Research has shown that the emotional burden of caring for patients may extend beyond the clinicians themselves, affecting not only their own psychological well-being but also that of their family members.

Beyond the white coat, physicians empathize with, support, and care for patients during some of the most challenging moments in their lives. Emotional engagement is an integral part of clinical practice; however, certain specialties place particularly high emotional demands on clinicians. These include specialties involving prolonged care of patients with terminal illness, such as oncology and palliative care; high-intensity fields, such as emergency medicine and critical care; and specialties focused on psychological distress and suicidal behavior, such as psychiatry.

In recent years, researchers have shown growing interest in what has been termed “empathy-based stress,” as described by the authors in a quantitative review published in Occupational Health Science. Empathy-based stress arises from exposure to another person’s trauma, empathic emotional responses, and subsequent adverse psychological consequences. It encompasses three related concepts: compassion fatigue, secondary traumatic stress (STS), and vicarious traumatization.

Although these terms are closely related and often used interchangeably, they describe distinct psychological responses. Compassion fatigue refers to emotional exhaustion that develops through prolonged caregiving and empathic engagement. STS describes the emotional distress that develops after learning about another person’s traumatic experiences. Vicarious traumatization refers to lasting changes in beliefs, assumptions, and worldviews resulting from repeated exposure to others’ traumatic experiences.

Enrique Cordero, MD, an emergency physician, psychologist, and member of the Spanish Society of Emergency Medicine, discussed the emotional impact of caring for patients experiencing suicidal crises or requiring involuntary psychiatric admission in an interview with El Médico Interactivo. He emphasized that unless this emotional burden is managed appropriately, its effects may extend beyond the workplace and affect clinicians’ personal and family lives.

“Today, we know that repeatedly bringing these experiences into the family environment can cause emotional distress for those who hear these stories. Without realizing this, we may cause collateral emotional harm to the people around us,” Cordero said.

Spillover and Crossover

Occupational psychology, sociology, and occupational health research describe two mechanisms through which work-related stress extends into family life: spillover and crossover.

Spillover is derived from the English phrase spill over, which means “to spill” or “to overflow” refers to the transfer (spillover) of stress, emotions, and behaviors from work into family life. Although emotional burden originates in the workplace, it manifests at home through behaviors such as irritability, impatience, emotional withdrawal, and reduced emotional availability. Anxiety, sadness, and frustration can also affect family environments.

Crossover derived from to cross over, meaning “to cross over to the other side.” Crossover describes the transfer of stress or emotions from one individual to another. For example, a healthcare professional’s emotional distress may gradually affect a partner or other family members who begin experiencing that stress themselves.

During the COVID pandemic, when healthcare professionals faced prolonged stress, repeated exposure to death, and persistent uncertainty, both spillover and crossover became increasingly apparent. Various studies have documented this phenomenon, showing that excessive workloads and repeated exposure to clinical trauma substantially affect the mental health of healthcare professionals and their families. Burnout studies estimated that more than half of healthcare professionals worldwide experienced critical levels of emotional exhaustion during the most intense phases of the pandemic.

Impact on Family

In 2025, researchers published the first study examining STS among family members of healthcare professionals in the UK.

The researchers noted that long working hours, demanding working conditions, and repeated exposure to traumatic clinical events place healthcare professionals at an increased risk for psychological distress.

Family members and close friends are often the primary sources of emotional support. However, providing support may also affect their mental health and well-being. Previous research has documented STS among family members of police officers, firefighters, emergency responders, social workers, lawyers, correctional officers, humanitarian workers, and war correspondents. However, until recently, this phenomenon had not been investigated among family members of healthcare professionals.

The study found that 33.8% of household members reported severe STS. Wives and female partners of healthcare professionals in clinical roles reported higher levels of STS than other household members and partners of healthcare professionals working in nonclinical roles. Healthcare professionals, particularly women in a clinical role, and being the partner of a healthcare professional were all independent predictors of higher STS.

One physician’s partner said, “Some images and stories are so distressing that they keep replaying in my mind.”

Family members also described healthcare professionals returning home as irritable, emotionally withdrawn, anxious, emotionally exhausted, or persistently low in mood, with these changes affecting the entire household.

One physician’s wife described her experience: “My husband is often angry and miserable. Our daughter has developed depression as a result. We hardly ever have sex. He just watches television before leaving for work.”

Disconnecting Matters

Speaking on behalf of the Spanish Society of Emergency Medicine, Cordero emphasized the importance of structured approaches to emotional processing and psychological support.

“We need to learn a form of professional emotional decompression that helps release accumulated stress, improves psychological well-being, and prevents the emotional burden of clinical work from spilling over into family life,” he said.

In one study, occupational psychology also identified psychological detachment as one of the most effective mechanisms for recovering from work-related stress. According to the Effort-Recovery Model, physically leaving the workplace at the end of the day is not enough. Clinicians must also mentally disengage from work-related responsibilities, concerns, and emotionally demanding experiences.

Research has shown that effective psychological detachment is associated with lower emotional exhaustion, fewer burnout symptoms, and better psychological recovery. Conversely, when clinicians are unable to disconnect mentally, work-related concerns often persist through rumination after returning home, prolonging stress, increasing spillover, and placing greater strain on family relationships.

The recovery framework developed by occupational psychologists Sabine Sonnentag and Charlotte Fritz from the Department of Psychology, University of Konstanz, Konstanz, Germany, identified three additional recovery experiences that complement psychological detachment: relaxation, engaging in enjoyable and mentally stimulating activities outside work (mastery), and having control over how one spends free time.

Support Programs

In Spain, the Comprehensive Care Program for Sick Physicians (PAIME) provides confidential assessment, treatment, and ongoing support for physicians experiencing mental health conditions.

Supported by the Spanish Medical Association, the program aims to protect physicians’ mental well-being while promoting high-quality patient care and patient safety.

This article was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.