Moral Injury and Light Triad Traits: Anxiety and Depression in Health-Care Personnel During the Coronavirus-2019 Pandemic in Honduras

Rodríguez, Elizabeth Andino; Agüero-Flores, Maitée; Landa-Blanco, Miguel; Agurcia, David; Santos-Midence, Cindy

doi:10.1177/15404153211042371

Cited by 14 publications

(11 citation statements)

References 40 publications

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“…The 33 eligible studies were from 13 different countries, of which the US was the most frequent contributor in the number of studies ( k = 11) and the UK in enrolled HCWs number ( n = 14,815). 1 Six studies were from Asia, 12 from Europe, two from Latin America (Cooper-Bribiesca et al, 2023 ; Rodríguez et al, 2021 ), and one enrolled participants from several countries (Thomas et al, 2023 ). The 33 studies involved n = 31,849 participants (range of n = 33–12,965).…”

Section: Resultsmentioning

confidence: 99%

“…MI imposes high emotional risks, as the individual can feel that their violations are beyond repair, resulting in shame, guilt, despair, and demoralisation (Jones, 2020 ; Litz et al, 2009 ). Evidence suggests that MI is associated with cognitive and behavioural alterations such as social withdrawal and suicidal behaviour, burnout, and with psychiatric disorders such as posttraumatic stress disorder (PTSD), depression, and anxiety (Bryan et al, 2018 ; Fani et al, 2021 ; Hall et al, 2022 ; Rodríguez et al, 2021 ; Testoni et al, 2022 ; Williamson et al, 2023 , 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis

Coimbra,

Zylberstajn,

van Zuiden

et al. 2024

European Journal of Psychotraumatology

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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 ( r s = .30–.41, all p s < .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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis

Coimbra,

Zylberstajn,

van Zuiden

et al. 2024

European Journal of Psychotraumatology

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“…The PRISMA flowchart delineates the review process (see figure 1). Of the 81 full texts included in the review,6 12–21 43–112 some reported multiple studies in the same paper, so there were 88 separate studies included in the review. Of these, six reported prevalence estimates or average scores that could not be pooled, so they were included in the narrative synthesis only.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Brennan,

Roberts,

Cole

2024

BMJ Open

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ObjectivesOccupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation.DesignA systematic review and meta-analysis.Data sourcesGoogle Scholar, PubMed, APA PsycINFO, Web of Science Core Collection, Scopus, ScienceDirect and Sage Journals Online were searched in June 2020 and updated in November 2022.Eligibility criteria for selecting studiesObservational studies that measured prevalence or average scores of moral injury, or PTED in any occupational group and any geographical location.Data extraction and synthesisTwo independent reviewers screened and coded eligible studies. Study design, participant demographics, sampling method, location, measurement tool and prevalence or average scores were extracted. Risk of bias was assessed using the Quality Assessment Checklist for Prevalence Studies tool. Meta-analysis was conducted using random effects models. Results that could not be combined were summarised qualitatively in a narrative synthesis using the Guidance for Systematic Reviews.ResultsIn total, 88 studies across armed forces and veterans, healthcare, first responders, educators, journalists, child protection service employees, the unemployed, public-sector employees and mixed occupations were included. Studies included in each separate meta-analysis based on the measure used ranged from 2 to 30. The pooled prevalence of clinically relevant moral injury in healthcare professionals was 45%, and exposure to any potentially morally injurious event (PMIE) across occupations was 67%. Exposure to transgressions by others and betrayal was significantly lower in the armed forces than civilian occupations. Pooled prevalence of PTED across occupations was 26%.ConclusionExposure to PMIEs, moral injury symptoms and PTED are prevalent at work and exposure to transgressions by others and betrayal are more likely in civilian occupations than the armed forces.PROSPERO registration numberCRD42020191766.

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“…10 The MISS-HP contains a mix of positively and negatively worded items to reduce response bias, and it has a strong evidence base in the literature. [10][11][12][13][14] We stored responses in a secure REDCap® drive, accessible only to IRB-approved study members, to ensure anonymity.…”

Section: Methodsmentioning

confidence: 99%

Moral Injury among Transplant Providers: Evaluating the Effects of Training in End-of-Life Counseling

David,

Rosell,

Hughes

2023

kjm

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Introduction. Ethical issues are pervasive in healthcare, but few specialties rival the moral complexity of transplant medicine. Transplant providers must regularly inform patients that they are no longer eligible to receive a potentially life-saving operation and the stress of these conversations poses a high risk of moral injury. Training in end of life counseling (EOLC) has been shown to significantly reduce provider stress and burnout. We hypothesized that training in EOLC reduces levels of moral injury among transplant providers. Methods. This was a mixed methods study. A survey was administered to staff in the solid organ transplant department at the University of Kansas Health System. Providers indicated whether they had received training in EOLC and completed the standardized Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). A two-sample, one-sided t-test compared levels of moral injury between trained and untrained staff. Subsequently, semi-structured interviews were conducted with transplant providers, and inductive coding followed by thematic network analysis was performed. Results. Thirty-seven percent of respondents reported a moral injury score at or above the threshold for psychosocial dysfunctioning associated with moral injury. Analysis revealed no difference in moral injury scores between the trained and untrained groups (p=0.362, power=0.842). Ten participants were interviewed. Thematic network analysis demonstrated high-level themes of “challenges”, “training” and “stress relief”. Conclusions. Our study demonstrated a concerning prevalence of moral injury among transplant providers and suggested that EOLC training does not significantly mitigate the threat of moral injury.

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Moral Injury and Light Triad Traits: Anxiety and Depression in Health-Care Personnel During the Coronavirus-2019 Pandemic in Honduras

Cited by 14 publications

References 40 publications

Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis

Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

Moral Injury among Transplant Providers: Evaluating the Effects of Training in End-of-Life Counseling

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