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International Perspectives in Psychology:
Research, Practice, Consultation
Exposure to Violence, Posttraumatic Stress, and Burnout
Among Teachers in El Salvador: Testing a Mediational
Model
Lisseth Rojas-Flores, Sofia Herrera, Joseph M. Currier, Joshua D. Foster, Katharine M. Putman,
Ashli Roland, and David W. Foy
Online First Publication, January 26, 2015. http://dx.doi.org/10.1037/ipp0000029
CITATION
Rojas-Flores, L., Herrera, S., Currier, J. M., Foster, J. D., Putman, K. M., Roland, A., & Foy, D.
W. (2015, January 26). Exposure to Violence, Posttraumatic Stress, and Burnout Among
Teachers in El Salvador: Testing a Mediational Model. International Perspectives in
Psychology: Research, Practice, Consultation. Advance online publication.
http://dx.doi.org/10.1037/ipp0000029
Exposure to Violence, Posttraumatic Stress, and Burnout Among
Teachers in El Salvador: Testing a Mediational Model
Lisseth Rojas-Flores and Sofia Herrera
Fuller Theological Seminary Joseph M. Currier and Joshua D. Foster
University of South Alabama
Katharine M. Putman
Azusa Pacific University Ashli Roland
Fuller Theological Seminary
David W. Foy
Pepperdine University
Community violence has reached concerning proportions in El Salvador, possibly
affecting all sectors of society. To date, little attention has focused on the effects of
violence exposure on educators in Central American countries. This study examined the
relationships between lifetime community violence exposure, posttraumatic stress
disorder (PTSD) symptomatology, and burnout in 2 independent samples of elementary
and high school teachers in El Salvador—Study 1 (N⫽193) and Study 2 (N⫽257).
Findings indicated that teachers across both samples were exposed to multiple violent
events over their lifetimes. Results of 2 separate regression analyses with bootstrapping
indicated significant indirect effects of violence exposure on burnout through PTSD
symptomatology across these independent samples. These results suggest that teachers
who were exposed to more frequent lifetime violence were at greater risk for occupa-
tional burnout, and this link was partly attributable to PTSD symptomatology. These
findings implicate teachers’ exposure to violence as a potentially disruptive influence in
educational settings and underscore the need for developing strategies for training and
support of teachers in El Salvador and other educators working in high violence,
postconflict Central American settings.
Keywords: community violence exposure, PTSD, teacher burnout, occupational stress, El Salvador
In addition to promoting academic develop-
ment in the classroom, teachers frequently play
an integral and multifaceted role in mitigating
the effects of social disorder in their communi-
ties by acting as educators, mentors, counselors,
advocates, and role models for the country’s
next generation. Teachers often serve a protec-
tive function in conjunction with students’ fam-
ilies, or at times even in place of inadequate
family supports, by providing much needed so-
cial resources (Croninger & Lee, 2001; Klem &
Connell, 2004; Springer, Parcel, Baumler, &
Ross, 2006). However, in so doing, they often
place themselves in proximity to violence and
may experience trauma on a number of levels.
Given security problems and lack of resources
for many schools in El Salvador (e.g., lack of
access to training, inadequate security, underde-
veloped mental health services), coupled with
the recent civil war, a series of natural disasters
(e.g., earthquakes; Sattler et al., 2006), and
criminal and institutional violence (Lopez-
Reyes, 1997), Salvadoran teachers may con-
front trauma on many levels. For example, they
Lisseth Rojas-Flores and Sofia Herrera, Graduate School
of Psychology, Fuller Theological Seminary; Joseph M.
Currier and Joshua D. Foster, Psychology Department, Uni-
versity of South Alabama; Katharine M. Putman, Depart-
ment of Graduate Psychology, Azusa Pacific University;
Ashli Roland, Graduate School of Psychology, Fuller Theo-
logical Seminary; David W. Foy, Graduate School of Edu-
cation and Psychology, Pepperdine University.
Correspondence concerning this article should be ad-
dressed to Lisseth Rojas-Flores, Graduate School of Psy-
chology, Fuller Theological Seminary, 180 North Oakland
Avenue, Pasadena, CA 91101. E-mail: lrojas@fuller.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
International Perspectives in Psychology: Research, Practice, Consultation © 2015 American Psychological Association
2015, Vol. 4, No. 2, 000 2157-3883/15/$12.00 http://dx.doi.org/10.1037/ipp0000029
1
can be exposed to trauma vicariously through
hearing stories of pain and suffering, witnessing
the effects of violence among students and fam-
ilies, or by being directly traumatized them-
selves. The accumulation of such indirect and
direct experiences of violence may impair
teachers’ psychological functioning and capac-
ity to meet work demands. The purpose of this
research was to explore rates of violence expo-
sure and to test direct and indirect associations
between violence exposure and burnout via lev-
els of posttraumatic stress disorder (PTSD)
symptoms. Given the pervasive and endemic
history of violence in El Salvador, we were
interested as to whether the same pattern of
results would emerge in two independent sam-
ples.
History of Violence in El Salvador
El Salvador has been noted to be one of the
world’s most violent countries in recent decades
(Geneva Declaration Secretariat, 2011). Fol-
lowing years of militarization and political vio-
lence, the country had a brutal civil war from
1980 to 1992 that resulted in ⬃75,000 deaths.
