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 2,423 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.

The impact of the COVID-19 pandemic on the prevalence and risk factors of workplace violence among healthcare workers in China

“…MISS-HP is translated into Chinese according to the standard procedure (27). At present, the Cronbach's value in the sample is 0.71 for nurses and 0.70 for doctors, and the internal consistency coefficient of the retest is 0.77, thus, the reliability and validity of this scale are acceptable (23).…”

“…The 9-item Patient Health Questionnaire (PHQ-9): there are 9 items to evaluate and monitor the severity of depression, and the frequency of each symptom from 0 (no at all) to 3 (almost every day) in the past 2 weeks is scored on a 4-point scale. The total scores are as follows: lowest/no depression (0-4), mild depression (5-9), moderate depression (10)(11)(12)(13)(14), moderate-severe depression (15- 19) or severe depression (20)(21)(22)(23)(24)(25)(26)(27)(28). According to the total score, we classify depression into dichotomous variables by <10 (no or mild depression) of the PHQ-9 total score.…”

“…In order to comply with and support the prevention and control of the epidemic situation in COVID-19, repeat online survey was conducted among two hospital-based samples enrolled by snowball convenient sampling in March 2020 and March 2021. More complete details on participant recruitment have been described elsewhere ( 23 ). Participants need to meet the following criteria to be eligible for inclusion in the study, (1) Doctors or nurses who have worked in hospitals in mainland China for at least 2 years; (2) Have the corresponding practicing qualification certificate; (3) Be able to use the Internet normally and complete online questionnaires; (4) Select the consent option of the online report (I agree to participate in the research).…”

Understanding physicians’ moral distress in the Covid 19 pandemic

“…Moral distress is a multidimensional phenomenon that can characterize a variety of negative physical and psychological effects on healthcare professionals (4,9). According to studies carried out during the pandemic, there are numerous negative emotions associated with moral events such as burnout, compassion fatigue, frustration, guilt, weakness, despair, regret, anger, grief, anxiety, helplessness, shame, embarrassment, loss, sadness, fear, sleep difficulties, post-traumatic stress disorder symptoms and anguish (7,22,23). Moral distress also causes job-patient dissatisfaction, decreasing care quality, and even wanting to leave their profession and position (22,24).…”

Moral injury: A review from the perspective of psychology

“…1 引言  古往今来, 战争一直是一个沉重的话题。暴 力与杀戮不仅对士兵造成生理上的创伤, 也在心 理上留下挥之不去的阴影, 其中创伤后应激障碍 (posttraumatic stress disorder, PTSD)是退役军人最 常见的精神障碍 (Bergman et al, 2017;Fulton et al, 2015;Steenkamp et al, 2017) (Chong et al, 2004;Raven et al, 2018)。 新冠肺炎疫情发生后, 医护人员的道德损伤也引 起了许多研究者的关注 (Mantri et al, 2020;Wang et al, 2020;Hines et al, 2021) 和自杀意念等症状方面非常有效 (Galovski et al, 2013;Resick et al, 2012;Resick et al, 2015),…”