Shared Trauma In War Zones: A Comparative Study of Compassion Fatigue and Compassion Satisfaction Among Mental Health Providers

Background and Purpose:
Shared traumatic reality (STR) describes situations in which mental health providers and their clients are exposed to the same collective trauma. Although STR has been linked to both distress and adaptation, comparative evidence across war contexts remains limited. This study compared mental health providers in Ukraine and Israel across three domains of functioning: professional resilience, occupational strain, and psychological distress, and examined whether work experience, caseload, and support systems operated differently across contexts.

Methods:
This exploratory cross-sectional study included 330 mental health providers surveyed in mid-2025, including 225 from Ukraine and 105 from Israel. Participants completed standardized measures of professional quality of life, burnout, psychological distress, resilience, and posttraumatic growth (ProQOL, MBI, DASS-21, PHQ-4, CD-RISC-10, PTGI). Group differences were examined using t tests and chi-square analyses. Principal component analysis identified broader domains of functioning, and hierarchical regression models tested the contributions of demographic, professional, and support-related variables, including interaction effects by national context.

Results:
Marked between-group differences emerged. Ukrainian providers scored significantly higher on posttraumatic growth, resilience, depression, anxiety, and depersonalization, whereas Israeli providers scored significantly higher on secondary traumatic stress, burnout, and emotional exhaustion. Principal component analysis yielded a three-component solution: Professional Resilience, Occupational Strain, and Psychological Distress. Ukrainians scored higher on Professional Resilience, t(233.01) = -4.96, p < .001, and Psychological Distress, t(239.22) = -9.87, p < .001, whereas Israelis scored higher on Occupational Strain, t(185.02) = 8.60, p < .001. Effect sizes were moderate to large, with Hedges’ g = 0.57 for Professional Resilience, 1.04 for Occupational Strain, and 1.13 for Psychological Distress. Regression analyses showed significant context-specific interactions. Greater work experience predicted lower Professional Resilience in Ukraine, but not in Israel. Higher caseload predicted lower Occupational Strain and lower Psychological Distress in Israel, but not in Ukraine. Greater support systems predicted lower Psychological Distress in both groups, with a stronger effect among Israelis. Cutoff analyses further showed substantially elevated odds among Ukrainian providers for burnout, secondary traumatic stress, depersonalization, and depression, while Israeli providers had greater odds of low resilience.

Conclusions and Implications:
STR was associated with substantial burden in both settings, but its psychological expression differed sharply by context. In Ukraine, STR was characterized by the co-occurrence of elevated distress and stronger resilience-related functioning; in Israel, it was characterized more by occupational depletion. Findings suggest that shared trauma is not psychologically uniform across war zones and that clinician support interventions should be tailored to the distinct occupational and emotional ecology of each conflict setting.