Despite a peace accord that promised social and
economic renewal, the threat of violence has not
abated. Estimates have suggested that ⬎50,000
Salvadorans have been killed since 1992, a fig-
ure approaching the total number of deaths in
the country as a result of the war (Richani,
2010). The Atlas of Violence in El Salvador
reported that in 2011 there were 70.1 homicides
per 100,000 persons in the country (Córdova,
Tablas, Figueroa, & Salguero, 2012). In addi-
tion, according to data from the Latin American
Public Opinion Project (LAPOP) that compared
El Salvador with other nations in the region, El
Salvador ranked near the top for violent crime
victimization (e.g., assault, armed robbery),
with almost a quarter (24%) of the 1,550 per-
sons surveyed being the victim of a violent
crime, and 40% having someone in their house-
hold victimized in the previous year (The World
Bank, 2011). Given these statistics, it is not
surprising that nearly half (44%) of Salvadorans
surveyed in the LAPOP reported feeling unsafe
in their communities at the time of the study
(World Bank, 2011).
Factors contributing to violence in postwar El
Salvador are complex and wide-ranging (see
Farah, 2011; Richani, 2010). Beyond the chal-
lenges of a postconflict culture, persistent pov-
erty, social exclusion/inequality, underemploy-
ment, rapid urbanization, and expansion of
marginal “colonias” (or barrios) have weakened
the state’s capacity to promote security for its
citizens (Richani, 2010). Similar to other Cen-
tral American nations, El Salvador’s rates of
violence have also been exacerbated by an in-
crease in gang activity and drug trafficking
(Farah, 2011; Jütersonke, Muggah, & Rodgers,
2009; Rodgers & Muggah, 2009; Richani,
2010; The World Bank, 2011). In addition, be-
tween 2001 and 2010, policy changes in the
United States led to the deportation of ⬃2.8
million immigrants, the majority of whom came
from Central America and Mexico (Office of
Immigration Statistics, 2010). Many of these
deportees lacked resources to legally meet the
demands of life in El Salvador (e.g., education,
familial ties, Spanish language ability), and pur-
sued personal security and stability by repro-
ducing gang structures and maintaining alli-
ances with U.S. counterparts. The interplay of
all aforementioned factors contributed to the
rise of insidious and widespread community
violence (CV) that most Salvadorans, including
teachers, had to deal with on a daily basis.
Community Violence Exposure
Research on violence exposure typically fo-
cuses on a number of possible events (e.g.,
physical and sexual assault, mugging, gang ac-
tivity, domestic violence, and life-threatening
accidents), which may assess both direct victim-
ization and indirect exposure (i.e., witnessing
violence, hearing about violence, or knowing
about/knowing people involved in incidents).
For this study, we investigated the effect of total
lifetime violence exposure among teachers. Al-
though rates of violence exposure have been
documented among persons living in underpriv-
ileged areas in the United States, examination of
teachers’ direct and indirect exposure to vio-
lence has been largely overlooked in domestic
(Espelage et al., 2013) and international settings
(Galand, Lecocq, & Philipot, 2007). Despite the
underrepresentation of Central Americans as a
whole in the research literature, a study con-
ducted by Putman et al. (2009) with Guatema-
lan aid workers found that lifetime rates of
violence exposure were relatively high among
Latin Americans when compared with U.S.
2 ROJAS-FLORES ET AL.
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populations. Guatemalan aid workers had expe-
rienced an average of eight indirect violence
and an average of six direct acts of violence.
The most common direct exposure events were
seeing a dead body (67%), being mugged or
beaten up (73%), and being in a life-threatening
accident (63%; Putman et al., 2009). Given that
Guatemala and El Salvador share a border, and
in light of the role similarities between the local
aid workers in the Putman et al. (2009) study
and the teachers from the present studies, it was
anticipated that high rates of violence exposure
would emerge for Salvadoran teachers in this
research.
Community Violence and PTSD
Symptomatology
Although research on trauma-related distress
has also largely neglected Central American
populations, the link between violence exposure
and PTSD has been well documented in U.S.
and international samples (see, Birmes et al.,
2001; Brown, Hill, & Lambert, 2005; Marshall
& Orlando, 2002; Panter-Brick, Eggerman,
Gonzalez, & Safdar, 2009; Scarpa, Haden, &
Hurley, 2006; Walling, Eriksson, Putman, &
Foy, 2011). Several studies also found that the
risk for PTSD was associated with a greater
accumulation of violence events and/or severity
of the incidents (Brown et al., 2005; Scarpa et
al., 2006). In addition, in a study of ⬎4,000
adult women, Resnick and colleagues (1993)
found that lifetime prevalence of PTSD was
three times higher among those who were vic-
timized by a violent crime than noncrime vic-
tims (25.8% vs. 9.4% of lifetime PTSD cases).
A strong body of research has found that al-
though men are often exposed to violence more
frequently than are women (Scarpa et al., 2006),
women are frequently at greater risk for devel-
oping PTSD as a result of violence exposure
(Brewin, Andrews, Rose, & Kirk, 1999; Scarpa
et al., 2006). Similarly, in a study examining
PTSD among 300 adult participants in the af-
termath of the civil war in El Salvador, females
reported significantly more general distress and
PTSD symptoms than males (De Castillo et al.,
2004). Thus, we controlled for the effects of
gender in our study as a way of accounting for
these probable patterns in our studies.
