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Front Psychiatry ; 13: 863232, 2022.
Article in English | MEDLINE | ID: covidwho-1928450


Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically and morally challenging situations during the COVID-19 pandemic that increase their risk for the development of moral distress (MD) and moral injury (MI). To date, however, the global circumstances that confer risk for MD and MI in these cohorts have not been systematically explored, nor have the unique circumstances that may exist across countries been explored. Here, we sought to identify and compare, across the globe, potentially morally injurious or distressful events (PMIDEs) in HCWs and PSP during the COVID-19 pandemic. A scoping review was conducted to identify and synthesize global knowledge on PMIDEs in HCWs and select PSP. Six databases were searched, including MEDLINE, EMBASE, Web of Science, PsychInfo, CINAHL, and Global Health. A total of 1,412 articles were retrieved, of which 57 articles were included in this review. These articles collectively described the experiences of samples from 19 different countries, which were comprised almost exclusively of HCWs. Given the lack of PSP data, the following results should not be generalized to PSP populations without further research. Using qualitative content analysis, six themes describing circumstances associated with PMIDEs were identified: (1) Risk of contracting or transmitting COVID-19; (2) Inability to work on the frontlines; (3) Provision of suboptimal care; (4) Care prioritization and resource allocation; (5) Perceived lack of support and unfair treatment by their organization; and (6) Stigma, discrimination, and abuse. HCWs described a range of emotions related to these PMIDEs, including anxiety, fear, guilt, shame, burnout, anger, and helplessness. Most PMIDE themes appeared to be shared globally, particularly the 'Risk of contracting or transmitting COVID-19' and the 'Perceived lack of support and unfair treatment by their organization.' Articles included within the theme of 'Stigma, discrimination, and abuse' represented the smallest global distribution of all PMIDE themes. Overall, the present review provides insight into PMIDEs encountered by HCWs across the globe during COVID-19. Further research is required to differentiate the experience of PSP from HCWs, and to explore the impact of social and cultural factors on the experience of MD and MI.

Journal of Military, Veteran and Family Health ; 7(2):71-80, 2021.
Article in English | APA PsycInfo | ID: covidwho-1898136


Introduction: Moral injury (MI) refers to the psychological distress associated with perceived betrayals or perceived transgressions of one's moral values. It has been studied primarily among military personnel and Veterans and has been found to be associated with posttraumatic stress disorder (PTSD), depression, anxiety, and other psychiatric symptoms. Recently, research has begun to investigate MI and its potential risk factors. Difficulties with emotion regulation (ER), which refers to difficulties with managing and moderating emotions, is a transdiagnostic factor associated with several psychiatric conditions, including PTSD, depression, and anxiety. The objective of the current study was to investigate the relations among MI;symptoms of PTSD, depression, anxiety, and stress;and difficulties with ER in a sample of Canadian military personnel and Veterans. A secondary aim was to discuss the potential relevance of these relations for military personnel, Veterans, and front-line health care workers during the COVID-19 pandemic. Methods: Assessments of MI, PTSD, depression, anxiety, stress, and difficulties with ER were administered to Canadian military personnel and Veterans. Correlational analyses were used to assess the relation of MI to these symptoms. Results: Increased levels of MI were associated with avoidance and alterations in mood and cognition symptom clusters of PTSD. Perceived betrayals were also significantly correlated with PTSD-related alterations in mood and cognition symptoms. Symptoms of PTSD were significantly associated with depression, anxiety, and stress. Difficulties with ER were significantly correlated with symptoms of PTSD, depression, anxiety, and stress, but not with MI (p = 0.07). Discussion: These results reveal an association between MI and specific symptom clusters of PTSD, and they highlight the association between difficulties with ER and symptoms of psychiatric illness among Canadian military personnel and Veterans. The potential implications of these findings and future work examining MI in military personnel, Veterans, and front-line health care workers during the COVID-19 pandemic are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) Introduction: Le prejudice moral (PM) designe la detresse psychologique decoulant des perceptions de trahison et de transgression de ses propres valeurs morales. Il a surtout ete etudie chez les membres du personnel militaire et les veterans, et il a ete etabli qu'il est associe au trouble de stress post-traumatique (TSPT), a la depression, a l'anxiete et a d'autres symptomes psychiatriques. Recemment, les recherches ont commence a porter sur les facteurs de risque potentiels du PM. Les troubles de regulation affective (RA), qui designent les difficultes a gerer et a moderer ses emotions, sont des facteurs transdiagnostiques lies a divers troubles psychiatriques, y compris le TSPT, la depression et l'anxiete. La presente etude vise a examiner les relations entre le PM, les symptomes de TSPT, la depression, l'anxiete, le stress et les troubles de RA aupres d'un echantillon de membres du personnel militaire et de veterans canadiens. Un objectif secondaire consistait a examiner la pertinence potentielle de ces relations pour le personnel militaire, les veterans et les travailleurs de la sante de premiere ligne pendant la pandemie de COVID-19. Methodologie: Les chercheurs ont evalue le PM, le TSPT, la depression, l'anxiete, le stress et les troubles de RA du personnel militaire et des veterans. Ils ont utilise des analyses de correlation pour evaluer le lien entre le PM et ces symptomes. Resultats: Un taux eleve de PM etait relie de maniere significative aux grappes d'evitement, de perturbations de l'humeur et de symptomes cognitifs relatifs aux TSPT. La perception de trahison etait egalement associee de maniere significative aux perturbations de l'humeur et aux symptomes cognitifs lies aux TSPT. Les symptomes de TSPT avaient un lien significatif avec la depression, l'anxiete et le stress. Les troubles de RA etaient correles de maniere significative avec les symptomes de TSPT, la depression, l'anxiete et le stress, mais pas avec le PM (p = 0,07). Discussion: Ces resultats revelent une association entre le PM et des grappes precises de symptomes de TSPT et font ressortir le lien entre les troubles de RA et les symptomes de maladie psychiatrique chez les membres du personnel militaire et les veterans canadiens. Les repercussions potentielles de ces constatations et les futurs travaux sur le PM chez les membres du personnel militaire, les veterans et les travailleurs de premiere ligne pendant la pandemie de COVID-19 sont abordes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Frontiers in psychiatry ; 12, 2021.
Article in English | EuropePMC | ID: covidwho-1728114


The COVID-19 pandemic has resulted in a still-unfolding series of novel, potentially traumatic moral and ethical challenges that place many healthcare workers at risk of developing moral injury. Moral injury is a type of psychological response that may arise when one transgresses or witnesses another transgress deeply held moral values, or when one feels that an individual or institution that has a duty to provide care has failed to do so. Despite knowledge of this widespread exposure, to date, empirical data are scarce as to how to prevent and, where necessary, treat COVID-19-related moral injury in healthcare workers. Given the relation between moral injury and post-traumatic stress disorder (PTSD), we point here to social and interpersonal factors as critical moderators of PTSD symptomology and consider how this knowledge may translate to interventions for COVID-19-related moral injury. Specifically, we first review alterations in social cognitive functioning observed among individuals with PTSD that may give rise to interpersonal difficulties. Drawing on Nietlisbach and Maercker's 2009 work on interpersonal factors relevant to survivors of trauma with PTSD, we then review the role of perceived social support, social acknowledgment and social exclusion in relation to potential areas of targeted intervention for COVID-19-related moral injury in healthcare workers. Finally, building on existing literature (e.g., Phoenix Australia—Centre for Posttraumatic Mental Health and the Canadian Centre of Excellence—PTSD, 2020) we conclude with individual and organizational considerations to bolster against the development of moral injury in healthcare workers during the pandemic.