The New Frontline: Exploring the Links between Moral Distress, Moral Resilience and Mental Health in Healthcare Workers Amidst the COVID-19 Pandemic

Abstract

Background: Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally injurious events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs.Methods: A 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 3 rd and September 3 rd , 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 regressions were used to evaluate association between moral resilience, demographic/professional factors and moral distress and to identify factors associated with moral resilience.Findings: Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety and depression symptoms (F > 5·5, p 9·1, p = ·002), compared to healthcare workers who were not. Higher exposure to potentially morally injurious events (B=2·98, 95% CI [2·90, 3·05]) and lower moral resilience (B=3·12, 95% CI [0·04, 6·20]) were associated with worse moral distress. Moral resilience moderated the relationship between exposure to potentially morally injurious events and moral distress (p ·27, pInterpretation: Elevated 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.Trial Registration: Data for this study was collected as part of a larger online survey (ClinicalTrials.gov: NCT04369690)Funding Statement: The Royal Ottawa Foundation for Mental Health allocated some funds to help support the wider project from which this study stems. The Royal Ottawa Foundation for Mental Health had no influence on the study design, data collection, analysis, interpretation, or decision to publish this manuscript. The authors have not been paid by any pharmaceutical company or other for profit organization to write this article.Declaration of Interests: CR receives royalties from Oxford University Press: Moral Resilience: Transforming Moral Suffering in Health Care. MG received honorariums for presentations on physician wellness by Amgen and Merck and is the CEO of PEAK MD Inc, through which she delivers keynote presentations, consultation to healthcare organizations, coach senior medical leaders and receive book royalties (unrelated to this research). None of the other authors have any conflict of interest to disclose.Ethics Approval Statement: This study was approved by the Clinical Trials Ontario-Qualified Research Ethics Board (Protocol #2131).