The effect of attorneys' work with trauma-exposed clients on PTSD symptoms, depression, and functional impairment: a cross-lagged longitudinal study.

To date, few studies have examined mental health consequences among attorneys exposed to clients' traumatic experiences. A longitudinal, 2-wave, cross-lagged study was used in a cohort of attorneys (N = 107) from the Wisconsin State Public Defender's Office. We assessed changes in posttraumatic stress disorder (PTSD), depression, and functional impairment over a 10-month period and tested the effects of intensity of contact with trauma-exposed clients on symptom levels over time. Attorneys demonstrated strong and significant symptom stability over time in PTSD, depression, functional impairment, and levels of exposure. Analyses involving cross-lagged panel correlation structural equation modeling path models revealed that attorneys' levels of exposure to trauma-exposed clients had significant positive effects, over time, on PTSD, depression, and functional impairment. Gender, age, years on the job, and office size did not predict any of the outcomes. Level of exposure to trauma-exposed clients predicted reduction of weekly working hours over time, but there was no reciprocal relationship between PTSD, depression, and functional impairment and level of exposure over time. These findings underscore the central role of exposure to trauma-exposed clients in predicting mental health outcomes and emphasize the need to support attorneys by managing the intensity of exposure as well as addressing emerging symptoms.