Health Crisis Research Articles

Death of the suicide law: A changing standard of liability for clinicians.

High rates of suicide continue to plague the modern world, with clinicians, researchers, and policymakers working urgently to ameliorate what has been recognized as a worldwide public health crisis. Under American Law, individuals- including health care providers, could generally not be held liable for causing the suicide of another person. This article presents a review of suicide law in the United States in the context of a recent civil case in which a physician with expertise in mental health was sued for the death of an ex-partner who committed suicide in his home. Historical events and landmark legal cases spanning the 15th century to now are examined and presented as a narrative review to inform society and mental health clinicians a-like towards interpreting the changing medical-legal landscape. As modern advances in science continue to discern the critical biopsychosocial factors that contribute to the act of suicide, there is an inevitably growing concern that suicide may no longer be an incomprehensible nor irrational event as has been assumed for centuries. Thus, it may be considered that individual with expertise and qualification to treat a group of individuals at higher risk of suicide (severe mental illness) may be subject to a different standard than the average individual. This article seeks to present a complex matter where no simple or broad-sweeping conclusions can yet be drawn, however remains a critically important matter for mental health clinicians.

Religious engagement and antibody response to the COVID-19 vaccine.

This research examined religious engagement and subsequent antibody responses to the COVID-19 vaccine. Using publicly available data from the Understanding Society survey, we employed a longitudinal design. Between January 2016 and May 2018, respondents completed measures of religious belonging, frequency of attending religious services (i.e., extrinsic religiosity), and the difference religion made to their lives (i.e., intrinsic religiosity). A COVID-19 survey wave was collected in March 2021 and measured antibody responses to the COVID-19 vaccine via blood draw. A final sample of 746 adults [462 (61.9%) females, Mage = 61.94, SD = 19.07] was achieved. Mediation analyses (PROCESS, Model 4; Hayes, Introduction to mediation, moderation, and conditional process analysis: A regression-based approach, The Guildford Press, 2022; Introduction to mediation, moderation, and conditional process analysis: A regression-based approach; The Guildford Press) revealed one pathway through which religion and antibody responses to the COVID-19 vaccine are associated, namely via extrinsic factors-attendance at religious services. In contrast, intrinsic religious factors which is the difference religion can make to one's life, was not a significant mediator. Overall, this analysis provides evidence that behavioural enactment of religion matters to the effectiveness of vaccination and the management of public health crises. It also highlights the value of social resources associated with engagement in valued social groups-and in particular religious social groups-for public health.

US Immigration Policy Stressors and Latinx Youth Mental Health.

The youth mental health crisis is exacerbated for Latinx adolescents, a group whose families are targets of anti-immigrant rhetoric and policy. To investigate how immigration-related stressors are associated with disruptions in parent-child relationships and, in turn, the mental health symptoms of Latinx adolescents. Data for this prospective cohort study of adolescent-mother dyads were derived from surveys completed at 3 time points spanning 4 years (time 1 [T1] in 2018, time 2 [T2] in 2020, and time 3 [T3] in 2022). Mediation analyses estimated paths from immigration-related stressors to parent-child relationship qualities to mental health symptoms from early to late adolescence. Multivariable and multivariate linear models within a structural equation modeling framework regressed mediators and outcome variables on their own T1 values, offering a scientifically rigorous test of mediation. The setting was a school district in suburban Atlanta, Georgia, and included Latinx adolescents (ages 11-16 years) randomly selected from grade and gender strata. Data were analyzed from June 2023 to March 2024. The primary independent variables were T1 mother reports of anti-immigrant worry and behavioral modification and adolescent reports of family member detention or deportation. Mediating variables were the reports of parental support and parent-child conflict of T2 adolescents. T3 adolescent reports of past 6-month internalizing and externalizing symptoms. A total of 547 Latinx adolescents (mean [SD] age, 13.3 [1.0] years; 303 female [55.4%]; 244 male [44.6%]) were included in this study. Response rates were 65.2% (547 of 839) among contacted parents and 95.3% (547 of 574) among contacted adolescents with parental permission. Four-year retention rates were 67% (366 of 547 adolescents) and 65% (177 of 271 mothers). Structural model results showed that T1 anti-immigrant worry and behavioral modification was associated with T3 increases in externalizing symptoms indirectly through T1 to T2 increases in parent-child conflict (β = 0.03; SE = 0.02; 95% CI, 0-0.08). For girls, T1 family member deportation or detention was associated with T1 to T3 increases in internalizing and externalizing symptoms indirectly through T1 to T2 declines in parental support (internalizing: β = 0.04; SE = 0.02; 95% CI, 0-0.08; externalizing: β = 0.03; SE = 0.02; 95% CI, 0-0.07). Sensitivity analyses supported structural model findings. Results of this cohort study suggest that legislative bodies, the health care system, and educational institutions should implement safeguards to mitigate potential harm conferred by anti-immigrant environments for parent-child relationships and, in turn, Latinx adolescents' mental health.

