Moral Injury Among Frontline Long-Term Care Staff and Management During the COVID-19 Pandemic

Background A growing body of research highlights the experiences of moral injury among healthcare professionals during the COVID-19 pandemic. Moral injury (i.e., participating in or witnessing acts that violate one's central moral values), is associated with a host of psychological sequelae and corresponding negative psychosocial impacts. There is a lack of research examining the experiences of moral injury among those working in long-term care settings during the COVID-19 pandemic. Given the drastic impact that the COVID-19 pandemic has had on long-term care facilities in Canada, it is important to understand the experiences of moral injury among those working in long-term care settings to inform the development of effective prevention and intervention strategies. Objectives & Method The objectives of this study were to understand the experiences and impact of moral injury among Canadian frontline long-term care workers (staff and management) during the COVID-19 pandemic. Participants (N = 32 long-term care staff and management working in Ottawa and Manitoba) completed in-depth, semi-structured qualitative interviews and clinical diagnostic assessments (Mini International Neuropsychiatric Interviews;MINI;Version 7.0.2) between March 2021-June 2021. Findings The core category of our qualitative grounded theory model of moral injury in long-term care exemplified four shared types of morally injurious experiences, paired with cognitive, affective, and physiological symptom domains. Seven associated main themes emerged, contributing to the experiences and impact of moral injury in long-term care: 1) Beliefs about older adults and long-term care;2) Interpretation of morally injurious experiences;3) Management of morally injurious experiences;4) Long-term care pandemic impacts;5) Personal pandemic impacts;6) Structural impacts in long-term care;and 7) Mental health needs and supports. Clinical assessments demonstrated anxiety disorders (n = 4) and feeding and eating disorders (n = 3) were among the most frequently classified current psychiatric disorders among long-term care workers. Conclusions This is the first Canadian study to examine the experiences and impact of moral injury in long-term care during the COVID-19 pandemic using qualitative and clinical diagnostic methodologies. Implications and insights for screening and intervention are offered.

Moral Injury Among Frontline Long-Term Care Staff and Management During the COVID-19 Pandemic.

Background: A growing body of research highlights the experiences of moral injury among healthcare professionals during the COVID-19 pandemic. Moral injury (i.e., participating in or witnessing acts that violate one's central moral values), is associated with a host of psychological sequelae and corresponding negative psychosocial impacts. There is a lack of research examining the experiences of moral injury among those working in long-term care settings during the COVID-19 pandemic. Given the drastic impact that the COVID-19 pandemic has had on long-term care facilities in Canada, it is important to understand the experiences of moral injury among those working in long-term care settings to inform the development of effective prevention and intervention strategies. Objectives & Method: The objectives of this study were to understand the experiences and impact of moral injury among Canadian frontline long-term care workers (staff and management) during the COVID-19 pandemic. Participants (N = 32 long-term care staff and management working in Ottawa and Manitoba) completed in-depth, semi-structured qualitative interviews and clinical diagnostic assessments (Mini International Neuropsychiatric Interviews; MINI; Version 7.0.2) between March 2021-June 2021. Findings: The core category of our qualitative grounded theory model of moral injury in long-term care exemplified four shared types of morally injurious experiences, paired with cognitive, affective, and physiological symptom domains. Seven associated main themes emerged, contributing to the experiences and impact of moral injury in long-term care: 1) Beliefs about older adults and long-term care; 2) Interpretation of morally injurious experiences; 3) Management of morally injurious experiences; 4) Long-term care pandemic impacts; 5) Personal pandemic impacts; 6) Structural impacts in long-term care; and 7) Mental health needs and supports. Clinical assessments demonstrated anxiety disorders (n = 4) and feeding and eating disorders (n = 3) were among the most frequently classified current psychiatric disorders among long-term care workers. Conclusions: This is the first Canadian study to examine the experiences and impact of moral injury in long-term care during the COVID-19 pandemic using qualitative and clinical diagnostic methodologies. Implications and insights for screening and intervention are offered.

Sleep disturbance during COVID-19: Correlates and predictive ability for mental health symptomatology in a Canadian online sample.

BACKGROUND: Sleep disturbance is associated with mental health symptomatology, but this impact is understudied during COVID-19. The aims of this study are to: 1) examine correlates of sleep disturbance, and 2) examine the longitudinal relationship between sleep disturbance and mental health symptoms 6 months later, during the pandemic. METHODS: Data were analyzed from COVID-19 Survey Canada conducted between May 2020 (T1) and November 2021 (T2) (n = 489). We examined COVID-related baseline correlates of sleep disturbance at T1, and used multivariable regressions to examine the relationship between T1 sleep disturbance and T2 post-traumatic stress (PTS), health anxiety, generalized anxiety, and depressive symptoms, controlling for baseline mental health symptoms and sociodemographics. RESULTS: Females, ages 30-49, and those with an annual household income <$50,000, showed a higher prevalence of clinically significant sleep disturbance. After adjustment, compared to those without sleep disturbance at baseline, those with sleep disturbance showed a significant increase in PTS symptoms at 6 months (b = 11.80, 95% CI = [8.21-15.38], p < 0.001). LIMITATIONS: Results are not nationally representative. Data may be subject to response biases due to self-report methods and we are unable to determine causality. CONCLUSION: Being able to predict adverse mental health implications of sleep disturbance will help clinicians be equipped to target future impacts of the COVID-19 pandemic as well as any future potential pandemics or traumas. This study emphasizes the importance of screening individuals for sleep disturbance.

"We Are at Risk Too": The Disparate Mental Health Impacts of the Pandemic on Younger Generations: Nous Sommes Aussi à Risque: Les Effets Disparates de la Pandémie Sur la Santé Mentale des Générations Plus Jeunes.

