TY - JOUR
T1 - The new frontline
T2 - exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic
AU - Spilg, Edward G.
AU - Rushton, Cynda Hylton
AU - Phillips, Jennifer L.
AU - Kendzerska, Tetyana
AU - Saad, Mysa
AU - Gifford, Wendy
AU - Gautam, Mamta
AU - Bhatla, Rajiv
AU - Edwards, Jodi D.
AU - Quilty, Lena
AU - Leveille, Chloe
AU - Robillard, Rebecca
N1 - Funding Information:
We wish to thank all the participants who gave their time to fill out this extensive survey during this period of turmoil. We also extend our gratitude to the individuals who kindly provided their comments on the survey content and format during the development stage, the ethics boards who rapidly and diligently provided insights on this project to enable a timely launch, the organizations who helped circulate the survey in their networks: Canadian Nurses Association, Canadian Physiotherapy Association, Canadian Association of Occupational Therapists, Ontario Public Health, Ontario Medical Association, Ontario Psychiatric Association, Ontario Society of Occupational Therapists, Canadian Counselling and Psychotherapy Association, Ordre des Psychologues du Québec, Associated Medical Services Healthcare, Mood Disorders Society of Canada, Canadian Arthritis Patient Alliance, Patients for Patient Safety Canada, the COVID-19 Resources Canada Platform, and Sleep On It! Canada. We also thank the Clinical Investigation Unit at the Ottawa Hospital Research Institute, the Ottawa Hospital, the Royal Ottawa Mental Health Centre, the University of Ottawa Heart Institute, the Centre for Addiction and Mental Health, the Children’s Hospital of Eastern Ontario, Sunnybrook Health Sciences Centre, and Southlake Regional Health Centre for their assistance with participant recruitment.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Global 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. 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 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. Findings: Respondents 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|]. Interpretation: 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.
AB - Background: Global 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. 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 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. Findings: Respondents 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|]. Interpretation: 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.
KW - Anxiety
KW - Depression
KW - Global crisis
KW - Healthcare workers
KW - Mental health
KW - Moral distress
KW - Moral resilience
KW - Pandemic
KW - Stress
UR - http://www.scopus.com/inward/record.url?scp=85122378239&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122378239&partnerID=8YFLogxK
U2 - 10.1186/s12888-021-03637-w
DO - 10.1186/s12888-021-03637-w
M3 - Article
C2 - 34991514
AN - SCOPUS:85122378239
SN - 1471-244X
VL - 22
JO - BMC psychiatry
JF - BMC psychiatry
IS - 1
M1 - 19
ER -