Research has shown that traumatization can
occur by indirect exposure to potentially trau-
matic events. For instance, in a study of 284
urban teachers and development workers in the
United States, Walling et al. (2011) found that
indirect exposure to violence was positively re-
lated with PTSD symptoms, even when control-
ling for rates of direct violence exposure. These
results align with general findings on vicarious
trauma that indirect exposure can lead to PTSD
for persons who work with survivors of trauma
and violence such as social workers, mental
health counselors, nurses, and other helping
professionals (Collins & Long, 2003; Salston &
Figley, 2003). In a recent article on violence and
teachers in the United States, Espelage et al.
(2013) noted that violence against teachers is
often overlooked, and summarized research
findings documenting that working in urban set-
tings and being male are additional risk factors
for violence exposure among teachers. Elemen-
tary and high school educators in El Salvador,
like therapists and nurses, can place themselves
in proximity to suffering by repeatedly hearing
their students’ traumatic narratives and witness-
ing the deleterious impact of violence exposure.
Hence, there is a need to further explore the
effects of lifetime CV exposure in this popula-
tion.
Burnout and PTSD Symptomatology
A key mental health concern for Salvadoran
teachers is work-related burnout. This construct
refers to a process that may develop for persons
with demanding jobs in response to severe/
chronic stressors (Doolittle, 2007; Fry, 1995).
Burnout can be characterized by a range of
possible physiological (e.g., fatigue, headaches,
hypertension), emotional (e.g., emotional ex-
haustion, depression, anxiety), behavioral (e.g.,
insomnia, decline in performance, social with-
drawal, and other interpersonal difficulties), and
cognitive (e.g., self-doubt, guilt, sense of disil-
lusionment) difficulties (Maslach, Jackson, &
Leiter, 1996; Moon and Hur, 2011; Salston &
Figley, 2003; Shirom, 2002; Shyman, 2010).
Exposure to violence can impair the ability to
engage meaningfully in one’s work (Putman et
al., 2009; Whealin et al., 2007). Furthermore,
psychological distress (e.g., anxiety, depression,
and somatic problems) and violence exposure in
the school have been related to lower profes-
sional functioning and lower efficacy in the
classroom among teachers in Europe and the
3TEACHERS AND VIOLENCE IN EL SALVADOR
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United States (Galand et al., 2007; Wilson,
Douglas, & Lyon, 2011). In addition, recent
findings with both Guatemalan aid workers
(Putman et al., 2009) and personnel in caring
professions, such as emergency workers in the
United States (Schutt & Marotta, 2011), suggest
that PTSD symptomatology might be a critical
risk factor for burnout among violence-exposed
groups, even when accounting for severity of
participants’ trauma histories. Given compara-
ble challenges facing Salvadoran teachers, they
in turn might be similarly at risk for developing
burnout, and PTSD symptomatology could play
a key role in understanding possible decrements
in work-related functioning in this population as
well.
Study Aims and Hypotheses
Violence exposure and its consequences for
teachers in El Salvador is a significant yet un-
derstudied concern in that country. Drawing on
information from two groups of Salvadoran
teachers, the present research was designed to
explore rates of direct and indirect exposure to
violence events and to delineate the effects of
total lifetime violence exposure on burnout via
a possible pathway of PTSD symptomatology
(i.e., indirect effect). Based on prior empirical
and theoretical work, we expect that teachers
who were exposed to more frequent lifetime
violence will experience higher rates of burn-
out, and this link will at least partly be ex-
plained by more severe PTSD symptomatology.
Method
Participants and Procedures
Both the studies reported in this article were
conducted in collaboration with the Diocese of
the Anglican Episcopal Church and the Minis-
try of Education in El Salvador. Study 1 (N⫽
193) was conducted in July 2007, and Study 2
(N⫽257) was conducted in March 2012. The
research procedures were largely the same for
both studies. Following institutional review and
approval (Graduate School of Psychology,
Fuller Theological Seminary), teachers were re-
cruited through advertisements from the Office
of the Ministry of Education across the educa-
tional departments in El Salvador. Participants
completed research procedures prior to attend-
ing a free, psycho-educational workshop on
coping with effects of trauma and stress. On
each participant’s arrival, the study procedures
and purpose were explained in detail in Spanish.
Participants were informed that their participa-
tion was voluntary and that they could attend
the workshop even if they declined to partici-
pate in the study. The survey lasted ⬃60 min for
each study, and research assistants were avail-
able to answer questions and debrief the partic-
ipants following completion of measures. Per-
sons who attended the workshop were offered a
light meal and US$7.00 to defer travel costs,
regardless of their involvement in the studies.
Of those teachers who attended the workshop,
fewer than 5% declined participation in either
study. (Refer to Table 1 for descriptions of the
two samples.)
Each participant completed a questionnaire
for Study 1 or Study 2 assessing his or her
demographic and professional background, vi-
olence exposure, PTSD symptoms, and burnout.
Whenever available, Spanish language versions
of measures with established psychometric
properties were implemented. Graduate re-
search assistants in clinical psychology trans-
lated the remaining instruments into Spanish. A
Salvadoran psychologist and researcher (second
author) revised all measures to ensure the lan-
guage reflected the regionalisms of El Salvador.
As a final step, the study measures were back-
translated into English to ensure the original
meaning and intent of the questions remained
intact.
Measures
Violence exposure. A variation of the Sur-
vey of Exposure to Community Violence
(SECV; Richters & Saltzman, 1990) was used
to measure exposure to violence in both studies.
