Amsalem Doron, Lazarov Amit, Markowitz John C, Naiman Aliza, Smith Thomas E, Dixon Lisa B, Neria Yuval
New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA.
School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
BMC Psychiatry. 2021 Nov 5;21(1):546. doi: 10.1186/s12888-021-03565-9.
Emerging cross-sectional data indicate that healthcare workers (HCWs) in the COVID-19 era face particular mental health risks. Moral injury - a betrayal of one's values and beliefs, is a potential concern for HCWs who witness the devastating impact of acute COVID-19 illness while too often feeling helpless to respond. This study longitudinally examined rates of depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and moral injury among United States HCWs in the COVID-19 era. We anticipated finding high levels of clinical symptoms and moral injury that would remain stable over time. We also expected to find positive correlations between clinical symptoms and moral injury.
This three-wave study assessed clinical symptoms and moral injury among 350 HCWs at baseline, 30, and 90 days between September and December 2020. Anxiety, depression, PTSD, and moral injury were measured using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Primary Care PTSD Screen (PC-PTSD), and Moral Injury Events Scale (MIES).
Of the 350 HCWs, 72% reported probable anxiety, depression, and/or PTSD disorders at baseline, 62% at day 30, and 64% at day 90. High level of moral injury was associated with a range of psychopathology including suicidal ideation, especially among healthcare workers self-reporting COVID-19 exposure.
Findings demonstrate broad, persisting, and diverse mental health consequences of the COVID-19 pandemic among United States HCWs. This study is the first to longitudinally examine the relationships between moral injury and psychopathology among HCWs, emphasizing the need to increase HCWs' access to mental healthcare.
新出现的横断面数据表明，在新冠疫情时代，医护人员面临特殊的心理健康风险。道德伤害——对自身价值观和信念的背叛，对于那些目睹急性新冠疾病的毁灭性影响却常常感到无力应对的医护人员来说，是一个潜在的问题。本研究纵向调查了新冠疫情时代美国医护人员中抑郁症、广泛性焦虑障碍（GAD）、创伤后应激障碍（PTSD）和道德伤害的发生率。我们预计会发现高水平的临床症状和道德伤害，且这些症状会随时间保持稳定。我们还期望发现临床症状与道德伤害之间存在正相关。
这项三阶段研究在2020年9月至12月期间，对350名医护人员在基线、第30天和第90天评估了临床症状和道德伤害。使用广泛性焦虑障碍量表-7（GAD-7）、患者健康问卷-9（PHQ-9）、初级保健创伤后应激障碍筛查量表（PC-PTSD）和道德伤害事件量表（MIES）来测量焦虑、抑郁、创伤后应激障碍和道德伤害。
在350名医护人员中，72%在基线时报告可能患有焦虑、抑郁和/或创伤后应激障碍，在第30天为62%，在第90天为64%。高水平的道德伤害与一系列精神病理学问题相关，包括自杀意念，尤其是在自我报告接触过新冠病毒的医护人员中。
研究结果表明，新冠疫情在美国医护人员中造成了广泛、持续且多样的心理健康后果。本研究首次纵向考察了医护人员中道德伤害与精神病理学之间的关系，强调了增加医护人员获得心理保健服务的必要性。
