“We need a little help”: a qualitative study on distress and coping among pediatric medical interpreters

Background: Pediatric medical interpreters facilitate communication among patients, families, and clinicians across linguistic and cultural barriers in high acuity, distressing medical encounters. Few studies explore distress among trauma interpreters, and even less research exists on distress and supports for coping among pediatric medical interpreters. Further research is important given the likely risk of secondary traumatic stress and burnout in this population, especially among interpreters working in high-acuity medical settings. This study explores distress among pediatric medical interpreters, available supports and resources for coping with distress, barriers to accessing support, and further resource needs. Methods: Thirteen Spanish-English interpreters at a midwestern pediatric hospital completed a demographic survey and one-on-one virtual semi-structured interviews. Participants were asked about contributors to distress, experiences accessing resources for coping with distress, coping strategies they employed, and suggestions about resources needed to help manage distress. Interviews were qualitatively coded using inductive thematic analysis. Results: Interpreters described that encounter type, setting, presence of emotional content, interpreter role, feeling uncertain or unprepared, consecutive consults, and consults related to their own life contribute to distress. Resources used for coping with distress were organizational (e.g., training programs), interpersonal (e.g., manager support), and intrapersonal (e.g., focus on interpreting). Interpreters shared challenges to accessing supports (e.g., employment status, exclusion from medical team debriefings). Interpreters suggested resources such as support groups, team debriefs, and training to facilitate coping with distress. four-step cognitive process interpreters use to analyze, retain, convert and render content from one language to another, which often includes visualizing and conveying the emotions of the content in their interpretation (6,15,16). Additionally, identification with the client’s trauma may increase when interpreters use the first-person perspective when interpreting (8,15) and if the patient and the interpreter are from the same community (17). Other strains on interpreters are a lack of boundaries and changing or confusing role expectations among the parties interpreters serve (18); strict expectations of objectivity and neutrality; that interpreters are viewed as tangential to the treating team, leading to feelings of isolation and frustration; and the perception that other clinicians do not believe interpreters are impacted by the stress of working with clients who have experienced trauma (10,15,19). Therefore, there is a clear need to provide interpreters with supports and resources to effectively manage the distress they may experience during and after high-stress encounters. Although studies have empirically noted burnout and secondary traumatic stress among interpreters working with Conclusions: Pediatric medical interpreters experience many diverse contributors to distress. Given their unique positions, interpreters are at an increased risk of negative psychological sequelae. Healthcare supervisors, clinicians, and institutions can promote interpreter coping and distress management by viewing interpreters as part of the medical team (e.g., including interpreters in team debriefings), providing coping trainings that are co-created with interpreters, and tailoring supports to interpreters’ specific position as language and culture brokers. As this study represented the experiences of Spanish-English interpreters from a single pediatric hospital, further research is warranted to understand more interpreters’ experience of distress and the supports and resources needed.