OBJECTIVES: The coronavirus 2019 (COVID-19) pandemic has resulted in profound global impact, with older adults at greater risk of serious physical health outcomes. It is essential to also understand generational differences in psychosocial impacts to identify appropriate prevention and intervention targets. Across generational groups, this study examined: (1) rates of precautions and adaptive and maladaptive health behaviors, (2) differences in levels of anxiety, and (3) rates of COVID-related concerns during Wave 1 of COVID-19 in Canada. PARTICIPANTS: We analyzed data from 2 Canadian population-based data sets: the Canadian Perspective Survey Series: Impact of COVID-19 survey (N = 4,627; March 29 to April 3, 2020), and Crowdsourcing: Impacts of COVID-19 on Canadians-Your Mental Health (N = 45,989; April 24 to May 11, 2020). MEASURES: We categorized generational age group. Participants self-reported changes in behaviors and COVID-related concerns, and a validated measure assessed anxiety symptoms. RESULTS: There are generational differences in behavioral responses to the pandemic. Adaptive health habits (e.g., exercise) were comparable across groups, while changes in maladaptive health habits (e.g., substance use) were highest among younger age groups, particularly Millennials (15 to 34 years old). COVID-related precautions were also highest among the younger generations, with Generation X (35 to 54 years old) exhibiting the highest rate of precautionary behavior. Results also revealed that the highest rate of clinically significant anxiety is among Millennials (36.0%; severe anxiety = 15.7%), and the younger generations have the highest rates of COVID-related concerns. CONCLUSION: These early data are essential in understanding at-risk groups given the unpredictable nature of the pandemic and its potential long-term implications.

COVID-19 as a traumatic stressor is an indicator of mental health symptomatology.

The mental health impacts of the COVID-19 pandemic are gaining attention. While many are experiencing increased stress due to COVID-19, some perceive the pandemic as traumatic. This preliminary study identified respondents who endorsed a COVID-19-related trauma as their most stressful traumatic experience (i.e., index trauma). We analyzed data from an online Canadian survey (May-July 2020; N =1,018). Nearly 3% of participants endorsed a COVID-19-related index trauma. These individuals had increased posttraumatic stress, anxiety, and depressive symptoms compared to the remaining sample. Results may inform targeted screening to identify those who may be at greater risk for COVID-19-related mental health sequelae.

"And then came COVID-19": Manitoban reflections on the emergence of the pandemic

The growing body of research on COVID-19 has demonstrated physical, mental, social, and financial impacts on global populations. There is an absence of research, told through the unique voices of the general public, during early, critical stages of the emergence of the pandemic and pandemic-related restrictions, describing Canadians' experiences. The Winnipeg Free Press sent out a public call through their print and online journal for personal reflections related to COVID-19 starting on March 22, 2020. A total of 44 reflections were published in this column (March 28-April 24, 2020). Authors de-identified and compiled reflections for qualitative analysis using Interpretive Description (Thorne, Interpretive Description, 2008, Left Coast Press). Reflections were written by a range of Manitobans, including health care workers, teachers, childcare workers, business owners, grandparents, mothers, fathers, daughters, travelers, veterans, young adults, and older adults. The central theme, "And then came COVID-19," was highlighted across writers' reflections, describing the sudden and significant impact of the pandemic on many facets of life. Following from this central, overarching theme are four related themes describing: Longing for normalcy;Layers of uncertainty;Lack of support;and "Hardy Winnipeggers": How are we coping? Findings contribute to a significant gap in our understanding concerning early COVID-19 experiences in Canada and offer insight regarding needs for educational and health-related supports. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (French) Le nombre croissant de recherches sur la COVID-19 a demontre les impacts physiques, mentaux, sociaux et financiers sur les populations du monde entier. Or, il y a une absence de recherche, racontee par les voix uniques du grand public, durant les premieres etapes critiques de l'emergence de la pandemie et des restrictions liees a la pandemie, decrivant les experiences des Canadiens. La Winnipeg Free Press a envoye un appel public par l'entremise de son journal imprime et en ligne pour obtenir des reflexions personnelles liees a la COVID-19 a partir du 22 mars 2020. Au total, 44 reflexions ont ete publiees dans cette rubrique (du 28 mars au24 avril 2020). Les auteurs ont desidentifie et compile des reflexions pour une analyse qualitative en utilisant la description interpretative (Thorne, Interpretive Description, 2008, Left Coast Press). Les reflexions ont ete redigees par un eventail de Manitobains, notamment des travailleurs de la sante, des enseignants, des educateurs, des proprietaires d'entreprises, des grands-parents, des meres, des peres, des filles, des voyageurs, des anciens combattants, des jeunes adultes et des personnes agees. Le theme central, << L'arrivee de la COVID-19 , a ete mis en evidence a travers les reflexions des ecrivains, decrivant l'impact soudain et significatif de la pandemie sur de nombreuses facettes de la vie. Ce theme central et global est suivi de quatre themes connexes decrivant : le besoin de normalite;les couches d'incertitude;le manque de soutien;et << la resilience des habitants de Winnipeg : Comment nous y adaptons-nous? Les resultats contribuent a combler une lacune importante dans notre comprehension des premieres experiences de la COVID-19 au Canada et offrent un apercu des besoins en matiere de soutien educatif et sanitaire. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement <strong xmlns:lang="en">Significance Statement-This is the first Canadian study to examine the early experiences of COVID-19 among the general public in central Canada during a critical time in the pandemic with regard to initiation of widespread provincial and national restrictions to slow the spread of the virus. Findings highlight the voices of the public and demonstrate a need for additional resources and supports. (PsycInfo Database Record (c) 2021 APA, all rights reserved)