Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic

Abstract

Background Moral injury among physicians and other health professionals has attracted attention in the mainstream literature, this study aim to assess the psychometric properties of the 10-item Moral Injury Symptoms Scale-Health Professional (MISS-HP) among healthcare professionals in China. Methods A total of 583 nurses and 2423 physicians were recruited from across mainland China. An online survey was conducted from March 27 to April 26, 2020 (during the middle of the COVID-19 pandemic) using the Chinese version of the MISS-HP. Reliability was assessed by internal consistency reliability and test-retest reliability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine scale structure. Results Cronbach’s α of the scale for both samples was acceptable (0.71 for nurses and 0.70 for physicians), as was test-retest reliability (ICCs for the individual items ranged from 0.41 to 0.74, with 0.77 for the overall scale in physicians). EFA suggested three factors, and the CFA indicated good fit to the data. Convergent validity was demonstrated with the 4-item Expressions of Moral Injury Scale (r = 0.45 for physicians, r = 0.43 for nurses). Discriminant validity was demonstrated by correlations with burnout and well-being (r = 0.34–0.47), and concurrent validity was suggested by correlations with depression and anxiety symptoms (r = 0.37–0.45). Known groups validity was indicated by a higher score in those exposed to workplace violence (B = 4.16, 95%CI: 3.21–5.10, p < 0.001). Conclusions The MISS-HP demonstrated acceptable reliability and validity in a large sample of physicians and nurses in mainland China, supporting its use as a screening measure for moral injury symptoms among increasingly stressed health professionals in this country during the COVID-19 pandemic.

Moral Injury and Light Triad traits: anxiety and depression in health-care personnel during the COVID-19 pandemic

“…Results of our study provide further evidence that Moral Injury significantly affects depression and anxiety in health-care personnel. Such results are similar to those found in a sample of Chinese nurses and physicians, in which Moral Injury correlated positively with depression and anxiety, while being inversely associated with well-being (Zhizhong et al, 2020).…”

“…Specifically, environments that promote social support among colleagues could enhance resilience in health-care personnel (De Brier, Stroobants, Vandekerckhove, & De Buck, 2020). This is of particular importance given the role that lack of trust and betrayal play as key domains of Moral Injury (Greenberg et al, 2020;Zhizhong et al, 2020). Additionally, healthcare organizations should promote staff participation in the institutional decisionmaking process.…”

“…The marked items (R) were later inversely recoded to calculate factor totals. The items follow the classification provided by Zhizhong et al (2020). (Cohen, 1992).…”

“…Moreover, scores equal or greater than 36 suggest significant risk of impairment in the social, professional or familiar domains (Mantri et al, 2020). Three dimensions build the MISS-HP: Shame and Guilt, Mistrust, and Lack of Forgiveness (Zhizhong et al, 2020). In the current study the MISS-HP had an adequate internal consistency, α=0.76, 95% CI [0.70, 0.81].…”

“…A different study made among New York health-care staff found that 57% reported acute stress, 48% depressive symptoms and 33% anxiety symptoms (Shechter et al, 2020). Additionally, studies made in health personnel during the COVID-19 pandemic have found significant relationships between Moral Injury and depression, anxiety, emotional exhaustion and depersonalization (Zhizhong et al, 2020).…”