{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:31:10Z","timestamp":1792427470356,"version":"4.5.0"},"reference-count":63,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Traumatic Stress"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Commercial content moderators (CCMs) serve as the hidden first responders of the internet, sifting through flagged user\u2010generated content to keep online platforms safe. In their work, they have repetitive, frequent exposure to traumatic content, including child sexual abuse material, graphic violence, death, hate rhetoric, and more. Yet, relative to other occupations in which trauma exposure is common, the mental health effects of content moderation have received little study. This is in large part because it is a newer profession that arose with the widespread adoption of social media. In this paper, we describe the work and working conditions typical of CCMs and how these contribute to potential mental health impacts. Global labor inequities are discussed with regard to how outsourcing moderation to low\u2010 and middle\u2010income countries with stressful working conditions may exacerbate the risk of posttraumatic stress. Research on the mental health effects of content moderation is synthesized. We propose a research agenda for preventing and mitigating the negative mental health impacts of trauma exposure that CCMs experience. Finally, the paper outlines principles for trauma\u2010informed, psychologically safe moderation systems and discusses implications for clinicians, employers, and occupational health professionals.<\/jats:p>","DOI":"10.1002\/jts.70087","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T16:31:40Z","timestamp":1780590700000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Commercial content moderation: Trauma exposure on the digital frontline"],"prefix":"10.1002","author":[{"given":"Jeffrey","family":"Demarco","sequence":"first","affiliation":[{"name":"Centre for Abuse, Trauma and Suicide Studies, Department of Psychology Middlesex University London United\u00a0Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Watson","sequence":"additional","affiliation":[{"name":"Patricia Watson and Associates, LLC, Maui  Hawaii USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonya B.","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California San Diego School of Medicine  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2013"},{"key":"e_1_2_4_3_1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425787","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2022"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2025.102622"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2018.1510279"},{"key":"e_1_2_4_6_1","volume-title":"Content moderation is too important for social media companies to outsource","author":"Barrett P. M.","year":"2020"},{"key":"e_1_2_4_7_1","unstructured":"Booth R.(2024 December 18).More than 140 Kenya Facebook moderators diagnosed with severe PTSD.The Guardian.https:\/\/www.theguardian.com\/media\/2024\/dec\/18\/kenya\u2010facebook\u2010moderators\u2010sue\u2010after\u2010diagnoses\u2010of\u2010severe\u2010ptsd"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/1079063213509411"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11896\u2010016\u20109223\u20108"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1534765608319082"},{"key":"e_1_2_4_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12103\u2010017\u20109417\u20103"},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1609\/hcomp.v8i1.7461"},{"key":"e_1_2_4_13_1","unstructured":"Doe v. YouTube Inc. (2022).Class settlement and release agreement.https:\/\/www.contentmoderatorytsettlement.com\/media\/4079108\/yod_class_settlement___release_agreement.pdf"},{"key":"e_1_2_4_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0032258X21104333"},{"issue":"3","key":"e_1_2_4_15_1","first-page":"4","article-title":"Community guidelines\u201d: The legal implications of workplace conditions for internet content moderators","volume":"90","author":"Drootin A.","year":"2021","journal-title":"Fordham Law Review"},{"key":"e_1_2_4_16_1","unstructured":"Dwoskin E. Whalen J. &Cabato R.(2019 July 25).Content moderators at YouTube Facebook and Twitter see the worst of the web \u2014 and suffer silently.The Washington Post.https:\/\/www.washingtonpost.com\/technology\/2019\/07\/25\/social\u2010media\u2010companies\u2010are\u2010outsourcing\u2010their\u2010dirty\u2010work\u2010philippines\u2010generation\u2010workers\u2010is\u2010paying\u2010price\/"},{"key":"e_1_2_4_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/japp.70024"},{"key":"e_1_2_4_18_1","doi-asserted-by":"publisher","DOI":"10.54501\/jots.v1i1.24"},{"key":"e_1_2_4_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/0032258X20917442"},{"key":"e_1_2_4_20_1","volume-title":"History of PTSD in veterans: Civil War to DSM\u20105","author":"Friedman M. J.","year":"2017"},{"key":"e_1_2_4_21_1","unstructured":"Gauthier G. M. Ali E. Asim A. Cornell\u2010Maier S. &Zoellner L. A.