity achievement will have a negative relationship with STS because those who chose their profession after an exploration process will be at lower risk of developing STS. The same logic applies to professional identity diffusion, and therefore the hypothesis is that it will have a positive relationship with STS. We also hypothesized that religious identity achievement and foreclosure statuses would be negatively correlated with STS, because individuals who have either explored and committed to their religious beliefs (achievement) or have accepted religious commitments without exploration but with strong conviction (foreclosure) would have more stable identity foundations and coping resources, thereby reducing their vulnerability to developing secondary traumatic stress. Research questions explored potential correlations between professional foreclosure and moratorium statuses and STS, as well as relationships between religious moratorium and diffusion statuses and STS, due to the lack of sufficient information in the literature regarding the possible relationships between these specific identity statuses and secondary traumatic stress. 

Questionnaires were filled out by 111 ER staff members, assessing religious and professional identity statuses using Bell's Religious Identity Statuses scale (Bell, 2009) and an adapted Professional Identity Statuses scale (Adams, 1999). STS was measured using Bride's Secondary Traumatic Stress Scale (Bride et al., 2004), encompassing intrusion, avoidance, and arousal symptoms. Pearson correlations and hierarchical regression analyses examined the relationships between identity statuses and secondary traumatic stress.

The findings provided partial support for the hypotheses. Professional identity diffusion showed a significant positive correlation with STS (r = .40, p < .001), as did professional identity moratorium (r = .33, p < .001). Contrary to our hypothesis, no significant relationships were found between professional identity achievement and foreclosure statuses and STS. Regarding religious identity, a weak but significant relationship was found between religious moratorium and STS (r = .25, p < .05), but hypotheses regarding religious achievement and foreclosure statuses were not supported. Hierarchical regression revealed that professional identity statuses explained an additional 16.2% of variance in STS beyond ER work experience. 

The study indicates that the absence of professional commitment (in diffusion and moratorium statuses) serves as a risk factor for developing secondary traumatic stress. The findings highlight potential associations between professional identity statuses and STS vulnerability in medical environments with high trauma exposure. While these correlational results suggest that identity status assessment could inform intervention strategies for emergency healthcare workers, longitudinal research is needed to establish causal relationships and validate the effectiveness of such approaches.

Keywords: Secondary traumatic stress, identity statuses, professional identity, religious identity, emergency room workers.