Stress, anxiety, and depression in second victims: an integrative review

Abstract

Adverse events in healthcare also affect the personnel involved, who may become “second victims”
and develop symptoms such as stress, anxiety, and depression. This study identified and analyzed
available evidence on these manifestations by an integrative review of studies published between
2014 and 2024 in databases such as Scopus, PubMed, and SciELO. Quantitative, qualitative, and mixedmethod
studies were included and evaluated using tools such as STROBE, CASPe, COSMIN, and MMAT.
Twenty-one studies were selected, reporting frequent symptoms like emotional overload, insomnia,
hypervigilance, withdrawal, guilt, and fatigue. These were associated with organizational factors (lack
of support, punitive culture) and personal factors (feelings of guilt). The phenomenon constitutes a
complex syndrome affecting mental health and professional performance. Findings support the need
for structured institutional responses, including prevention strategies, emotional support, and cultural
transformation to reduce its consequences and promote safe work environments.