The synergy between loneliness and cannabis use on suicidal thoughts and behaviors among young adults in higher education

ABSTRACT Background Loneliness continues to be a public health crisis, and cannabis use has increased among some young adults following its legalization in certain states. Loneliness and cannabis use each contributes to suicide risk, but no studies have explored their potential synergy. This study aimed to explore the interaction between loneliness and cannabis use among students in higher education. Methods We analyzed data from the Healthy Minds Study (2020–2021; N = 101,744) and used multivariable logistic regression models to show the synergy between loneliness and cannabis use on suicidal thoughts and behaviors adjusting for sociodemographic variables and mental health. We calculated the interaction contrast ratio to show the synergy of combined exposures. Results While loneliness and cannabis use both increased odds of suicidal thoughts, those who were lonely and used cannabis had the greatest odds, exceeding the sum of these individual effects. The synergy between loneliness and cannabis use on suicide attempt was not statistically significant at a conventional level. Conclusion Synergy exists between loneliness and cannabis use in relation to suicidal thoughts among young adults in higher education. Future research can explore the utility of screening and addressing loneliness and cannabis in tandem for suicide prevention.

Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada.

Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic. Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined. A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic. Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.

Keep the (social) distance! Turnout and risk perception during health crisis

This article investigates the relationship between risk perception and electoral participation of citizens. To assess this, we use the case study of the novel coronavirus and its relationship with voter turnout during the 2020 Romanian elections. We assess the relationship between COVID-19 and citizens’ intention to cast a vote by employing an individual model. Additionally, using the share rate of the infected population with COVID-19, we examine the association between the intensity of the outbreak across counties and electoral participation. Either though our research is cross-sectional and focuses on covariation rather than causal relationships, provides insightful results. The individual model shows that the higher the risk perception of infection is, the lower the intention to cast a vote. The aggregated exploratory model employed shows that an increase in the percentage of the shared infected population decreases the chance of electoral participation.

Addressing the spatial disparity of COVID-19 vaccination services: A spatial optimisation approach

The COVID-19 pandemic has posed global public health threats. The mass COVID-19 vaccination has continuously played a central role in containing this pandemic. To maximise the benefits of COVID-19 vaccination, equal accessibility to vaccination at different spatial scales is critical. Limited research has investigated the spatial disparity and location optimisation of COVID-19 vaccination services. In this study, we utilised the spatial big data of COVID-19 vaccination sites and used the Gini index to measure the spatial disparity of COVID-19 vaccination service levels. Then, we leveraged spatial optimisation models to enhance the spatial deployment of vaccination sites in the study area of England, UK. The results demonstrate the feasibility and efficiency of the proposed methods. Specifically, the spatial disparity of vaccination services is largely mitigated by the optimised configuration of vaccination sites, as the Gini index decreases from 0.84 (before optimisation) to 0.12 (after optimisation). The suggested vaccination sites would improve the equality of vaccination services and reduce the financial costs of maintaining the vaccination programme, which has implications for public health policymakers. This research illustrates that spatial optimisation could be instrumental in effectively addressing public health crises.

