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

Abstract

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 mixed-method 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.