The new frontline: exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic

BMC Psychiatry

Cynda Hylton Rushton¹  Jodi D. Edwards²  Lena Quilty³  Edward G. Spilg⁴  Tetyana Kendzerska⁴  Wendy Gifford⁵  Mamta Gautam⁶  Rajiv Bhatla⁷  Chloe Leveille⁸  Mysa Saad⁹  Jennifer L. Phillips⁹  Rebecca Robillard^1,10 

[1] Berman Institute of Bioethics & School of Nursing, Johns Hopkins University, 1809 Ashland Avenue, 21205, Baltimore, MD, USA;Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, 40 Ruskin Street, K1Y 4W7, Ottawa, Ontario, Canada;School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, K1G 5Z3, Ottawa, Ontario, Canada;Centre for Addiction and Mental Health, 1025 Queen Street, Toronto, M6J 1H1, Ontario, Canada;Department of Medicine, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada;Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Ontario, Canada;Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, K1Z 7K4, Ottawa, Ontario, Canada;Royal Ottawa Mental Health Centre, 1145 Carling Avenue, K1Z 7K4, Ottawa, Ontario, Canada;The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, K1Z 7K4, Ottawa, Ontario, Canada;The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, K1Z 7K4, Ottawa, Ontario, Canada;Faculty of Medicine, University of Ottawa, 1145 Carling Avenue, K1Z 7K4, Ottawa, Ontario, Canada;The University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, K1Z 7K4, Ottawa, Ontario, Canada;School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, K1N 6N5, Ottawa, Ontario, Canada;

关键词: Healthcare workers;    Moral distress;    Moral resilience;    Mental health;    Stress;    Anxiety;    Depression;    Pandemic;    Global crisis;   

DOI  :  10.1186/s12888-021-03637-w

来源: Springer

【 摘 要 】

BackgroundGlobal health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs.MethodsA total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed.FindingsRespondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|].InterpretationElevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.

【 授权许可】

CC BY