Abstract

The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors. From a convenience sample, we performed an email-based, longitudinal survey of HCWs at a tertiary care hospital between March and July 2020. Surveys measured occupational and resilience factors and psychiatric distress and moral injury, assessed by the Impact of Events Scale-Revised and the Moral Injury Events Scale, respectively. Responses were assessed at baseline, 1-month, and 3-month time points. Moral injury remained stable over three months, while distress declined. A supportive workplace environment was related to lower moral injury whereas a stressful, less supportive environment was associated with increased moral injury. Distress was not affected by any baseline occupational or resiliency factors, though poor sleep at baseline predicted more distress. Overall, our data suggest that attention to improving workplace support and lowering workplace stress may protect HCWs from adverse emotional outcomes.

Highlights

  • Increased healthcare worker (HCW) distress and psychiatric morbidity have been associated with public health disasters and biological threats

  • Measures of HCW distress have been elevated, including symptoms of stress, anxiety, exhaustion and symptoms related to post-traumatic stress disorder

  • We previously showed that at the beginning of the US surge, HCW moral injury was similar in severity to that reported by military service members returning from combat deployments and was positively related to percentage of work in inpatient care and sleep disturbance [18]

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Summary

Introduction

Increased healthcare worker (HCW) distress and psychiatric morbidity have been associated with public health disasters and biological threats. Such events have included the 2003 severe acute respiratory syndrome (SARS) outbreak, the 2009 H1N1 influenza outbreak and the 2014 Ebola outbreak [1,2,3,4,5,6]. Measures of HCW distress have been elevated, including symptoms of stress, anxiety, exhaustion and symptoms related to post-traumatic stress disorder. In recognition of these consequences and associated risks, the World Health Organization has recognized HCW stress as an important factor impacting patient safety and occupational health [7]

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