Communicating without doing harm: a scoping review on media coverage of traumatic events

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Ivan Franko National University of Lviv

Vrije Universiteit Amsterdam

Communicating without doing harm: a scoping review on media coverage of traumatic events

S. Onufriv

O. Abdelhamid

S. van Dormolen

Annotation

The literature review collected and systematized existing knowledge and experience of effective communication in media outlets about traumatic events with people, guided by the principle of “do no harm”. The essence of this efficiency is that journalists, communicating with respondents, in particular military and civilian, did not injure the heroes of their journalistic materials and the audience. It is also about avoiding stigmatization and re-traumatization during media coverage of traumatic events. The high prevalence and profound effects of PTSD among civilians and journalists in conflict zones alike underscore the need for a conscious approach to the subject and trauma-related events by media outlets. Research has shown, however, that increased and improved knowledge about mental health plays a crucial role in its de-stigmatization. Despite the negative consequences of the influence, the media have the potential to develop appropriate professional recommendations for overcoming the trauma of war based on the experience of covering war events in Ukraine.

Key words: communication, traumatic event, re-traumatization, de-stigmatization, post- traumatic stress disorder (PTSD), media coverage.

Анотація

Комунікація без заподіяння шкоди: оглядове дослідження висвітлення в медіа травматичних подій

С. Онуфрів, Львівський національний університет імені Івана Франка

О. Абдельхамід, С. ван Дормолен Амстердамський вільний університет

У статті зібрано та систематизовано досвід ефективного висвітлення в медіа травматичних подій згідно з принципом «не нашкодь». Суть цієї ефективності полягає в тому, щоб журналісти, спілкуючись з респондентами, зокрема військовими і цивільними, не травмували психологічно героїв своїх журналістських матеріалів та аудиторію. Йдеться також про уникнення стигматизації та ретравматизації під час висвітлення в медіа цієї теми. Високий рівень поширення і глибокі наслідки травм, зокрема посттравматичного стресового розладу (ПТСР) як серед цивільного населення, так і серед журналістів у зонах конфлікту, підкреслюють необхідність усвідомленого підходу до висвітлення в медіа травматичних подій.

Особливу увагу приділено тригерам травми, уникненню стигматизації та ретравматизації, а також методам комунікації в традиційних і нових медіа. Дослідження показали, що рівень знань про психічне здоров'я відіграє вирішальну роль у його дестигматизації. Об'єкт аналізу - 22 академічні рецензовані наукові розвідки на зазначену тематику дослідження, які опубліковані в міжнародних електронних базах SCOPUS, Web of Science та PubMed.

У всьому світі перед журналістами, які висвітлюють збройні конфлікти, стоїть завдання не лише висвітлювати поточні події, але й робити це, пам'ятаючи про травми, які пережили (колишні) військові, цивільне населення і самі журналісти. Попри негативні наслідки впливу, медіа мають потенціал для того, щоб на основі досвіду висвітлення воєнних подій в Україні напрацювати відповідні професійні рекомендації для подолання травми війни.

Ключові слова: комунікація, травматичні події, ретравматизація, (де)стигматизація, посттравматичний стресовий розлад (ПТСР), висвітлення в медіа.

Introduction

Russia's invasion of Ukraine on February 24, 2022 brought up an important issue for the Ukrainian media: how to write in the media about trauma without re-traumatising and stigmatising. Military actions in Ukraine emphasize the urgency of adequate and timely (traditional and online) journalistic coverage. But how does one report on a situation that left so many traumatized?

In September 2022, for the first time since the beginning of the full-scale war, a study of the psychological state of the population was conducted in Ukraine. “Lessons learned from other emergency situations indicate that war will have direct and indirect effects on the mental health and well-being of Ukrainians. 40% of respondents experienced threats to their own lives and/or were direct witnesses of such threats in connection with being in the combat zone actions and/or under fire. More than 41% of citizens have relatives or loved ones who were or are in the war zone, including 16% who have lost someone close to them. 6% of respondents were under occupation, were directly threatened with violence or witnessed such threats. Every twentieth respondent (5%) experienced or witnessed all of the specified types of traumatic events (shelling, threats to the lives of loved ones, occupation or captivity). Only 9% of citizens said that they had not faced any such event during the period of full-scale war. The majority of respondents (more than 90%) had manifestations of at least one of the symptoms of post-traumatic stress disorder, and 57% of citizens are at risk of developing PTSD (Moz, 2022).

