“Humanizing Work” -- Psychosocial Risk and Resilience Model for Burnout and Psychological Distress among Humanitarian Aid Workers in Bangladesh: A Mixed Methods Study

Most studies on the mental health of humanitarian aid workers have concentrated on sociodemographic variables or trauma exposure as predictors of psychopathological outcomes. However, less is known about the psychosocial and organizational factors contributing to occupational stress-related disorders in this high-risk occupation group. This mixed-methods, cross-sectional study sought to establish a psychosocial model for burnout and psychological distress among humanitarian staff that comprehensively tested the psychological effects of common adversities and workplace psychosocial stressors in combination. The model further investigated the potential mediating role of individual coping styles and the protective role of organizational psychological safety climate. N=111 full-time aid workers from 52 organizations in Bangladesh completed an online survey, and n=13 participants were followed-up with virtual individual interviews between December 2020 and May 2021. A stepwise model building process with path analysis established an integrated conceptual model with overlapping but distinct pathways from common adversities and workplace stressors to burnout. While greater exposure to both types of stressors was associated with higher levels of burnout and distress, workplace psychosocial stressors had a greater total effect on psychological outcomes than common adversities (β = .52, 95% CI [0.42, 0.90], p = < .001 vs. β = .20, 95% CI [0.03, 0.59], p = .032). Both types of stressors had indirect effects on burnout through negative emotion-focused coping (β = .12, 95% CI [0.30, 2.14], p = .007). However, only workplace stressors and not common adversities directly affected psychological distress (β = .45, 95% CI [0.09, 0.24], p = < .001 vs. β = -.01, 95% CI [-0.09, 0.09], p = .927). Expanded path models indicated that specific domains of stressors, namely, deployment-related interpersonal stressors, work-life interface, and work organization and communication stressors, significantly influenced psychological outcomes. Conditional process analysis showed that higher perceived levels of psychological safety climate buffered the adverse indirect effects of deployment-related interpersonal stressors via negative emotion-focused coping on burnout (β = -.21, 95% CI [-0.08, -0.01], p = .008) and distress (β = -.23, 95% CI [-0.03, -0.01], p = .005). Contrary to findings from the extant literature, sociodemographic variables (except psychiatric history), task-focused coping, and avoidance-focused coping were not significant exogenous variables. Thematic analysis of qualitative data yielded themes that largely converged with and elaborated on statistical results. Qualitative results offered additional insights about the “chronic emergency” organizational culture and professional attitudes of “martyrdom” unique to humanitarian aid workers, which may normalize and reinforce a high-stress work environment and minimized recognition of staff’s mental health needs. The psychosocial model, complemented with qualitative elaboration, can inform the development of evidence-based interventions for staff care. Reducing workplace stressors, improving adaptive coping, and enhancing the psychosocial safety climate of organizations may prevent and alleviate occupational stress-related disorders in humanitarian aid workers and other first responders