In Urrutia’s (1995) previous study in El Salva-
dor, construct validity was established when the
SECV was found to positively correlate with
PTSD symptoms on the Los Angeles Symptoms
Checklist (LASC). Putman et al. (2009) imple-
mented a similar version of the SECV success-
fully in Guatemala. The measure includes items
that are relevant to the experience of community
and war-related violence in El Salvador. The
measure used in Study 1 included 35 items
about whether teachers had experienced a num-
ber of common violence events in El Salvador
4 ROJAS-FLORES ET AL.
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(see Table 2). Two indices were calculated to
obtain an overall estimation of participants’ vi-
olence exposure; a direct victimization index of
21 items and an indirect scale derived by sum-
ming 14 questions related to witnessing or hear-
ing about violence. Study 2 incorporated the
same items for the direct exposure index, but
used an expanded version of the indirect sub-
scale in which items assessing vicarious expo-
sure (i.e., hearing about trauma) and witnessing
violence were separated. For the purpose of
comparing rates of violence exposure across the
samples in this article, these latter items were
collapsed to form a single index of indirect
exposure for Study 2 (i.e., endorsing witnessing
and/or hearing about the different violence
events was coded as indirect exposure). These
subscales were based on item groupings used in
previous research with the SECV (Putman et al.,
2009; Walling et al., 2011).
PTSD symptomatology. Both studies re-
lied on a 17-item subscale assessing PTSD
symptomatology from the LASC (King, King,
Leskin, & Foy, 1995), a measure that had been
implemented successfully across three different
geographical regions in El Salvador (Urrutia,
1995). Similarly, Putman and colleagues (2009)
had successfully used this translation in Guate-
mala. The measure incorporated the three symp-
tom domains of PTSD as defined by the DSM–IV:
reexperiencing (three items; e.g., nightmares, in-
trusive memories), avoidance (six items; e.g.,
emotional numbness, avoidance of reminders),
and hyperarousal (eight items; e.g., irritability, ex-
cessive jumpiness). Participants rated the extent to
which each symptom had been a problem during
the previous month. Responses ranged from 0 ⫽
not a problem to 2 ⫽an extreme problem in Study
1 (possible range ⫽0–34), and 0 ⫽not a problem
to4⫽an extreme problem in Study 2 (possible
range ⫽0–68). The total scores were considered
in both samples in order to provide a holistic
representation of PTSD symptom severity. To
meet PTSD diagnostic criteria, a respondent must
endorse an appropriate combination of symptoms
with a rating of two or higher in the three symp-
tom domains. A partial PTSD diagnosis may be
considered if a respondent endorses two of the
Table 1
Demographic Features and Occupational Backgrounds of Participants
Study 1 (N⫽193) Study 2 (N⫽257)
MSD n(%)MSDN(%)
Age in years 40.07 8.97 41.35 11.68
Gender
Female 127 (66.8) 176 (68.3)
Marital Status
Married 107 (56.0) 116 (45.2)
Unmarried but live with partner 18 (9.4) 22 (8.5)
Separated/divorced 17 (8.9) 31 (11.9)
Widowed 4 (2.1) 5 (1.9)
Single (never married) 45 (23.6) 83 (32.4)
Area of residence
Rural 112 (58.1) 34 (13.1)
Urban 81 (41.9) 223 (86.9)
Educational sector
Public 161 (83.4) 216 (83.9)
Private/parochial 28 (14.5) 38 (15.0)
Both 2 (1.0) 3 (1.0)
Area of work
Rural 144 (74.6) 53 (20.7)
Urban 44 (23.8) 200 (77.9)
Both 3 (1.6) 4 (1.5)
Current position
Classroom teacher 95 (49.7) 215 (83.7)
Administrator 80 (41.8) 35 (13.6)
Both 16 (8.5) 7 (2.7)
Number of years experience 15.34 1.89 15.44 10.29
5TEACHERS AND VIOLENCE IN EL SALVADOR
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Table 2
Rates of Direct and Indirect Exposure to Violent Events
Study 1 (N⫽193) Study 2 (N⫽257)
n(%) n(%)
Direct exposure
I have been chased by gangs or individuals. 48 (24.9) 32 (12.5)
I have been asked to use, sell, or help distribute illegal drugs. 8 (4.1) 0 (0.0)
I have been in a serious accident where I thought that
someone would get hurt very badly or die. 80(41.5) 54 (21.0)
I have been at home when someone has broken into or tried
to force their way into the house or apartment. 37 (19.2) 21 (8.2)
I have been picked-up, arrested or taken away by the police. 13 (6.7) 5 (1.9)
I have been threatened with serious physical harm by
someone. 51 (26.4) 28 (10.9)
I have been slapped, hit, or punched by a family member. 46 (23.8) 35 (13.6)
I have been slapped, hit, or punched by someone who is not
a member of my family. 26 (13.5) 9 (3.5)
I have been beaten up or mugged. 116 (60.1) 78 (30.4)
I have been sexually assaulted or raped. 23 (11.9) 16 (6.2)
I have seen someone carrying or holding a gun or a knife (do
