Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic

Abstract

The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes.

Moral injury and mental health outcomes among Israeli health and social care workers during the COVID-19 pandemic: a latent class analysis approach

“…Preliminary evidence for MI symptoms among healthcare professionals during the COVID-19 pandemic has recently come from China (Wang et al, 2020), Honduras (Rodríguez et al, 2021), and the US (Hines et al, 2021). The estimated prevalence of MI in China and Honduras was 41.3% and 45.6%, respectively.…”

Individual Resilience in the Organization in the Face of Crisis: Study of the Concept in the Context of COVID-19

“…Rather, it is formed over time and through his family and social environment: ‘ Resilience is not a state that freezes us, it is a process in continuous movement of adaptation and sometimes even of creation ’ (Brissiaud, 2008 , p.23). Therefore, we should rather rejoice in this because it leaves everyone with the hope of being able to resist and bounce back from the traumas of tomorrow (Hines et al, 2021 ).…”

“…This reconstruction work could take a long time. First, it will have to go through understanding and action to restore meaning to an existence that has not had any since the trauma (Cyrulnik, 2004 ; Hines et al, 2021 ). Understanding comes from the environment that should play the role of the resilience guardian leading the resilient to find a second strength that will allow him to temporarily close his scars of the past, open the way to a new life and make him a new meaning capable of ensuring his survival (Cyrulnik, 2002 ).…”

We’re Not Gonna Fall: Depressive Complaints, Personal Resilience, Team Social Climate, and Worries about Infections among Hospital Workers during a Pandemic

“…Teams at work constitute particularly relevant groups, because they offer individuals comparable perspectives and thus validation of thoughts and feelings [ 56 , 57 ], which could reduce the effect that worries have on depressive complaints. Indeed, studies show that social support helps individuals cope better with stress [ 58 , 59 ], prevents moral injury [ 60 ] and burnout [ 61 , 62 ], and buffers COVID-19 worries’ negative effect on health [ 63 ]. Therefore, team social climate is expected to function as an important contextual resource in preserving psychological health, by buffering the effect of worries about infections on depressive complaints (Hypothesis 3b).…”