The research was conducted using an online survey on the Kantar Ukraine panel. It covered people aged 18-55 in Ukrainian cities with a population of over 50,000. Participation in the survey was voluntary and anonymous. The research methodology, its indicators and the questionnaire are based on scientific developments of the Institute of Social and Political Psychology of the National Academy of Pedagogical Sciences of Ukraine.

Estimates suggest that between 15.3% and 26% of all civilians enduring conflict experience Post Traumatic Stress Disorder (PTSD) (Johnson et al., 2021). Among journalists covering war and conflict, this amount is as high as 28.6% (Feinstein, Owen, & Blair, 2002). PTSD “is a disorder that occurs as a delayed or chronic response to stressful events or situations (either prolonged or limited in time) of an extremely dangerous or catastrophic nature” (Niewiadomska, Chwaszcz & Radon, 2017, p. 11). These events can be any traumatic experience, ranging from a natural disaster to rape, and from a car accident to war (Feinstein, Owen, & Blair, 2002). PTSD does not necessarily arise immediately after the traumatic experience, but generally occurs within several weeks to months after the event. In addition, the duration of the disorder varies considerably and has potential to become chronic (Niewiadomska, Chwaszcz & Radon, 2017). The psychosocial consequences related to PTSD are multifaceted, and may include: insomnia, anxiety, violence, and a difficulty with everyday work and caring for one's self (Tabarovsky, 2016). The high prevalence and profound effects of PTSD among civilians and journalists in conflict zones alike underscore the need for a conscious approach to the subject and trauma-related events by media.

This need is further enhanced by the possibility of re-traumatizing victims and civilians by such reporting. Re-traumatization is a reaction to a (traumatic) event influenced by previous traumatizing encounters, causing a more severe reaction. In itself, this new event does not have to be traumatizing, but may merely remind one of earlier experiences (Alexander, 2012). In addition, media outlets should be mindful of the stigma surrounding trauma and PTSD. The consequences of this stigmacome in many formes, including discrimination, (self-)exclusion and reduced help-seeking behavior (Krzemieniecki & Gabriel, 2021). As a result, many mental injuries go undiagnosed (Colborne, 2015). Research has shown, however, that increased and improved knowledge about mental health plays a crucial role in its de-stigmatization. Media outlets have the potential to make a positive contribution in this (Krzemieniecki & Gabriel, 2021). Complicating the fulfillment of this role, however, is the contradictory information throughout the field regarding the do's and don'ts of communication in relation to de-stigmatization and the avoidance of (re-)traumatization. This is, for instance, reflected in the discussion on trigger warnings: while trigger warnings intend to alert people to potentially trauma triggering content, recent studies suggest these warnings have no effect, place one's trauma at the core of their identity and may even have adverse results (Jones, Bellet & McNally, 2020).

Globally, journalists covering conflict have been tasked not only with reporting on the ongoing disputes, but also with doing this mindfully of the traumas experienced by civilians, (former) soldiers and themselves. The way this is to be done, however, remains ambiguous. The aim of this literature review is thus to assemble existing knowledge and experience concerning, the effective communication about traumatic events with people suffering from PTSD, guided by the principle of “do no harm”. Specific focus will be on trauma triggers, the avoidance of stigma and re-traumatization, and communication techniques throughout both traditional and new forms of media. Accordingly, the research question guiding this review is: what is known about the ways to write about psychologically traumatic events, PTSD, and trauma respectfully that would avoid re-traumatization of the victims and would contribute to alleviating stigma?

To address this question, a scoping literature review will be conducted. While the ongoing tensions along Ukraine's borders are the primary motivation for this review, for reasons of feasibility, literature covering a wide range of geographical areas, traumas and academic disciplines will be considered.

Methods. Study design. To explore what is already known about the ways to communicate about traumatic events, without re-traumatizing and stigmatizing, and to determine the scope of the available literature (Grant & Booth, 2009), a scoping literature review was conducted. A scoping review is “a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge” (Colquhoun et al., 2014, pp.1292-1294). The completeness of this systematic search, however, is determined - and constrained - by the time and size available for the study (Grant & Booth, 2009). For methodological guidance, the first five stages of the framework for scoping reviews (by Arksey and O'Malley, extended by Levac et al.) were utilized: i) “Identifying the research question”; ii) “Identifying relevant studies”; iii) “Study selection”; iv) “Charting the data”; and v) “Collating, summarizing, and reporting the results”. The sixth and final stage “Consultation” (Colquhoun et al., 2014, p. 1293) did not fit the scope of this review, and has therefore been omitted. Following these stages enabled the reviewers to conduct a literature review as complete, systematic and valid as possible, within the limited time available.