not include police, security officers, or military). 89 (46.1) 133 (51.8)
I have been attacked or stabbed with a knife. 13(6.7) 11 (4.3)
I have been seriously wounded in an incident of violence. 7 (3.6) 3 (1.2)
I have been shot, or shot at with a gun. 11 (5.7) 4 (1.6)
I have seen a dead person somewhere in the community (do
not include wakes or funerals). 133 (68.9) 116 (45.1)
I have seen someone committing suicide. 18 (9.3) 2 (0.8)
I have seen someone being killed by another person. 25 (13.0) 32 (12.5)
I have been so sick that I could have died. 44 (22.8) 66 (25.7)
I have lived in a war where there was fighting, people hurt,
or dead bodies. 110 (57.0) 102 (39.7)
I have been in a big earthquake that badly damaged the
building I was in. 67 (34.7) 108 (42.0)
I have been in another kind of disaster like a fire, hurricane,
or flood. 53 (27.5) 76 (29.6)
Indirect exposure
I have seen or know someone who was chased by gangs or
individuals. 94 (48.7) 156 (60.7)
I have seen or know someone who was asked to use, sell, or
help distribute illegal drugs. 37 (19.2) 43 (16.7)
I have seen or know someone who was in a serious accident. 99(51.3) 137 (53.3)
I have seen or know someone who was picked-up, arrested or
taken away by the police. 100 (51.8) 160 (62.3)
I have seen or know someone who was threatened with
serious physical harm by another person. 82 (42.5) 93 (36.2)
I have seen or know someone who was slapped, hit, or
punched by a family member. 84 (43.5) 119 (46.3)
I have seen or know someone who was slapped, hit, or
punched by someone who is not a member of the family. 79 (40.9) 74 (28.8)
I have seen or know someone who was beaten up or mugged. 103 (53.4) 131 (51.0)
I have seen or know someone who was sexually assaulted or
raped. 54 (28.0) 74 (28.8)
I have seen or know someone who was attacked or stabbed
with a knife. 42 (21.8) 70 (27.2)
I have seen or know someone who was seriously wounded in
an incident of violence. 8 (3.9) 87 (33.9)
I have seen or know someone who was shot, or shot at with
a gun. 30 (15.5) 46 (17.9)
I know someone who committed suicide. 99 (51.3) 91 (35.4)
I have seen or know someone who was murdered. 125 (64.8) 143 (55.6)
6 ROJAS-FLORES ET AL.
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three criteria. Cronbach’s alphas for the full LASC
were .83 for Study 1 and .92 for Study 2.
Burnout. The emotional exhaustion scale
from the Maslach Burnout Inventory (MBI;
Maslach et al., 1996) was used to assess burnout
in the first study. The scale consists of nine
items assessing feelings of being emotionally
overextended and exhausted by one’s work. Re-
sponses were based on a 4-point scale regarding
the frequency with which participants may ex-
perience emotional exhaustion, with anchor
points of 0 ⫽never to 3 ⫽everyday (possible
range ⫽0–27). Cronbach’s alpha was .74 for
this MBI subscale in Study 1. For parsimony’s
sake, based on Shirom (1989) and Doménech-
Betoret’s (2009) support for a single dimension
construct of burnout, only the emotional ex-
haustion subscale of the MBI was included.
The Shirom–Melamed Burnout Measure
(SMBM; Shirom, 2002) was used in Study 2 to
assess burnout. The SMBM is a 14-item self-
report questionnaire assessing physical fatigue
(five items), cognitive weariness (five items),
and emotional exhaustion (four items). Re-
sponses ranged from 0 ⫽never or almost never
to 6 ⫽always or almost always (possible
range ⫽0–84). The items were scored to pro-
vide an overall composite of the second set of
participants’ work-related burnout. Cronbach’s
alpha was .93 for the total SMBM in Study 2.
Results
Rates of Violence Exposure
Rates of violence exposure are presented in
Table 2 and descriptive statistics (means, stan-
dard deviations, and ranges) for those variables
are outlined at the bottom of Table 3. The
average number of direct exposures to violence
for Study 1 was 5 (range ⫽0–15). Rates of
direct victimization were generally lower
among teachers in the second sample; the aver-
age number of events was 4 (range ⫽0–12).
The top five direct experiences of violence in
Study 1 included seeing a dead body, being
physically assaulted, experiencing war-related
violence, seeing someone holding a gun/knife,
and being involved in a life-threatening acci-
dent. Roughly a quarter to one half of the Study
2 teachers reported direct experiences with see-
ing someone carrying a gun/knife, seeing a dead
person in their community, being beaten up or
mugged, or experiencing war-related violence.
In addition, a quarter to one third of teachers
across the two groups indicated exposure to
other noninterpersonal potentially traumatic ex-
periences that had occurred in the country over
recent years (e.g., earthquakes and other natural
disasters).
