.. (Figley, 2002).,,,,,,, (,, 2015; Stamm, 2010). (,, ; )..,.,. DSM-5(American Psychiatry Association, 2013) ( A4) , (secondary traumatic stress
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1 (K-ProQOL 5) * (Professional Quality of Life Scale, ProQOL 5; Stamm, 2010). ProQOL 5 489, K-ProQOL 5,, -.,,, 3., ,,. K-ProQOL 5. * 2014 ( ) (NRF-2014S1A3A ). (Corresponding Author) :,, 11-1 Tel : / ahn12@ewha.ac.kr
2 .. (Figley, 2002).,,,,,,, (,, 2015; Stamm, 2010). (,, ; )..,.,. DSM-5(American Psychiatry Association, 2013) ( A4) , (secondary traumatic stress, STS), (burnout, BO), (compassion fatigue, CF), (vicarious traumatization, VT). (McCann & Pearlman, 1990),.,,,,.
3 . (CF), PTSD. (Figley, 2002), (Adams, Boscario, & Figley, 2006). Empathy Fatigue(Stebnicki, 2007). Stamm (2010) (STS) (BO). (STS),, PTSD.,. (BO),,,,.,, 3 (Maslach, Schaufeli, & Leiter, 2001), (,,, ). (Cieslak et al., 2013).,.. (Impact of Event Scale-Revised, IES-R; Weiss, 2004), (Trauma and Attachment Belief Scale, TABS; Pearlman, 2003),
4 (Secondary Traumatic Stress Scale, STSS; Bride, Robinson, Yegidis, & Figley, 2004), (Professional Quality of Life Scale, ProQOL; Stamm, 2010).. IES-R (Impact of Event Scale, IES; Horowitz, Wilner, & Alvarez, 1979) (intrusion) (avoidance), (hyperarousal) 22. (, 2011), (, 2012). TABS (vicarious trauma) TSI (Traumatic Stress Institute Belief Scale, Pearlman, 1996). TABS (,,,,, ) 84, (self) (others) 10. (, 2012;,, 2015), (, 2015), (, 2016) TABS. IES-R TABS STSS ProQOL. STSS,,, 17. (,, 2011), (, 2012;,, 2015), (, 2015), (, 2012), (, 2016)., ProQOL Figley(1995) CFST(Compassion Fatigue Self-Test). CFST (compassion satisfaction) CSFT(Compassion Satisfaction and Fatigue Test; Stamm & Figley, 1996) 2005 ProQOL. STSS, ProQOL (CS) (CF). (Hensel et al., 2015) 38
5 23 ProQOL(17 ) CFST(6 )., ProQOL (,,, 2015;,, 2014a). (, 2007),,,, (,,, 2015), (,, 2012;,, 2012;,, 2014;,, 2014b).. (2010) ProQOL. ProQOL. ProQOL ProQOL 5(Stamm, 2010) 30. ProQOL 5 (compassion satisfaction, CS) (compassion fatigue, CF), 2, (burnout, BO) (secondary traumatic stress, STS) , 5 (1=, 5= ). (1, 4, 15, 17, 27). ProQOL 5 T. T 25% (%tile) 25%tile 75%tile,,. ProQOL 5 25%tile T 44, 43, 42, 75%tile 57, 56, 56. ProQOL 5,. ProQOL 5 (CS), (BO), (STS)
6 . Stamm(2010) 1. ProQOL 5., ProQOL 5,,,. ProQOL 5. Stamm(2010). ( K-ProQOL 5) CS BO STS.. CS BO STS CS BO STS CS BO STS CS BO STS.... PTSD..,,. CS=compassion satisfaction; BO=burnout; STS=secondary traumatic stress.