Search strategy and study selection

Knowledge and literature from a variety of disciplines are relevant to answering the research question. Therefore, more `framed' search tools, such as PICO and SPIDER, proved unsuitable for the literature search. Instead, as the research question guides all subsequent stages of a scoping review (Colquhoun et al., 2014), the key concepts embedded in the research question - as well as a variety of synonyms - have been used to create literature search strings. These key concepts are: “Communication” (i.e., for “write”), “Traumatic event”, “PTSD”, “Re-traumatization”, and “De-stigmatization” While the presence of the first three concepts was required in all hits (i.e., search string connection by “AND”), the presence of either one of the latter two concepts was sufficient (i.e., search string connection by “OR”). The literature search was performed in the electronic libraries SCOPUS, Web of Science, on 5 December 2021. The first two libraries were chosen for their wide-ranging and varied literature collections, covering all academic disciplines. The latter library, in contrast, was chosen for its prominence in the (bio)medical field (VU, n.d.); a domain with crucial insights into trauma, PTSD and its consequences. All 595 search results were subsequently imported into Rayyan - Intelligent Systematic Review. Using Rayyan enabled the reviewers to screen the results simultaneously, yet independently. Any conflicts that arose during the screening process were registered by Rayyan, whereupon the reviewers met to discuss and resolve them.

The first screening stage involved a title, abstract and keyword screening in Rayyan, to determine the relevance of the retrieved studies. A set of inclusion and exclusion criteria was established prior to screening. Included studies must address: traumatic events and communication approaches; the reporting of traumatic events/PTSD in the media; the effects of (inappropriate) communication on people with trauma/PTSD; and, the role of media and communication in (de-)stigmatizing trauma/PTSD. Conversely, studies were excluded when they focused on: dealing with trauma in healthcare facilities; unrelated consequences of PTSD; medical perspectives and definitions; and, stigma and trauma in combination with other medical aspects (e.g., HIV/AIDS). Due to the limited availability of studies, no criteria were set regarding geographical location, year of publication or methodology used. However, while acknowledging grey literature may possess relevant tools and tips, only academic, peer-reviewed articles were included.

To chart the data, a custom-made data extraction sheet was developed. The data extraction sheet functioned as an iterative tool to identify key findings, organize and code the data, and subsequently analyze the findings (Aveyard & Payne, 2016). In addition to summarizing the methodological and publication details of the studies, their key findings were extracted and divided into five categories: i) Media & PTSD (general), i.e., findings regarding any aspects of the interplay between the two; ii) Communication & PTSD, i.e., findings specific to this interaction, and the subsequent do's and don'ts of communication; iii) Communication & Re-Traumatization, i.e., specific findings on this interaction and the prevention of (re)traumatization; iv) Communication & (De-Stigmatization, i.e., specific findings on this interaction and the promotion of de-stigmatization; and v) Other, i.e., relevant information not covered by any of the four domains. Whereas some data fell into more than one category, this was taken into account during both data extraction and analysis. The used categories arose iteratively, throughout the screening process as well as during the piloting and creation of the data extraction sheet. The included studies were divided and reviewers extracted half of the data.

Although quality appraisal has not been a formal part of scoping reviews (Colquhoun et al., 2014; Grant & Booth, 2009), to enhance the quality and validity of the present review, the quality of the included studies has been assessed. This quality appraisal was conducted simultaneously with the data extraction. The Mixed Method Appraisal Tool (MMAT) - Version 2018, by McGail University, was used for the appraisal. This tool allowed for the assessment of the quality of both mixed method and purely qualitative/quantitative studies, using a checklist of general criteria (e.g., concerning the research question) as well asmethod-specific requirements (e.g., randomization) (Hong et al., 2018). This appraisal enabled the incorporation of a large variety of studies, while taking their independent value and methodology into account. Due to the limited availability of literature, however, studies with a lower quality score were not directly excluded. Instead, the different appraisal qualities were considered throughout the data analysis.

Data synthesis. By directly categorizing the data during their extraction, a first round of coding was conducted. During the subsequent analysis, the findings in each category were assessed and compared, to identify similarities, differences and additional codes. This constituted the basis of the data analysis. The section that follows presents the results of the analysis via a narrative synthesis. This synthesis consists of both a tabular presentation of the included studies and a narrative summary of the findings by category (Petticrew & Roberts, 2008). A synthesis of the findings across categories, and in relation to other studies, will be provided in the discussion.

The results have been divided into the four categories outlined above, following the baseline of the literature review. In this section, a selection of elements and findings from each of these categories will be discussed.

Table 1