Impact of COVID-19 on the Utilization of Maternal and Child Health Services at a Regional Referral Hospital in Kenya

Background and Objective Pandemics, like COVID-19, disrupt healthcare, potentially reversing progress in various disease areas. The impact on maternal and child health (MCH) services in Kenya during the pandemic is yet to be determined. Recognizing this impact is crucial for formulating policies and programs that minimize disruptions in reproductive health services during future health crises. The purpose of this study was to determine the effect of COVID-19 on the uptake of MCH services at Thika Level V Hospital, a regional referral hospital in Kenya. Methods In this cross-sectional mixed methods study, we reviewed antenatal clinic (ANC), MCH, and family planning (FP) registers for data on the uptake of the various services during the COVID-19 pandemic (July to October 2020) compared to a year before the COVID-19 pandemic (July to October 2019). MCH clients (N = 60) and healthcare workers (N = 19) were interviewed about the impact of the pandemic on MCH services at the hospital. Differences in clinic attendance before and during the pandemic were compared using the student t-test. Thematic analysis was conducted on the interview responses. Results The number of MCH/FP clients dropped from 12,915 pre-pandemic to 7,429 during the pandemic. Significant differences were noted in ANC revisits (p = 0.026) and those completing the World Health Organization recommended minimum of four ANC visits (p<0.001) during the COVID-19 pandemic. The number of revisits at the child welfare clinic was also significantly lower (p = 0.004) during the COVID-19 lockdown period. MCH clients stated that the decline in the uptake of MCH services was attributable to the fear of contracting disease, financial difficulties, and strain on the healthcare workforce. Conclusion and Global Health Implications This study found a decline in access to MCH/FP services during the COVID-19 crisis with the potential to reverse gains made in securing the safety of the pregnant mother and unborn baby.

Integrating clinical research into electronic health record (EHR) workflows to support a learning health system

Abstract Objective Integrating clinical research into routine clinical care workflows within electronic health record systems (EHRs) can be challenging, expensive, and labor-intensive. This case study presents a large-scale clinical research project conducted entirely within a commercial EHR during the COVID-19 pandemic. Case Report The UCSD and UCSDH COVID-19 NeutraliZing Antibody Project (ZAP) aimed to evaluate antibody levels to SARS-CoV-2 virus in a large population at an academic medical center and examine the association between antibody levels and subsequent infection diagnosis. Results The project rapidly and successfully enrolled and consented over two thousand participants, integrating the research trial with standing COVID-19 testing operations, staff, lab, and mobile applications. EHR-integration increased enrollment, ease of scheduling, survey distribution and return of research results at a low cost by utilizing existing resources. Conclusion The case study highlights the potential benefits of EHR-integrated clinical research, expanding their reach across multiple health systems and facilitating rapid learning during a global health crisis.

Family functioning and mental health before and during the COVID-19 pandemic: a two-cohort comparison of emerging adults

AbstractThe aim of the present study was to analyze how family relationships changed during the COVID-19 pandemic and to determine whether the health crisis modified the association between family dimensions and emerging adult children’s mental health. A large sample of 1732 emerging adults was recruited at two different moments. In 2015, 755 emerging adults were recruited, 201 from campus A (sample 1) and 554 from campus B (sample 2). In 2020, a new sample was recruited and 977 emerging adults completed the questionnaire, 198 from campus A (sample 1 / “Pre-pandemic sample”, recruited before the lockdown) and 779 from campus B (sample 2 / “COVID-19 sample” / recruited after the lockdown. The results reveal that the COVID-19 sample of emerging adults perceived poorer parent-child relationships (lower parental involvement and warmth) and reported poorer mental health (lower flourishing and higher psychological distress) than their counterparts in Cohort 1. For their part, the Pre-pandemic sample reported higher levels of psychological distress than their counterparts in Cohort 1. In all samples (Cohort 1 and Cohort 2, both Pre-pandemic and COVID-19), parenting functions were positively associated with children’s flourishing and negatively associated with their psychological distress. However, these associations were stronger in Cohort 2 than in Cohort 1, both when assessed before and when assessed during the pandemic. The results of the study support the increasingly important role played by the family as a protective factor for mental health, even in stressful situations when family relationships tend to deteriorate. Study limitations include the use of a sample composed mainly of young emerging adult university students. Future studies should strive to include more emerging adults from the entire age range encompassed by emerging adulthood, as well as members of the non-university-going emerging adult population. Investing in public programs focused on family functions during emerging adulthood is an essential strategy for protecting and improving young adults’ mental health and promoting positive family relationships in stressful situations.