7 . ProQOL 5. ProQOL 5. ProQOL (Stamm, 2010),. K-ProQOL 5. K-ProQOL 5. Stamm(2010) ProQOL 5,.. ProQOL 5, (IRB). 489 ProQOL 5,.,.. (,,,,,,,,, ), (,,,,,,, ). 6 ( 200 ) (289 ) 489
8 . - 4, PTSD (DSM-IV-TR; APA, 2000) (90.6%), 26 (8.7%), (SD = 8.13; =25 ~62 ), (239, 79.9%) (43, 14.4%), (17, 5.7%). (162, 54.2%), (52, 17.4%), (,,, ; 25, 8.3%), 60(20.1%)., (SD= 50.66; =4 ~240 ), (SD=10.90; =1 ~50 ), 7.05 (SD=8.48; =1 ~48 ).,,., (F=8.38, p<.001) (M=104.29, SD=60.92) (M=68.76, SD=48.57) (M=69.60, SD=73.80). (F=6.86, p<.01) (M=14.55, SD=9.25) (M=19.27, SD= 11.66) (M=20.07, SD=14.18). (F=6.72, p<.01) (M=10.71, SD=12.86) (M=5.69, SD= 6.37) (M=6.76, SD=7.78). ProQOL 5(Stamm, 2010). (forward-adaptation) 1
9 (Brislin, 1970:, 2003 ). (, 2003). ProQOL ProQOL , 1, K-ProQOL 5. (Maslach Burnout Inventory, MBI) (Maslach & Jackson, 1981),, (2002) MBI K-ProQOL 5 (BO). MBI (Emotional Exhausion, 9 ), (Depersonalization, 5 ), (Personal Accomplishment, 8 ) 3 7 Likert (0 = ~6= )., K-ProQOL 5 CS. MBI Cronbach s.87,.58,.85. (Posttraumatic Diagnostic Scale, PDS) (Foa, Cashman, Jaycox, & Perry, 1997) DSM-IV 1: (0= /, 1= 1 1 /, 2= 1 /2~4, 3= /5 ) 20 (,,, 2010). (2005) PDS K-ProQOL 5 (STS)
10 . Cronbach s.93. CES-D(Center for Epidemiologic Studies Depression Scale, CES-D) CES-D(Rdloff, 1977) CES-D(,,, 2001). CES-D 20 4 Likert (0= /1, 1= /1~2, 2= /3~4, 3= /5~7 ) (4, 8, 12, 16). CES-D K-ProQOL 5 Cronbach s.91. (Trauma History Checklist THC) (,,, 2015) DSM-5(APA, 2013) A. THC ( ) ( ),,,. K-ProQOL 5,, -,, (Cronbach s α). K-ProQOL 5-4. K-ProQOL 5., K-ProQOL 5.., RMSEA, CFI, TLI. RMSEA(Root Mean Squared Error of Approximation) (, 2000; Hu & Bentler, 1999) TLI(Tucker Lewis Index) CFI(Comparative Fit Index) (, 2000; Bentler, 1990). K-ProQOL 5,,
11 M SD - Cronbach s α α (CS) (BO) (STS)
12 K-ProQOL 5. K-ProQOL 5 T, Scheffe, Dunnett T3. AMOS 18.0 SPSS K-ProQOL 5 -,, ( 2)., (0.7 ), -.30, (, 2006)., 2.97~3.85(SD= 0.76~0.98), 1.75~2.84(SD=0.74~1.15), 1.69~2.87(SD= 0.76~1.09). ProQOL 5 Likert 1-5 3,,. -.59~.78,.37 ~.71,.41~.72,. Cronbach's α.89,.74,.80. 2, BO K-ProQOL (SD=6.08), 23.71(SD=5.08), 23.06(SD=5.71). K-ProQOL 5 -
13 70.81(p<.001),.71(p<.001),.65(p<.001) -. K-ProQOL 5 (Confirmatory Factor Analysis, CFA)., ProQOL 5 ( 1). Stamm(2010), 1, 2 (CF) (CS) ,, 3, K-ProQOL 5 3., Stamm. ProQOL
14 3 (Kline, 2011), K-ProQOL 5 10 (MacCallum, Widaman, Zhang, & Hong, 1999). (item parceling) (Kiston & Widaman, 1994).,, (Bandalos, 2002)., (unidimensionality). (Construct Reliability, CR) (Average Variance Extracted, AVE),.70 (Hair, Anderson, Tatham, & Black, 1998),.50 (Fornell & Larcker, 1981). K-ProQOL (Construct Reliability, CR) (Average Variance Extracted, AVE),.89,.77,.81.68,.52,.55 df RMSEA (90% ) CFI TLI ( ) ( ) ( ) RMSEA = Root Mean Squared Error of Approximation; CFI = Comparative Fit Index; TLI = Comparative Fit Index.
