Abstract
Background: During the COVID-19 pandemic, health-care workers (HCWs) may have been confronted with situations that may culminate in moral injury (MI). MI is the psychological distress that may result from perpetrating or witnessing actions that violate one's moral codes. Literature suggests that MI can be associated with mental health problems. Objective: We aimed to meta-analytically review the literature to investigate whether MI is associated with symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, burnout, and suicidal ideation among active HCWs during the COVID-19 pandemic. Method: We searched eight databases for studies conducted after the onset of the COVID-19 pandemic up to 18 July 2023, and performed random-effects meta-analyses to examine the relationship between MI and various mental health outcomes. Results: We retrieved 33 studies from 13 countries, representing 31,849 individuals, and pooled 79 effect sizes. We found a positive association between MI and all investigated mental health problems ( rs = .30-.41, all ps < .0001). Between-studies heterogeneity was significant. A higher percentage of nurses in the samples was associated with a stronger relationship between MI and depressive and anxiety symptoms. Samples with a higher percentage of HCWs providing direct care to patients with COVID-19 exhibited a smaller effect between MI and depressive and anxiety symptoms. We observed a stronger effect between MI and PTSD symptoms in US samples compared to non-US samples. Conclusion: We found that higher MI is moderately associated with symptoms of PTSD, anxiety, depression, burnout, and suicidal ideation among HCWs during the COVID-19 pandemic. Our findings carry limitations due to the array of MI scales employed, several of which were not specifically designed for HCWs, but underscore the need to mitigate the effect of potentially morally injurious events on the mental health of HCWs.
| Original language | English |
|---|---|
| Article number | 2299659 |
| Pages (from-to) | 1-17 |
| Number of pages | 17 |
| Journal | European Journal of Psychotraumatology |
| Volume | 15 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2024 |
Bibliographical note
Publisher Copyright:© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Funding
This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil (CAPES) [Finance Code 001]. MFM was funded by CNPq [Conselho Nacional de Desenvolvimento Científico e Tecnológico] 303389/2016-8. We would like to thank authors who shared data with us: April Kimble, Arzu Sert-Özen, Austėja Dumarkaitė, Brandon Griffin, Brian Bayani, Danielle Lamb, Deborah J. Morris, Elanor Lucy Webb, Elizabeth Andino Rodríguez, Evaldas Kazlauskas, Gadi Zerach, Gonca Üstün, Haolin Xu, Ines Testoni, Jason Nieuwsma, Kathrine Jauregui Renaud, Lourdes Dale, Mahlagha Dehghan, Miguel Landa Blanco, Mihaela Alexandra Gherman, Nicola Sambuco, Nora Mooren, Robert Lennon, Roger Daglius Dias, Romulo Babasa, Rupa Bhundia, Sevinç Ulusoy, Shane Chug, Shira Maguen, Tayla Greene, Victoria Thomas, Yossi Levi-Belz, Zhizhong Wang, Zülal Çelik
| Funders | Funder number |
|---|---|
| Coordenação de Aperfeiçoamento de Pessoal de Nível Superior | |
| Conselho Nacional de Desenvolvimento Científico e Tecnológico |
Keywords
- COVID-19
- Moral injury
- PTSD
- betrayal
- depression
- healthcare workers
- mental health
- meta-analysis
- nurses
- suicide