A Dynamic Evolutionary Analysis of the Vulnerability of Global Food Trade Networks

The global food trade network (FTN) is a critical infrastructure for achieving the Sustainable Development Goals (SDGs). The FTN’s vulnerability to geopolitical conflicts, public health crises, and climate change events directly impacts food security and the ability to meet the SDGs. This study aims to analyze the dynamic evolution of the vulnerability of FTN, focusing on the period from 2000 to 2022, to aim for strategies for enhancing the resilience and sustainability of the global food system. Based on complex network analysis, we examine the structural characteristics and evolution of FTN for four major crops: soybeans, wheat, rice, and maize. We identify a trend towards increased network density and regionalization, with a decline in average shortest path length (ASPL) and an increase in the average clustering coefficient (ACC). These changes indicate a shift towards a more interconnected and resilient FTN in response to various shocks, including the COVID-19 pandemic and the Russia–Ukraine conflict. The findings suggest that the global FTN has adapted to increase resilience, which is essential for achieving the SDGs related to food security and sustainable development. The study’s insights can guide policy interventions to further strengthen the network against future shocks and promote global food security.

Bystanders to a Public Health Crisis

Per- and polyfluoroalkyl substances (PFAS) are devastating our food systems and our health. Due to widespread use, these synthetic, long-lasting chemicals, are omnipresent at dangerous levels in our envi-ronment and our homes. Recent studies link even small exposure to PFAS to a host of adverse health outcomes, including cancer, autoim-mune diseases, thyroid disease, liver damage, childhood obesity, infer-tility, and birth defects. Food consumption is a primary route of PFAS exposure. PFAS mi-grate from water, soil, fertilizers, pesticides, and compost into virtually every plant, fish, animal, and animal product, and ultimately (in the greatest concentration) into the consumer. In addition, food pro-cessing equipment, disposable dishes, and containers leach dangerous levels of these chemicals into processed food products, further infusing our every meal with PFAS. Consequently, it is no surprise everything from chocolate cake and microwave popcorn to free range eggs, wildcaught fish, organic milk, and organic kale can harbor staggering quantities of these toxic substances. Despite the widespread presence of these substances and strong sci-entific evidence of their harmful impact on humans, federal regulation of PFAS in food is currently nonexistent. At least fifteen agencies have a mandate to ensure the safety of our food. More is not always better. In the case of regulatory agencies, it can lead to fragmented demand for attention, diffusion of responsibilities, and bureaucratic bystander apathy. This story has played out time and again with other toxic con-taminants like polychlorinated biphenyls (PCBs) and pesticides and is playing out yet again with PFAS. Despite our country’s devastating experience with past contaminants and the unprecedented scientific progress of our time, the federal response to new food safety threats has only become more sluggish and inadequate. This article lays a pathway for change, taking the issue of PFAS food contamination as a case study for the broader dysfunction in the food safety regulatory system. Part II reviews the history of federal food regulation and explores the role that each federal actor in the field plays in ensuring the safety of the food supply. Part III provides back-ground on the chemical and toxicological profile of PFAS and their widespread presence in the environment in general and the food sup-ply in particular. Part IV examines possible approaches to more effec-tive regulation of environmental contaminants in food and proposes a readily available but currently overlooked mechanism for combatting the current public health crisis of PFAS in food. Lastly, Part V cata-logues the expected benefits of the solution and addresses anticipated skepticism. It concludes that the proposed approach can effectively protect consumers from PFAS in food today, while simultaneously gar-nering much needed data to usher in a more permanent solution in the future.

Web-based Dashboard on ECMO Utilization in Germany: An Interactive Visualization, Analyses, and Prediction Based on Real-life Data

In Germany, a comprehensive reimbursement policy for extracorporeal membrane oxygenation (ECMO) results in the highest per capita use worldwide, although benefits remain controversial. Public ECMO data is unstructured and poorly accessible to healthcare professionals, researchers, and policymakers. In addition, there are no uniform policies for ECMO allocation which confronts medical personnel with ethical considerations during health crises such as respiratory virus outbreaks.Retrospective information on adult and pediatric ECMO support performed in German hospitals was extracted from publicly available reimbursement data and hospital quality reports and processed to create the web-based ECMO Dashboard built on Open-Source software. Patient-level and hospital-level data were merged resulting in a solid base for ECMO use analysis and ECMO demand forecasting with high spatial granularity at the level of 413 county and city districts in Germany.The ECMO Dashboard (https://www.ecmo-dash.de/), an innovative visual platform, presents the retrospective utilization patterns of ECMO support in Germany. It features interactive maps, comprehensive charts, and tables, providing insights at the hospital, district, and national levels. This tool also highlights the high prevalence of ECMO support in Germany and emphasizes districts with ECMO surplus – where patients from other regions are treated, or deficit – origins from which ECMO patients are transferred to other regions. The dashboard will evolve iteratively to provide stakeholders with vital information for informed and transparent resource allocation and decision-making.Accessible public routine data could support evidence-informed, forward-looking resource management policies, which are urgently needed to increase the quality and prepare the critical care infrastructure for future pandemics.

