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

Abstract

Background:The COVID-19 pandemic poses unique challenges to health and social care workers (HSCWs) who face morally challenging and life-threatening decisions. Following exposure to events that transgress moral beliefs and expectations, HSCWs might experience psychological, social, and spiritual problems referred to as Moral Injury (MI). Objective: The objectives of this study were to examine patterns of exposure to potentially morally injurious events (PMIEs) among HSCWs and their associations with MI, mental health outcomes and psychological correlates. Method: A sample of 296 Israeli HSCWs volunteered to complete a cross-sectional electronic survey with validated self-report questionnaires in February and March 2021. Latent Class Analysis (LCA) was used to identify classes characterized by unique patterns of exposure to PMIEs. Socio-demographic, work and COVID-related variables were used to predict patterns of exposure to PMIEs, and differences in mental-health outcomes and psychological correlates between classes were assessed. Results: Three subgroups were identified: 'high exposure' (19.5%), 'betrayal-only' (31.3%), and 'minimal exposure' (49.4%). Perceived stress increases the odds for inclusion in the 'high exposure' and 'betrayal-only' classes. Participants in both the High Exposure class and the betrayal-only classes reported higher levels of depressive, anxiety, posttraumatic and more moral injury symptoms as compared to the 'minimal exposure' class. Importantly, both 'high exposure' and 'betrayal-only' classes reported lower levels of self-compassion and higher levels of self-criticism, relative to those in the 'minimal exposure' class. Conclusions: The study's findings offer an overview of the complex associations between patterns of exposure to PMIEs and associated predictors and outcomes. Clinicians treating HSCWs coping with COVID-19 related stress should be aware of the contribution of exposure to PMIEs to HSCWs' distress and to the unique constellation of high self-criticism and low selfcompassion among HSCWs with exposure to PMIEs.

The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic Psychological Needs

“…In Italy and Austria, moral distress and moral injury were the main stressors with which healthcare workers were confronted, and organizational justice and decentralized decision-making were essential for mitigating their negative effects [56]. In Israel, exposure to PMIEs was high during the COVID-19 pandemic in healthcare, leading to depression, anxiety, increased selfcriticism, and decreased self-compassion [57]. In China, during the COVID-19 pandemic, nurses found that organizational autonomy and connectedness support were essential for managing the wide array of ethical problems which arose [43], leading to depression, anxiety, low well-being, and emotional exhaustion [58].…”

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

“…Healthcare workers (HCWs) are at high risk of being exposed to potentially morally injurious events (PMIEs) in their clinical practice. [1][2][3] Furthermore, PMIEs are likely to be more common in the context of the coronavirus (COVID-19) pandemic due to the increased pressure to provide sufficient care for patients. 2 4 Moral injury (MI) may appear because of the violation of one's moral code as a consequence of a particular action or absence of them.…”

Perceived workplace support and mental health, well-being and burnout among health care professionals during the COVID-19 pandemic: a cohort analysis

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T he COVID-19 pandemic has posed serious risks to the mental health of health care professionals (HCPs), which, if not addressed, will affect staffing and service provision in the future. 1,2 Their potential vulnerability to mental health issues could be explained by the unique challenges faced by them, including vicarious trauma, 3 moral injury [4][5][6][7] and increased risk of infection. 8 Long working hours, discrimination for working in hospitals and workplace practices may also be contributing factors.

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