Table 1 Help-seeking themes and subthemes—definitions, exemplars and frequency

1. Cultural aspects to help-seeking

a. Aid cowboy culture

Perception that aid workers need to be stoic, resilient and ‘in charge’, with the self-management of occupational stress a key aspect of this.

7/14

‘I think because I was in somewhat of a senior role, there was a sense of I needed to be strong, resilient and keep it together, you know, like an aid cowboy’.

Perceived need to portray a ‘strong’ exterior, despite any incongruence with intrinsic experiences.

b. Organisational culture (help-seeking seen as poor coping)

Perception within organisation that conveying impacts/seeking help for work stress indicates poor coping or inability to perform duties.

8/14

‘When it came time to renew your contract, my organisation wouldn’t because they see you as crazy or damaged goods or not being able to perform at your previous level’.

Belief that signalling help or support needs is seen within organisations as indicating poor coping and potentially impaired performance.

c. East/west cultural views

Cultural differences in attitudes regarding the appropriateness or value of help-seeking.

7/14

‘A lot of my colleagues are from cultures where seeking help isn’t even considered in times of stress, like those from African or middle east backgrounds … a lot of it's cultural’.

That attitudes towards personal help seeking at times of distress often vary between cultural groups.

2. Risks with formal, internal support

a. Distrust and lack of confidentiality

Unwillingness to disclose work related distress due to fear that information may be passed on or put on personnel files.

11/14

‘The main thing is that I don't always trust the human resources staff and the in-house counsellors to actually keep things confidential.’

Concern regarding confidentiality breaches and distrust regarding internal support sources.

b. Discrimination

Perception that known mental health issues, or related support needs, risk workplace discrimination.

11/14

‘If you display signs of weakness psychologically or your mental health, you wonder will that have a detrimental effect on your career?’

Perception that known mental health issues risk workplace discrimination.

3. Lack of shared understanding of humanitarian context

a. Friends

Friends outside the sector as poor support option due to a lack of understanding, and sometimes interest, which can increase sense of isolation.

14/14

‘You just been through this phenomenal like life changing experience with all of the pros and cons and then you come back to normality…They don’t understand it. They don’t care’.

Friends outside the sector as poor support option due to a lack of understanding and interest.

b. Colleagues

Preference for help from colleagues/peers due to shared understanding and useful assistance.

14/14

‘You tend to reach out to them because there’s that kind of unwritten understanding of what you do and what you see and what you experience’.

Preference for colleague help and support due to shared experience and understanding.

c. External professional support

External services experienced as unsatisfactory due to provider’s limited understanding of humanitarian role and the sector.

6/9 (service users)

‘I don’t think it’s their fault, because this psychologist didn’t have any experience in the humanitarian field, she did what she knew best but I never went back’.

Limited provider understanding of the humanitarian sector can undermine perceived effectiveness of this service.

4. Self-censoring and withdrawal

a. Protect oneself and family

Not disclosing work stress to family protects them from vicarious distress and generally avoids emotional and management burden for worker.

12/14

‘If you actually tell them [about stressors, incidents], they can’t do much about it, so then they will be constantly calling you … eventually it takes a toll on you. So not telling them is so much easier for me’.

Emotional burden that work stress disclosures may have on family and the worker, and the resulting preference to limit disclosures.

b. Withdrawal from toxic environments/ conversations

The risk that excessive or ‘routinised’ review of work stressors with colleagues may increase stress and requires protective limits.

4/14

‘Sometimes I wouldn’t go around to somebody's place to have a drink to unwind because you knew it would invariably lead to somebody talking about the shitty day they had, and sometimes I thought I need to protect myself.’

Removing oneself from environments/conversations that maintain focus on stressors can protect wellbeing.

5. Role maturity

c. Learning to be resilient (prove yourself)

Learning organisational expectations regarding self-management of work stress and reliably demonstrating control and competence.

5/14

‘When I started out in this field, we were always taught to be resilient in the face of difficulty and that this will benefit us in the future… I just took everything in and in and in and not a word came out. Everyone always complimented me on what a hard worker I was’.

Learning organisational expectations regarding self-management of work stressors and this contributing to field-credibility.

d. Learning to seek help

Learning the value of help from others; over time and/or as the result of adverse mental health experiences.

4/14

‘I’ve had my breakdowns but at the age I am now I’ve learnt that it takes someone strong to ask for help’.

The value of help-seeking may be learned through time and experience and can support personal coping and wellbeing.