Associations between moral injury and ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD among help-seeking nurses: a cross-sectional study

Jovarauskaitė, Lina; Murphy, Dominic; Truskauskaitė‐Kunevičienė, Inga; Dumarkaitė, Austėja; Andersson, Gerhard; Kazlauskas, Evaldas

doi:10.1136/bmjopen-2021-056289

Cited by 11 publications

(8 citation statements)

References 21 publications

(18 reference statements)

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“…This finding strongly suggests that the two tests tap into different facets of the psychological state that arises in response to the atrocities of war. The results of the current research are in line with recent studies that indicate a mechanistically different nature of moral injury and PTSD symptoms despite the association between them and a medium vs strong effect of moral injury on PTSD symptoms in civilians [1,18].…”

Section: Discussionsupporting

confidence: 90%

Post-traumatic Stress Disorder and Moral Injury Among Ukrainian Civilians During the Ongoing War

2023

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While severity of post-traumatic stress disorder (PTSD) symptoms and moral injury among civilians affected by armed conflicts is generally understudied, even less research exists on civilian populations during an active war. This paper reports a large-scale study that administered standard assessments of PTSD and moral injury severity, as well as rich demographic questionnaires, to nearly 1300 Ukrainian civilians during the ongoing Russian invasion. Analyses revealed an extremely high prevalence of severe PTSD symptoms and moral injury, relative to both proposed clinical cut-offs and to earlier measurements from a similar population. Further regression analyses identified risk factors and protective factors. Greater severity of PTSD symptoms was observed among women, older and forcibly displaced individuals, and individuals from geographic regions under Russian occupation. Higher education correlated with milder PTSD symptoms. Moral injury was particularly strong in younger individuals. The present study is one of the first to report a large scale set of psychological data collected from the civilian population of Ukraine during the ongoing Russian invasion. It is obvious from the scope and long-term nature of the atrocities that psychological treatment of the civilian population will be required both presently, while the hostilities are ongoing, and in the future. This data contributes to a detailed understanding of the psychological response to traumatic stress, including its overall prevalence and presence in specific demographically and geographically defined civilian groups.

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Section: Discussionsupporting

confidence: 90%

Post-traumatic Stress Disorder and Moral Injury Among Ukrainian Civilians During the Ongoing War

2023

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“…The MIES ( k = 14) and the MISS-HP ( k = 12) were the most frequently used MI measures. Two studies used the same sample but investigated different mental health problems, and therefore both were included (Dumarkaite et al, 2023 ; Jovarauskaite et al, 2022 ). Twenty-five studies had undergone peer review, while eight remained unreviewed at the time of our article's completion.…”

Section: Resultsmentioning

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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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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“…In turn, recent studies of MI in HCP have examined whether exposure to ethical and moral violations may lead to MI (e.g. Hagerty et al, 2022a ; Lai et al, 2020 ; Nelson et al, 2022 ; Petrie et al, 2022 ); the prevalence of MI symptoms in HCP who worked during the pandemic (Rushton et al, 2022 ); associations between exposure to PMIEs and symptoms of PTSD in HCP (Jovarauskaite et al, 2022 ); and the workplace and systemic factors that may contribute to MI in HCP (Xue et al, 2022 ; Zahiriharsini et al, 2022 ). Alongside this, studies of first responder or public safety personnel are drawing on MI to examine the psychological distress associated with the moral and ethical conflicts that arise in these occupations (Jafari et al, 2019 ; Papazoglou et al, 2020 ; Smith-MacDonald et al, 2021 ; Tapson et al, 2022 ).…”

Section: From Military Moral Injury To Workplace Moral Injurymentioning

confidence: 99%

‘Against everything that got you into the job’: experiences of potentially morally injurious events among Canadian public safety personnel

Rodrigues

Mercier

McCall

et al. 2023

European Journal of Psychotraumatology

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Background: Moral injury (MI) has become a research and organizational priority as frontline personnel have, both during and in the years preceding the COVID-19 pandemic, raised concerns about repeated expectations to make choices that transgress their deeply held morals, values, and beliefs. As awareness of MI grows, so, too, does attention on its presence and impacts in related occupations such as those in public safety, given that codes of conduct, morally and ethically complex decisions, and high-stakes situations are inherent features of such occupations. Objective: This paper shares the results of a study of the presence of potentially morally injurious events (PMIEs) in the lived experiences of 38 public safety personnel (PSP) in Ontario, Canada. Method: Through qualitative interviews, this study explored the types of events PSP identify as PMIEs, how PSP make sense of these events, and the psychological, professional, and interpersonal impacts of these events. Thematic analysis supported the interpretation of PSP descriptions of events and experiences. Results: PMIEs do arise in the context of PSP work, namely during the performance of role-specific responsibilities, within the organizational climate, and because of inadequacies in the broader healthcare system. PMIEs are as such because they violate core beliefs commonly held by PSP and compromise their ability to act in accordance with the principles that motivate them in their work. PSP associate PMIEs, in combination with traumatic experiences and routine stress, with adverse psychological, professional and personal outcomes. Conclusion: The findings provide additional empirical evidence to the growing literature on MI in PSP, offering insight into the contextual dimensions that contribute to the sources and effects of PMIEs in diverse frontline populations as well as support for the continued application and exploration of MI in the PSP context.

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Associations between moral injury and ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD among help-seeking nurses: a cross-sectional study

Cited by 11 publications

References 21 publications

Post-traumatic Stress Disorder and Moral Injury Among Ukrainian Civilians During the Ongoing War

Post-traumatic Stress Disorder and Moral Injury Among Ukrainian Civilians During the Ongoing War

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

‘Against everything that got you into the job’: experiences of potentially morally injurious events among Canadian public safety personnel

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