15 , ( =740.02, df=90; RMSEA=.156; CFI=.68; TLI=.62) 2 ( =393.69, df=89; RMSEA=.107; CFI=.85; TLI=.82) 3 ( =245, df=87; RMSEA=.078; CFI=.92; TLI=.91) K-ProQOL 5 3 C.R. (CS) CS *** CS *** CS *** CS *** CS *** (BO) BO *** BO *** BO *** BO *** BO *** (STS) STS *** STS *** STS *** STS *** STS *** CS=compassion satisfaction; BO=burnout; STS=secondary traumatic stress. *** p <.001.
16 (CS) - 2. (BO) -.77 *** - 3. (STS) -.29 ***.77 *** -. *** p< ~.82,.50~.71,.61-~.80 (p<.001). -.77, -.29,.77 ( 5). K-ProQOL 5 K-ProQOL 5 CES-D, PDS, MBI 6. K-PorQOL 5 (CS) MBI (r=.66, p<.001), CED-D(r=-.39, p<.001), PDS(r=-.26, p<.001), MBI (r=-.34, p<.001) (r=-.41, p<.001). K-PorQOL 5 (BO) MBI (r=-.40, p<.001), (r=-.63, p<.001) (r=.53, p<.001). CED-D(r=.61, p<.001) PDS(r=.51, p<.001) K-ProQOL 5 (concurrent validity). K-ProQOL 5 (STS) PDS (r=.58, p<.001), CED-D(r=.45, p<.001). MBI (r=.57, p<.001), (r=.47, p<.001) (r=-.10, p>.05). K-ProQOL 5 T 2, 25%tile 75%tile 7
17 K-ProQOL CS - 2. K-ProQOL BO -.61 *** - 3. K-ProQOL STS -.25 ***.64 *** - 4. CES-D -.39 ***.61 ***.45 *** - 5. PDS -.26 ***.51 ***.58 ***.56 *** - 6. MBI -.34 ***.63 ***.57 ***.51 ***.44 *** - 7. MBI.66 *** -.40 *** *** MBI -.41 ***.53 ***.47 ***.43 ***.45 ***.62 *** -.21 *** - M (SD) (6.08) (5.08) (5.71) (9.25) 7.75 (7.73) (9.55) (7.21) 7.27 (5.20). CS=compassion satisfaction; BO=burnout; STS=secondary traumatic stress; CES-D=Center for Epidemiologic Studies Depression Scale; PDS=Posttraumatic Diagnostic Scale; MBI=Maslach Burnout Inventory. *** p <.01. (CS) ~54 55 (BO) ~58 59 (STS) ~ T 1) 42 ( =30 ), 43 ( =31 ) ~54 ( =37 ), 55 ( =38 ), 2) 44 ( =20 ), 45 ( =21 ) ~58 ( =27 ), 59 ( =28 ), 3) 42 ( =18 ), 43 ( =19 ) ~55 ( =25 ), 56 ( =26 ).,, PDS, CES-D, MBI. 8
18 M (SD) M (SD) M (SD) F n=68 (22.7%) n=153 (51.2%) n=78 (26.1%) PDS (9.88) 7.09 (7.06) 5.74 (5.60) F(2,292)=12.24 *** >, a (CS) CES-D (10.45) (7.76) (8.64) F(2,288)=21.73 *** > > a MBI (10.57) (8.41) (9.56) F(2,295)=11.19 ***, > b MBI 9.85 (6.00) 7.68 (4.74) 4.23 (3.66) F(2,296)=87.64 *** > > a MBI (6.28) (5.87) (4.88) F(2,294)=25.90 *** < < b n=67 (22.4%) n=187 (62.5%) n=45 (15.1%) PDS 4.72 (4.82) 6.92 (6.68) (9.97) F(2,292)=37.69 ***, < a (BO) CES-D 8.81 (8.34) (7.22) (10.72) F(2,288)=46.41 *** < < a MBI (6.71) (7.93) (10.06) F(2,295)=62.36 *** < < a MBI 4.18 (3.29) 7.21 (4.60) (6.20) F(2,296)=15.08 *** < < a MBI (6.77) (6.94) (6.87) F(2,294)=40.03 *** > > b n=71 (23.7%) n=151 (50.5%) n=77 (25.8%) (STS) PDS 3.35 (3.69) 6.72 (6.20) (9.39) F(2,292)=48.19 *** < < a CES-D 9.56 (7.28) (8.65) (9.45) F(2,288)=24.80 *** < < b MBI (7.01) (7.68) (9.96) F(2,295)=55.02 *** < < a MBI 4.23 (3.98) 7.16 (4.39) (5.94) F(2,296)=30.39 *** < < a MBI (8.13) (7.04) (6.60) F(2,294)=1.50. PDS=Posttraumatic Diagnostic Scale; CES-D=Center for Epidemiologic Studies Depression Scale; MBI=Maslach Burnout Inventory. a = Dunnet T3, b = Scheffe. *** p<.001.., PDS MBI. PDS. MBI.
