The Occupational Moral Injury Scale (OMIS) - Development and Validation in Frontline Health and First Responder Workers

Abstract

Moral Injury is an emerging construct that has been primarily examined in military groups but is increasingly expanding to a broader range of non-military occupational settings. A key barrier to this research on moral injury in broader occupational groups has been the lack of valid and reliable measures specifically developed for non-military settings. The current paper addresses this gap by developing the Occupational Moral Injury Scale (OMIS), a measure designed to capture both morally injurious events (MIEs) and primary markers of moral injury (guilt, shame, anger, loss of trust, existential conflict) in any occupational setting, without the need for modification. A combination of Confirmatory Factor Analyses (CFA) and Item Response Theory (IRT) analyses were used in scale development and refinement. Drawing upon a sample of 1454 frontline health and first responder workers across two studies, factor analytic results revealed an expected bifactor structure of five primary factors capturing exposure to morally injurious events (MIEs; Commission with Agency, Commission under Duress, Act of Omission, Witnessing, Betrayal) and a general factor of moral injury. Subscales demonstrated excellent internal consistency, and when compared to theoretically relevant constructs OMIS scores demonstrated strong convergent and divergent validity. Differential validity was also observed among the OMIS subscales. The OMIS provides a psychometrically validated tool for assessing moral injury risk in any occupational setting. The OMIS will help facilitate further research and understanding of how moral injury presents in high-risk occupational settings beyond the military and allow for direct comparison between these groups for the first time.

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

“…No studies were identified through reference list review or EThOS. However, we identified one eligible thesis (de Groot, 2021 ), one accepted manuscript in press (Lennon et al, 2023 ), two pre-prints in Google Scholar (Ma et al, 2022 ; Thomas et al, 2023 ), and one eligible thesis in ProQuest Dissertations (Kimble, 2023 ). Additionally, when contacting authors from one eligible article (Morris et al, 2022 ), they shared data from a recently finalised, unpublished study (Morris, 2022 ).…”

“…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).…”