Lifetime rates of indirect exposure were
largely equivalent across the two groups. On
average, teachers in Study 1 had experienced
seven indirect exposures to violence (range ⫽
0–14), and in Study 2 the average number of
indirect events was 8 (range ⫽0–15). Over half
of each sample had seen or known someone
who was mugged or beaten up, was murdered,
was picked up or arrested by the police, or had
been in a serious accident. The most common of
these types of indirect exposures from Study 1
were seeing or knowing someone who was mur-
dered, was seriously injured by a violent act,
was beaten up or mugged, picked up by the
police, or involved in a life-threatening acci-
Table 3
Bivariate Correlations Between Study Variables
Study 1 (N⫽193) Study 2 (N⫽257)
1234512345
1) Violence exposure—indirect — .74
ⴱⴱⴱ
.94
ⴱⴱ
.15
ⴱ
.24
ⴱⴱ
— .69
ⴱⴱⴱ
.98
ⴱⴱ
.19
ⴱⴱ
.19
ⴱⴱ
2) Violence exposure—direct — .92
ⴱⴱ
.22
ⴱⴱ
.23
ⴱⴱ
— .83
ⴱⴱⴱ
.23
ⴱⴱⴱ
.17
ⴱⴱ
3) Violence exposure—total — .19
ⴱⴱ
.25
ⴱⴱ
— .21
ⴱⴱ
.20
ⴱⴱ
4) Posttraumatic stress — .48
ⴱⴱ
— .59
ⴱⴱⴱ
5) Burnout — —
M6.17 5.29 11.46 7.23 7.48 8.58 3.67 12.25 14.85 15.81
SD 3.99 3.29 6.78 4.83 4.63 6.94 2.72 9.03 10.64 9.52
Range 0–15 0–15 0–30 0–21 0–22 0–14 0–12 0–26 0–56 0–49
ⴱ
p⬍.05.
ⴱⴱ
p⬍.01.
ⴱⴱⴱ
p⬍.001.
7TEACHERS AND VIOLENCE IN EL SALVADOR
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dent. Similarly, over half of the Study 2 had also
seen or known someone who was picked up by
police, was chased by gangs, was murdered,
involved in a serious accident, or beaten up or
mugged.
With regards to posttraumatic symptomatol-
ogy, teachers endorsed a number of PTSD
symptoms. A global score and a partial score of
all clusters of PTSD symptoms were calculated.
In Study 1, 38 (19.9%) participants met the
cutoff criteria for a probable diagnosis of PTSD,
while 37 (14.8%) participants in Study 2 met
criteria for a probable PTSD diagnosis. Further-
more, in Study 1, the teachers surveyed indi-
cated they had either a moderate or extreme
problem with the following symptoms: trusting
others (63.2%), anxiety and tension (56%), dif-
ficulty sleeping (51.3%), restlessness (47.7%),
difficulty with memory (44%), and difficulty
expressing feelings (42.5%). Similarly, in Study
2 the teachers indicated they had moderate to
extreme problems with the following symp-
toms: memories of experiences (34.6%), trust-
ing others (31.5%), anxiety and tension (31.
9%), irritability (30.7%), restlessness (27.6%),
and difficulty concentrating (26%).
Bivariate correlations for study variables are
outlined in Table 3. All indices of violence
exposure—indirect, direct, and total—were
positively associated with PTSD and burnout in
both samples, ps⬍.05. In addition, preliminary
analyses indicated that men in Study 1 reported
higher levels of total violence exposure (n⫽63,
M⫽16.03, SD ⫽6.47) than female teachers
(n⫽127, M⫽9.27, SD ⫽5.76); F(1, 188) ⫽
53.48, p⬍.001,
2
⫽.221. In Study 2, younger
teachers (ages 30 and under), regardless of gen-
der, reported greater total exposure to violence
(n⫽57, M⫽10.43, SD ⫽6.27) than teachers
aged 31 years or more (n⫽202, M⫽7.61,
SD ⫽6.03); F(1, 257) ⫽9.55, p⫽.002,
2
⫽
.036. No other associations were found between
the demographic and outcome variables; char-
acteristics of teachers’ occupational background
(area of work, type of school, years of experi-
ence) were not correlated with the indices of
violence exposure or psychological symptom-
atology in either sample. Given preliminary
analyses and in light of intercorrelations be-
tween demographics and violence exposure, age
and gender were included as covariates in the
mediation analyses. We also relied upon the
total violence exposure assessment—summing
over direct and indirect forms of exposure—as
the independent variable in the mediation anal-
ysis.
Mediation Analyses
Two mediation analyses were conducted to
test the hypothesis that exposure to violence
indirectly affected burnout through its effects
on PTSD symptomatology. This hypothesized
model was tested for both teacher samples using
ordinary least squares path analysis (Hayes,
2013). No statistically significant effects were
found for gender or age in the mediation anal-
yses in the presence of the other variables in the
models. As can be seen in Figure 1, the direct
effect of total violence exposure (including the
sum of both direct and indirect exposures) on
burnout was attenuated when PTSD symptom-
atology was statistically controlled. In Study 1,
the direct effect remained significant (⫽.16,
p⫽.04); in Study 2, the direct effect fell to
statistically nonsignificant in the presence of
PTSD (⫽.07, p⫽.18). The indirect effect of
violence exposure on burnout via PTSD was
further evaluated by (a) estimating a biased-
corrected bootstrap confidence interval using
10,000 bootstrap samples, and (b) conducting a
normal theory test (Sobel) of the indirect ef-
fect’s statistical significance. Both tests con-
firmed the presence of the indirect effect in both
samples (Study 1: 95% CI ⫽.04–.16, z⫽3.31,
p⫽.0009; Study 2: 95% CI ⫽.06–.31, z⫽
3.19, p⫽.001). In summary, results of these
mediation analyses were consistent with the hy-
pothesis that teachers who were exposed to
more frequent violence experienced higher rates
Exposure to
violence
Posrauma c
stress symptoms
Burnout
.30***
.21**
.29*** (.16*)
.19** (.07)
.44***
.57***
Figure 1. Coefficients are standardized regression coeffi-
cients based on recommended procedures by Hayes (2013)
for testing statistical mediation. Coefficients on the top are
from Study 1 and those coefficients on the bottom are from
Study 2. Coefficients in parentheses represent associations
between total violence exposure and burnout after control-
ling for PTSD symptomatology in the two samples. Gender
and age were included as covariates in all statistical tests.