19 ProQOL 5.,,., K-ProQOL 5 (CS), (BO), (STS). -.77,.77, Stamm(2010). Stamm. K-ProQOL 5 MBI,..,., (Bride, Jones, & Macmaster, 2007; Jenkins & Baird, 2002; Nelson-Gardell & Harris, 2003), (, 2011; Sommer & Cox, 2006), (Sprang, Clark, & Witt-Woosley, 2007), (Bride et al., 2007), (,, 2012; Bakker, Demerouti, & Euwema, 2005), (Bride et al., 2007).. K-ProQOL 5. K-ProQOL 5., K-ProQOL 5
20 .,., K-ProQOL 5,,. ProQOL 25%. K-ProQOL 5. K-ProQOL 5 CS(M=34.88, SD=6.08), BO(M=23.71, SD=5.08), STS(M=23.06, SD=5.71) Stamm (2010). K-ProQOL 5 ProQOL 5, K-ProQOL 5 8, 14, 16.,,,,,,, ProQOL. 1, ProQOL 5. K-ProQOL 5 (CS), (BO) ( ) (STS).,. 21 (14.2%), 29 (10.3%),
21 30 (10.0%). Stamm (2010).,.,, (2016) (, ; Secondary Trauma Care Inventory, STCI),,,,.,,,..,. Stamm(2010),,,,, ProQOL 5,,.,. K-ProQOL 5.,.,
22 (, 2014).,.. (2011). :,,., (2012)..., (2014)., :., , (2015).,, :., (2015).., , (2012). :,,., ,, (2010).., (2016).., (2011).,., (2015). :., (2003).., (2007).. (2005). :.,
23 , (2012).., , (2002).,., ,, (2015). :., , (2015).., ,,,,, (2012).,,., , (2010). :., ,, (2001). CES-D., , (2012).., , (2014).,,,., (2012).., (2014). :., , (2014a).., , (2014b).,,., ,, (2005). : 6., ,, (2016). (STCI) (2006). :. (2000).., Adams, R. E., Boscarino, J., & Figley, C. R. (2006). Compassion fatigue and psychological distress among social workers: A validation study. American Journal of Orthopsychiatry, 76,
24 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th rev.). Washington, DC: American Psychiatric Association. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. Bakker, A. B., Demerouti, E., & Euwema, M. C. (2005). Job resources buffer the impact of job demands on burnout. Journal of Occupational health Psychology, 10, Bandalos, D. L. (2002). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling, 9, Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2004). Development and validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14, Bride, B. E., Jones, J. L., & Macmaster, S. A. (2007). Correlates of secondary traumatic stress in child protective services workers. Journal of Evidence-Based Social Work, 4, Brislin, R. W. (1970). Back translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1, Cieslak, R., Shoji, K., Douglas, A., Melville, E., Luszczynska, A., & Benight, C. C. (2013). A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma. Psychological Services, 11, Figley, C. R. (1995). (Ed.). Compassion fatigue: Coping with secondary traumatic stress disorder. New York: Brunner/Mazel. Figley, C. R. (2002). Compassion fatigue: Psychotherapists' chronic lack of self care. Journal of Clinical Psychology, 58, Fornell, C., & Larcker, D. F. (1981). Evaluating Structural Equation Models with Unobservable and Measurement Error. Journal of Marketing Research. 18, Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psycholigical Assessment, 9, Hair, J. F. Jr., Anderson, R. E., Tatham, R. L., & Black, W. C. (1998). Multivariate data analysis (5th ed). Upper Saddle River, NJ: Prentice-Hall. Hensel, J. M., Ruiz, C., Finney, C., & Dewa, C. S. (2015). Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. Journal of traumatic Stress, 28, Horowitz, M. J., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective distress. Psychosomatic Medicine, 41, Hu, L., & Bentler, P. M. (1999). Cutoff criteria
