Wang Zhizhong, Al Zaben Faten, Koenig Harold G, Ding Yuanlin
Department of Epidemiology and Statistic, School of Public Health at Guangdong Medical University, Dongguan, Guangdong, China.
Division of Psychiatry, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
BJPsych Open. 2021 Jul 19;7(4):e135. doi: 10.1192/bjo.2021.972.
Moral injury has been found to be prevalent among healthcare professionals during the COVID-19 public health crisis.
The present study examines the relationship between spirituality, moral injury, and mental health among physicians and nurses in mainland China during the COVID-19 pandemic.
An online cross-sectional study was conducted involving 3006 physicians and nurses in mainland China, where the COVID-19 pandemic has caused high rates of hospital admission and death. The Moral Injury Symptoms Scale-Health Professional was administered, along with measures of mental health and spirituality. Hierarchical linear regression modelling was used to examine the mediating and moderating role of moral injury in the relationship between spirituality and mental health.
Spirituality was positively correlated with moral injury (β = 2.41, < 0.01), depressive symptoms (β = 0.74, < 0.01) and anxiety symptoms (β = 0.65, < 0.01) after controlling sociodemographic variables. Moral injury significantly mediated the relationship between spirituality and both depression and anxiety, explaining 60% (0.46/0.76) of the total association between spirituality and depression and 58% (0.38/0.65) of the association with anxiety. No moderating effect of moral injury was found on the spirituality-mental health relationship.
Although they were the findings of a cross-sectional study, these results suggest that concern over transgressing moral values during the pandemic may have been a driving factor for negative mental health symptoms among Chinese health professionals for whom spirituality was somewhat important. Future longitudinal studies are needed to determine the causal nature of these relationships.
在新冠疫情公共卫生危机期间，道德伤害在医护人员中普遍存在。
本研究探讨中国内地新冠疫情期间医生和护士的精神性、道德伤害与心理健康之间的关系。
开展一项在线横断面研究，涉及中国内地3006名医生和护士，新冠疫情导致了高住院率和高死亡率。采用了《卫生专业人员道德伤害症状量表》，以及心理健康和精神性的测量工具。使用分层线性回归模型来检验道德伤害在精神性与心理健康关系中的中介和调节作用。
在控制社会人口学变量后，精神性与道德伤害（β = 2.41，<0.01）、抑郁症状（β = 0.74，<0.01）和焦虑症状（β = 0.65，<0.01）呈正相关。道德伤害显著中介了精神性与抑郁和焦虑之间的关系，解释了精神性与抑郁之间总关联的60%（0.46/0.76）以及与焦虑关联的58%（0.38/0.65）。未发现道德伤害对精神性与心理健康关系有调节作用。
尽管这些是横断面研究的结果，但这些结果表明，对于精神性在一定程度上重要的中国医护人员而言，疫情期间对违背道德价值观的担忧可能是负面心理健康症状的驱动因素。未来需要进行纵向研究以确定这些关系的因果性质。