ⴱ
p⬍.05,
ⴱⴱ
p⬍.01,
ⴱⴱⴱ
p⬍.001, ns p ⬎.05.
8 ROJAS-FLORES ET AL.
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of burnout partly due to more severe PTSD
symptomatology.
Discussion
Teachers across both samples reported mul-
tiple violent events over their lifetimes, likely
reflecting the general risk for violence in El
Salvador and the occupational hazards of work-
ing in a helping profession in this country.
Teachers reported high rates of direct victimiza-
tion; those findings align with general epidemi-
ological research (Córdova et al., 2012; World
Bank, 2011) and related clinical findings from
the region (Putman et al., 2009; Urrutia, 1995).
Over a quarter to half of the teachers in both
groups reported experiencing war-related stres-
sors (e.g., witnessing fighting, people being
hurt, dead bodies) and substantive numbers had
endured natural disasters. Importantly, many of
the teachers had experienced events that would
be considered traumatic from a Criterion A di-
agnostic standpoint, such as direct and indirect
encounters with physical assault, weapons, dead
bodies, police arrests, and life-threatening situ-
ations.
Findings of these studies suggest that the
Salvadoran teachers had not only been exposed
to a high level of CV in their lifetime, but they
had also experienced moderately high levels of
PTSD symptomatology. This is not an alto-
gether surprising finding given evidence for the
cumulative effects of exposure to trauma
(Brown et al., 2005; Scarpa et al., 2006). We
found 19.9% of teachers meeting criteria for a
probable PTSD diagnosis in Study 1 and 14.8%
of teachers in Study 2. Although limitations in
our sampling and measurement procedures re-
strict the ability to draw conclusions about the
prevalence of PTSD in this population, these
figures are higher than similar descriptive stud-
ies with Guatemalan refugees (Sabin, Lopes
Cardozo, Nackerud, Kaiser, & Varese, 2003)
and violence-exposed aid workers (Eriksson et
al., 2001). However, rates of possible PTSD
symptoms in our samples were lower than those
for survivors of the war in Kosovo (61%; Ai et
al., 2002), as well as for war-exposed civilians
in El Salvador found in earlier research (41%;
Urrutia, 1995). In fact, our findings most closely
align with the Putman et al. (2009) report that
17% of Guatemalan humanitarian aid workers
had met criteria for a probable diagnosis. This
could reflect consistency of measures imple-
mented across this research. Other possibilities
include the degree to which different popula-
tions have been exposed to different levels of
trauma and CV, the nature of the violence ex-
perienced, and/or the participants’ ability to
cope with the violence itself. While it can be
argued that cultural factors may influence dif-
ferences in how trauma is experienced and pro-
cessed, research has also suggested that other
contextual factors such as time, proximity to the
traumatic event, or identity of the perpetrator
may also influence these observed differences
(Brown et al., 2005; Ozer, Best, Lipsey, &
Weiss, 2008; Scarpa et al., 2006; Urrutia, 1995).
Namely, a long line of research has revealed a
linear association between violence exposure
and PTSD, and posttraumatic symptomatology
is typically more intense when the trauma oc-
curred closer in time, location, and/or entailed
an act that was committed by a trusted friend or
family member. We were not able to assess all
of these finer contextual details in this study.
As anticipated, teachers’ levels of posttrau-
matic symptomatology and burnout were higher
for those with more severe histories of trauma
exposure. Violence exposure (including both
direct and indirect exposure) had a statistically
significant positive direct effect, whereby those
who reported greater exposure to violent events
were more likely to report problems with PTSD
symptoms and burnout at the time of study. In
addition, when accounting for age and gender,
results demonstrated in both studies that teach-
ers’ levels of PTSD symptomatology emerged
as a possible mediating factor between violence
exposure and burnout. The indirect effect of
violence exposure on burnout via PTSD found
in both samples, confirms the hypothesis that
teachers who were exposed to more frequent
violence experienced higher rates of burnout
partly due to more severe PTSD symptomatol-
ogy. It appears that among teachers with higher
levels of violence exposure, difficulty dealing
with heightened psychological distress (PTSD
symptomatology) partly explains the link be-
tween violence exposure and poorer psycholog-
ical and occupational functioning. Overall,
these findings support the possible utility of the
burnout construct with teachers and other help-
ing professionals working in impoverished and
violent contexts, and highlight the need to
screen for PTSD symptomatology and violent
9TEACHERS AND VIOLENCE IN EL SALVADOR
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events in mental health assessments with these
populations.
The difference in number of violent events
endorsed by the two teacher samples could be
possibly attributed to passage of time between
data collection for each sample. Study 1 data
were collected in 2007, at the height of a gang
violence surge in El Salvador. During this time,
El Salvador had ⬎39,000 active gang members
(USAID, 2010). Study 2 data were collected in
2012 when several Salvadoran municipalities
had initially declared, yet not implemented,
zones of peace as a result of a nationwide ar-
mistice between gangs and the government.