Disparities in accessing specialty behavioral health services during the COVID-19 pandemic and why we need pediatric integrated primary care

ObjectiveYouth unmet behavioral health needs are at public health crisis status and have worsened since the onset of the coronavirus disease 2019 pandemic (Covid-19). Integrating behavioral health services into pediatric primary care has shown efficacy in addressing youth behavioral health needs. However, there is limited guidance on facilitating equitable access to care in this setting, including in triaging access to co-located services (i.e., onsite outpatient behavioral health services with only the behavioral health provider) or to specialty behavioral health services in other clinics within larger health systems.MethodsA retrospective, comparative study was conducted to examine variability in access to co-located and specialty behavioral health (SBH) services for a pre-Covid-19 cohort (April 2019 to March 2020; n = 367) and a mid-Covid-19 cohort (April 2020 to March 2021; n = 328), while accounting for integrated primary care consultation services. The sample included children 1-18 years old served through a large, inner-city primary care clinic. Logistic regression models were used to examine the association between scheduled and attended co-located and SBH visits, pre- and mid-Covid-19 effects, and sociodemographic factors of race and ethnicity, language, health insurance (SES proxy), age, and sex.ResultsThe majority of youth were not directly scheduled for a co-located or SBH visit but the majority of those scheduled attended their visit(s). The odds of not being directly scheduled for a co-located or SBH visit were greater for the mid-Covid-19 cohort, Black youth, and older youth. Accounting for integrated primary care consultation visits addressed these disparities, with the exception of persisting significant differences in scheduled and attended co-located and SBH visits for Black youth even while accounting for IPC consultation.ImplicationFindings from the current study highlight the effective role of integrated primary care consultation services as facilitating access to initial behavioral health services, especially given that referrals to integrated primary care co-located and SBH services within the larger health system often involve barriers to care such as longer wait-times and increased lack of referral follow through. Ongoing research and equitable program development are needed to further this work.

Juvenile Justice-Based Interdisciplinary Collective Care: An Innovative Approach.

Mental health concerns among juvenile-justice-involved youth (JJIY) continue to be a major health crisis in the United States (US). While scholarship has explored mental health concerns among JJIY, and the link to negative life outcomes, there are gaps in the existing research, particularly in effective interventions and models aimed at addressing both the mental health concerns and criminogenic risk contributing to recidivism and other negative life outcomes of this population. In this paper, we present Justice-Based Interdisciplinary Collective Care (JBICC), an innovative framework to address both the mental health needs and delinquent behavior of youth offenders. The model bridges community partners, with the purpose of informing future interventions, implementations, and research in this area. Increased justice-based interdisciplinary collective collaboration between the juvenile justice system and community programs/organizations would be a major benefit to youth offenders and their families. We also focus on the need for cultural responsiveness to be interwoven throughout all aspects of treatment. JBICC offers an opportunity to expanded services outside traditional settings and methods to ensure that youth offenders and their families receive validating and culturally responsive access to services.

MHFA pilot in correctional setting benefits COs, inmates

Observing the need and opportunity for corrections officers to effectively respond to at‐risk inmates experiencing a mental health crisis, Rutgers Health researchers, with the assistance of the National Council for Mental Wellbeing, conducted a Mental Health First Aid (MHFA) pilot program in a prison setting. The evidence‐based intervention was aimed at corrections officers (COs), who are considered to be the first line of response in a correctional setting.

Penerapan Metode Human Centered Design pada Perancangan Sistem Informasi Curhat Online Berbasis Web

Mental health is a very worrying health case in recent times. The number of cases that have hit the young generation of our nation is a serious threat. Pressures and challenges are often major factors in mental health crises and lack of support and places to tell stories to make a person keep everything in his mind that can hurt his mind and mentality. In this case, the research aims to overcome the problem through the implementation of a website-based online vent information system designed as a means of online vent using a Human-Centered Design approach. This Human-Centered Design approach involves a stage of user context specification, user needs, system design, and system testing using the Blackbox testing method and WebQual method. The main objective of this information system is to provide a safe and structured platform for individuals to express their feelings and emotions comfortably and safely, as well as provide support to reduce the level of mental and mental stress among the young generation of Indonesia.