(2025).I've seen enough: Measuring the toll of content moderation on mental health[Preprint]. arXiv.https:\/\/doi.org\/10.48550\/arXiv.2511.09813"},{"key":"e_1_2_4_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/police\/paad052"},{"key":"e_1_2_4_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2024.106757"},{"key":"e_1_2_4_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/jts.22362"},{"key":"e_1_2_4_25_1","doi-asserted-by":"publisher","DOI":"10.1108\/JCRPP\u201008\u20102023\u20100047"},{"key":"e_1_2_4_26_1","doi-asserted-by":"publisher","DOI":"10.1037\/pst0000231"},{"key":"e_1_2_4_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12911\u2010021\u201001534\u20106"},{"key":"e_1_2_4_28_1","doi-asserted-by":"crossref","unstructured":"Hartmann D. Oueslati A. Staufer D. Pohlmann L. Munzert S. &Heuer H.(2025).Lost in moderation: How commercial content moderation APIs over\u2010 and under\u2010moderate group\u2010targeted hate speech and linguistic variations.Proceedings of the 2025 CHI Conference on Human Factors in Computing Systems(Article175 pp.1\u201326).https:\/\/doi.org\/10.1145\/3706598.371399","DOI":"10.1145\/3706598.3713998"},{"key":"e_1_2_4_29_1","unstructured":"Hern A.(2019 September 17).Revealed: catastrophic effects of working as a Facebook moderator.The Guardian.https:\/\/www.theguardian.com\/technology\/2019\/sep\/17\/revealed\u2010catastrophic\u2010effects\u2010working\u2010facebook\u2010moderator"},{"key":"e_1_2_4_30_1","unstructured":"Hern A.(2021 February 11).Facebook moderators \u2018told not to discuss working conditions.\u2019The Guardian.https:\/\/www.theguardian.com\/technology\/2021\/feb\/11\/facebook\u2010moderators\u2010say\u2010they\u2010were\u2010told\u2010not\u2010to\u2010discuss\u2010covid\u2010working\u2010conditions"},{"key":"e_1_2_4_31_1","unstructured":"International Centre for Missing and Exploited Children. (2023).Protecting children online: The importance of content moderation.https:\/\/cdn.icmec.org\/wp\u2010content\/uploads\/2023\/06\/TP\u2010ICMEC\u2010Downloadable\u2010Part\u20102\u2010The\u2010Importance\u2010Of\u2010Content\u2010Moderation.pdf"},{"key":"e_1_2_4_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2021.01.039"},{"issue":"8","key":"e_1_2_4_33_1","doi-asserted-by":"crossref","first-page":"4454","DOI":"10.1177\/14614448221122224","article-title":"I'm not this Person\u201d: Racism, content moderators, and protecting and denying voice online","volume":"26","author":"Jereza R.","year":"2024","journal-title":"New Media & Society"},{"key":"e_1_2_4_34_1","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2017.1353383"},{"key":"e_1_2_4_35_1","doi-asserted-by":"crossref","unstructured":"Lee D. Seo S. Park C. Kim S. Chang B. &Song J. Y.(2024).Exploring intervention techniques to alleviate negative emotions during video content moderation tasks as a worker\u2010centred task design.Proceedings of the 2024 ACM Designing Interactive Systems Conference(pp.1701\u20131721).https:\/\/doi.org\/10.1145\/3643834.3660708","DOI":"10.1145\/3643834.3660708"},{"key":"e_1_2_4_36_1","doi-asserted-by":"crossref","unstructured":"Lundmark R. Lindholm A. Lindberg O. &Rantatalo O.(2025).Wellbeing among police personnel investigating online child sexual abuse: A scoping review. Advance online publication.Trauma Violence & Abuse.https:\/\/doi.org\/10.1177\/15248380251358228","DOI":"10.1177\/15248380251358228"},{"key":"e_1_2_4_37_1","unstructured":"Makhijani R. Shah P. Avadhanula V. Gocmen C. Stier\u2010Moses N. E. &Mestre J.(2021).QUEST: Queue simulation for content moderation at scale. arXiv.https:\/\/doi.org\/10.48550\/arXiv.2103.16816"},{"key":"e_1_2_4_38_1","doi-asserted-by":"publisher","DOI":"10.1504\/IJTPM.2024.137818"},{"key":"e_1_2_4_39_1","unstructured":"McIntyre N.(2023 November 20).Bumble Grindr and Hinge moderators struggle to keep users\u2014and themselves\u2014safe.Wired.https:\/\/www.wired.com\/story\/bumble\u2010grindr\u2010and\u2010hinge\u2010moderators\u2010trauma\/"},{"key":"e_1_2_4_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2022.04.003"},{"key":"e_1_2_4_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010023\u201005445\u2010w"},{"key":"e_1_2_4_42_1","unstructured":"Newton C.(2019 February 25).The secret lives of Facebook moderators in America.The Verge.https:\/\/www.theverge.com\/2019\/2\/25\/18229714\/cognizant\u2010facebook\u2010content\u2010moderator\u2010interviews\u2010trauma\u2010working\u2010conditions\u2010arizona"},{"key":"e_1_2_4_43_1","doi-asserted-by":"crossref","unstructured":"Nicholas A. &Ennis G.