25 for fit indexes in covariance structure analysis: Conventional criteria versus new alternative. Structural Equation Modeling, 6, Hunsaker, S., Chen, H., Maughan, D., & Heaston, S. (2015). Factors that influence the development of compassion fatigue, burnout, and compassion satisfaction in emergency department nurses. Journal of Nursing Scholarship, 47, Jenkins, S. R., & Baird, S. (2002). Secondary traumatic stress and vicarious trauma: A validational study. Journal of Traumatic Stress, 15, Kim, K., Han. Y., & Kim, J. (2015). Korean nurses ethical dilemmas, professional values and professional quality of life. Nursing Ethics, 22, Kiston, J. M., & Widaman, K. F. (1994). Unidimensional versus domain representative parceling of questionnaire items: An empirical example. Educational and Psychological Measurement, 54, Kline, R. B. (2011). Principles and practice of structural equation modeling. New York, NY: Guilford. Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job Bournout. Annual Review of Psychology, 52, Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Occupational Behaviour, 2, McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4, Nelson-Gardell, D., & Harris, D. (2003). Childhood abuse history, secondary traumatic stress, and child welfare workers. Child Welfare: Journal of Policy, Practice, and Program, 82, Pearlman, L. A. (2003). Trauma and attachment belief scale. Los Angeles, CA: Western Psychological Services. Pearlman, L. A. (1996). Psychometric review of TSI Belief Scale, revision L. In B. H. Stamm (Ed.). Measurement of stress, trauma and adaptation (pp ). Lutherville, MD: Sidran Press. Sommer, C., & Cox, J. (2006). Sexual violence counselors' reflections on supervision: Using stories to mitigate vicarious traumatization. Journal of Poetry Therapy, 19, Sprang, G., Clark, J. J., & Whitt-Woosley, A. (2007). Compassion Fatigue, Compassion satisfaction, and burnout: Factors Impacting a professional s quality of life. Journal of Loss and Trauma, 12, Stamm, B. H. (2010.). The concise ProQOL manual (2nd ed.). Pocatello, ID: ProQOL.org. Stamm, B. H., & Figley, C. R. (1996). Compassion satisfaction and fatigue test. Retrieved November 23, 2015, from
26 vo110n3/stamm.pdf. Stebnicki, M. A. (2007). Empathy fatigue: Healing the mind, body, and spirit of professional counselors. American Journal of Psychiatric Rehabilitation, 10, Weiss, D. S. (2004). The Inpact of Event Scale-Revised. In J. P. Wilson & T. M. Keane (Eds.). Assessing psychological trauma and PTSD(2 nd Ed, pp ). New York: Guilford Press. : : :
27 Validation of the Korean Version of Professional Quality of Life Scale 5(K-ProQOL 5) for Mental Health Professional Hyesun Joo Yoonwha Cho Hyunnie Ahn Department of Psychology, Ewha Womans University This study aimed to develop Korean version of the Professional Quality of Life Scale 5 (K-ProQOL 5; Stamm, 2010) and test its validity and reliability. 489 mental health practitioners participated in the research, and responses from 299 participants who had recently seen at least one trauma survivor were used for data analysis. All items of K-ProQOL 5 showed adequate mean, standard deviation, internal consistency and item-total correlations. A confirmatory factor analysis was conducted and yielded a structure of three inter-correlated factors, compassion satisfaction, burnout, and secondary traumatic stress. 79 out of the 299 participants took the test four weeks later to confirm good test-retest reliability. Cut-off scores were identified to help mental health workers to see their relative standing in each sub-test, and the validity of those scores were checked. Finally, implications and limitations of the study and ways of appropriate applications of K-ProQOL 5 were addressed. Key words : Professional Quality of Life, ProQOL 5, compassion satisfaction, burnout, secondary traumatic stress
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