Divided by the jab: affective polarisation based on COVID vaccination status

ABSTRACT Group-based affective polarisation can emerge around new issues that divide citizens. The public response to vaccines against COVID-19 provided a clear example of a new basis for group divides. Despite scientific consensus regarding the dangers of SARS-CoV-2 as well as the safety and effectiveness of available vaccinations, the public response to the COVID-19 pandemic was strongly politicised during the height of the health crisis. Positive social identities and negative out-group stereotyping developed around support or opposition to the vaccines. Panel survey data from Austria shows that vaccination identities are clearly identifiable and are related to extensive trait-based stereotyping of in- and out-group members. Moreover, we show that vaccination identities are linked to political identities and orientations that pre-date the politicisation of COVID-19 vaccines. Indeed, vaccination identities are more strongly related to political orientations than the decision to get vaccinated itself. Importantly, vaccination identities help us understand downstream attitudes, preferences, and behaviours related to the pandemic, even when controlling for other important predictors such as vaccination status and partisanship for anti-vaccine parties. We discuss the implications and generalizability of our findings beyond the context of the pandemic.

Partnership to tackle MH crisis for people with disabilities launched

The United Health Foundation, the philanthropic foundation of the UnitedHealth Group has awarded the nonprofit disability rights advocacy organization, The Arc of the United States, a three‐year, $2.5 million grant to improve mental health care for people with intellectual and developmental disabilities (IDD), a news release by The Arc stated. Up to 40% of people with IDD have co‐occurring mental health conditions, and this critical funding will help address their unmet mental health needs. Currently, only 1 in 10 children and adolescents with IDD and mental health disorders receive specialized services. These statistics highlight the need for training and awareness to ensure providers and caregivers are equipped to support the mental health needs of people with disabilities. This includes expanding access to quality mental health care services, improving coordination between disability and health systems, training over 2,000 providers and caregivers to recognize mental health needs in people with IDD, and launching public awareness campaigns to counteract stigma and misconceptions. A key component of the grant is partnering with the National Council for Mental Wellbeing to adapt its evidence‐based Mental Health First Aid program with information on IDD. Over three years, the United Health Foundation grant will help train caregivers, health care professionals, first responders, educators and family members to recognize the mental health needs of people with IDD and decrease the number of mental health crisis incidents experienced by this population.

Perceived Organizational Effectiveness during a Public Health Crisis and Moral Wellness among Nurse Leaders: A Cross-Sectional Study

Background. During a public health crisis, such as the COVID-19 pandemic, nurse leaders coordinate timely high-quality care, maintain profit margins, and ensure regulatory compliance while supporting the health and wellbeing of the nursing workforce. In a rapidly changing environment where resources may be scarce, nurse leaders are vulnerable to moral injury; however, organizational effectiveness may help to buffer moral challenges in healthcare leadership, thereby fostering greater moral resilience and reducing turnover intention. Aim. To understand mechanisms by which perceived organizational effectiveness contributes to nurse leaders’ moral wellness (i.e., moral injury and moral resilience) and thereby effects work outcomes (i.e., engagement, burnout, and turnover intention). Methods. A cross-sectional survey of nurse leaders (N = 817) from across the United States was conducted using a snowball methodology, independent t-tests, and structural equation modeling to examine theoretical relationships among moral injury, moral resilience, and organizational effectiveness. Results. Higher ratings on every facet of perceived organizational effectiveness were significantly related to greater moral resilience (p<0.001 for all t-tests) and lower moral injury (p<0.001 for all t-tests) among nurse leaders. Structural equation models indicated both moral resilience and moral injury were significant mediators of the relationship between organizational effectiveness and work outcomes. Moral resilience and moral injury significantly mediated the effect of organizational effectiveness on burnout. Moral resilience was also a significant mediator of the relationship between organizational effectiveness and moral injury. Conclusion. Dismantling organizational patterns and processes in healthcare organizations that contribute to moral injury and lower moral resilience may be important levers for increasing engagement, decreasing burnout, and reducing turnover of nurse leaders.