(2026).Handling the worst: A review of approaches to handling trauma materials for the minimization of worker distress Journal of Workplace Behavioral Health. Advance online publication.https:\/\/doi.org\/10.1080\/15555240.2026.2621352","DOI":"10.1080\/15555240.2026.2621352"},{"key":"e_1_2_4_44_1","volume-title":"Identifying hazard control options: The hierarchy of controls","author":"Occupational Safety and Health Administration","year":"2023"},{"key":"e_1_2_4_45_1","unstructured":"Office of the United Nations High Commissioner for Human Rights. (2021 July 23).Moderating online content: Fighting harm or silencing dissent?https:\/\/www.ohchr.org\/en\/stories\/2021\/07\/moderating\u2010online\u2010content\u2010fighting\u2010harm\u2010or\u2010silencing\u2010dissent"},{"key":"e_1_2_4_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11896\u2010010\u20109066\u20107"},{"key":"e_1_2_4_47_1","unstructured":"Perrigo B.(2023 May 1).150 African workers for AI companies vote to unionize.TIME.https:\/\/time.com\/6275995\/chatgpt\u2010facebook\u2010african\u2010workers\u2010union"},{"key":"e_1_2_4_48_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0099378"},{"key":"e_1_2_4_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chipro.2024.100085"},{"key":"e_1_2_4_50_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1666543"},{"key":"e_1_2_4_51_1","doi-asserted-by":"crossref","unstructured":"Scott C. F. Marcu G. Anderson R. E. Newman M. W. &Schoenebeck S.(2023).Trauma\u2010informed social media: Towards solutions for reducing and healing online harm.Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems(Article 341 pp.1\u201320).https:\/\/doi.org\/10.1145\/3544548.3581512","DOI":"10.1145\/3544548.3581512"},{"key":"e_1_2_4_52_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0080573"},{"key":"e_1_2_4_53_1","doi-asserted-by":"publisher","DOI":"10.5817\/CP2023\u20104\u20108"},{"key":"e_1_2_4_54_1","doi-asserted-by":"publisher","DOI":"10.3390\/bs15040487"},{"key":"e_1_2_4_55_1","unstructured":"Spence R. DeMarco J. &Martellozzo E.(2022 April 22).Invisible workers hidden dangers.The Psychologist.https:\/\/www.bps.org.uk\/psychologist\/invisible\u2010workers\u2010hidden\u2010dangers"},{"key":"e_1_2_4_56_1","doi-asserted-by":"publisher","DOI":"10.54501\/jots.v1i5.91"},{"key":"e_1_2_4_57_1","doi-asserted-by":"publisher","DOI":"10.1027\/1864\u20101105\/a000454"},{"key":"e_1_2_4_58_1","doi-asserted-by":"crossref","unstructured":"Steiger M. Bharucha T. J. Venkatagiri S. Riedl M. J. &Lease M.(2021).The psychological well\u2010being of content moderators: The emotional labor of commercial moderation and avenues for improving support.Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems(Article 341 pp.1\u201314).Association for Computing Machinery.https:\/\/doi.org\/10.1145\/3411764.3445092","DOI":"10.1145\/3411764.3445092"},{"key":"e_1_2_4_59_1","unstructured":"Substance Abuse and Mental Health Services Administration. (2023).Counselling approaches to promote recovery from problematic substance use and related issues[Treatment Improvement Protocol Series 65; Publication No. PEP23\u201002\u201001\u2010003].U.S. Department of Health and Human Services.https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK601482\/"},{"key":"e_1_2_4_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2019.09.013"},{"key":"e_1_2_4_61_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010025\u201006950\u20106"},{"issue":"1","key":"e_1_2_4_62_1","first-page":"98","article-title":"A new social contract for the social media platforms: Prioritizing rights and working conditions for content creators and moderators","volume":"21","author":"Wamai J. W.","year":"2023","journal-title":"International Journal of Labour Research"},{"key":"e_1_2_4_63_1","unstructured":"World Health Organization. (2019).International statistical classification of diseases and related health problems(11th ed.).https:\/\/icd.who.int\/"},{"key":"e_1_2_4_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16918"}],"container-title":["Journal of Traumatic Stress"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jts.70087","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jts.70087","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jts.70087","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T16:32:03Z","timestamp":1780590723000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jts.70087"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":63,"alternative-id":["10.1002\/jts.70087"],"URL":"https:\/\/doi.org\/10.1002\/jts.70087","archive":["Portico"],"relation":{},"ISSN":["0894-9867","1573-6598"],"issn-type":[{"value":"0894-9867","type":"print"},{"value":"1573-6598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]},"assertion":[{"value":"2026-02-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jts.70087"}}