This unprecedented negotiation led to a notice-
able but temporary significant reduction in the
number of homicides in the country. The out-
come of this truce is still unclear because gang
leaders have declared they will continue the
practice of extortion, a form of intimidation that
most Salvadorans experience in their daily life
(Romero & Mejía, 2013; Milenio, 2013).
Gender and age factors related to violence
exposure are noteworthy and further highlight
vulnerability for PTSD among study partici-
pants. Male teachers in Study 1 reported more
direct CV exposure than did female teachers.
This finding is consistent with other studies that
found men were often exposed to violence more
frequently than were women (Brewin et al.,
1999; Scarpa et al., 2006). In contrast, in Study
2, participants younger than 30 years, regardless
of gender, reported having experienced more
incidents of violence. It is possible that higher
rates of exposure among younger participants
may coincide with the documented surge in
gang violence in the country in the two decades.
Thus, mental health interventions with Salva-
doran adults exposed to violent events should
take into account gender and age when address-
ing traumatic stress symptoms.
Taken together, these results further support
the need to explore other factors that may in-
fluence teachers’ ability to engage in their work
in a productive and satisfying manner. Although
the cross-sectional design of the present re-
search limits the ability to address causation,
these findings align with Putman et al. (2009) in
further suggesting that trauma-related problems
could be a key risk factor among teachers in El
Salvador and other developing countries. The
psychological well-being of teachers is vital for
promoting an optimal learning experience for
students. Adverse trauma reactions may impair
teachers’ capacity to meet the responsibilities
of their jobs. For example, burnout might limit
teachers’ ability to negotiate important rela-
tional aspects of their jobs and interact with
their students in meaningful ways. However, it
is important to note that the impact of specific
events either within or outside of teachers’ pro-
fessional role was not assessed in either study.
Future studies are needed to examine teachers’
interactions with students in the classroom as a
function of their violence exposure. Addition-
ally, future research will benefit from investi-
gating whether teachers’ exposure to violence
via working in the Salvadoran educational sys-
tem increases vulnerability for these outcomes
or whether the present results simply reflect a
more general risk factor associated with living
in El Salvador in recent decades. Future re-
search would also do well to explore the role of
possible protective factors such as coping, so-
cial support, and religion/spirituality that may
serve as buffers against the development of
pathology. Additionally, intervention research
would be useful in determining primary, sec-
ondary, and tertiary prevention interventions for
teachers in general, those most at risk, and those
already experiencing distress symptoms.
Study Limitations
This research had several limitations that
warrant some discussion. The lack of assess-
ment for the timing and relational context of
violence exposure among the teachers was
noted above. Although the present results sug-
gest the cumulative effects of violence, indices
of exposure only generated small to medium
effects. Hence, it is possible that certain types of
more severe traumatic stressors—such as phys-
ical assault, rape, or war-related experiences—
might engender serious psychological concerns
in their own right. In addition, from a measure-
ment standpoint, diagnostic interviews are the
ideal way to assess PTSD and other trauma-
related distress symptomatology, and it is pos-
sible that certain indicators of distress were
missed by exclusively using questionnaire data
in these studies. Findings would also have been
enhanced by a random sampling procedure (as
noted above as well). These samples of teachers
self-selected themselves to attend workshops on
managing the effects of trauma and stress. As
10 ROJAS-FLORES ET AL.
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such, this recruitment strategy may have led to
an overrepresentation of highly distressed
teachers, or teachers with greater difficulties
might have elected not to participate in the
research study. As such, these samples are not
representative of teachers as a whole in El
Salvador. Future research with teachers in El
Salvador would benefit from incorporating
more sophisticated sampling and measure-
ment strategies to overcome these limitations
and expand upon these findings.
Implications for Training and
Supporting Teachers
Notwithstanding limitations of the present re-
search, several possible implications for train-
ing and supporting teachers in El Salvador and
other violence-stricken countries might be
drawn. In accordance with recent efforts on the
part of the Ministry of Education in El Salvador
to provide mental health services to teachers
working in select high-risk communities, these
results suggest that the type of psychological
assistance could be expanded in scope and ge-
ography to other areas known for sustained lev-
els of violence in the country. For example, to
reduce possible adverse effects of personal and
vicarious trauma that can result from chronic
exposure to violence, teachers in both urban and
rural areas may benefit from professional devel-
opment training that provides information about
self-care. This type of training could focus on
promoting emotional competence and could be
delivered on a regular basis or at planned inter-
vals, so that new and already established teach-
ers develop an understanding of how to cope
with their own trauma-related distress. In addi-
tion, teachers may benefit from formal support
groups facilitated by mental health practitio-
ners, or informal peer networks to discuss their
coping strategies and process reactions to vio-
lence among their students. For teachers who
are in crisis, intensive interventions to regain
stability and work through their traumas (e.g.,
individual counseling or psychotherapy) should
be offered. This research could help identify
teachers at highest risk and prioritize interven-
tion resources. School administration would
also do well to develop the organizational struc-
tures and services to identify these distressed
teachers and provide the type of intervention
that may meet their psychological needs, given
that PTSD symptoms were shown to be related
to job burnout in both samples. With the provi-
sion of these types of supports, teachers may be
equipped to continue to work with the next
generation of Salvadorans in overturning the
system of violence in their country.
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Received May 20, 2013
Revision received November 15, 2014
Accepted November 22, 2014 䡲
13TEACHERS AND VIOLENCE IN EL SALVADOR
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