Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA.
Stress Health. 2024 Jun;40(3):e3321. doi: 10.1002/smi.3321. Epub 2023 Oct 2.
Moral injury (i.e., perpetrating, witnessing, failing to prevent, or being a victim of acts that transgress one's moral beliefs, values, or ethics) has largely been studied in military-connected populations and is associated with a range of adverse psychological sequelae. Emerging literature suggests that healthcare workers also experience moral injury, particularly in the context of the ongoing COVID-19 pandemic. However, it is not known if moral injury contributes to substance use among healthcare workers or whether these effects might differ by gender, race/ethnicity, or occupational level. In March 2022, we collected self-reported pilot data from a diverse sample of US healthcare workers (N = 200) We examined the cross-sectional relationships between moral injury and several measures of substance use (i.e., current non-medical use of prescription drugs [NMUPD], current cannabis use, current use of other illicit drugs, and hazardous drinking) using separate logistic regression models. Next, we used separate interaction models to examine if any of these relations differed by gender, race/ethnicity, or occupational level. In main effects models, healthcare workers reporting greater moral injury had greater odds of current NMUPD (adjusted odds ratio (aOR) = 1.07; p < 0.001), current use of other illicit drugs (aOR = 1.09; p < 0.01), and hazardous drinking (aOR = 1.07; p < 0.01). These relations did not differ by race/ethnicity or occupational level (ps > 0.05); however, men were more likely to report current NMUPD and hazardous drinking (ps < 0.05) in the presence of high moral injury than women healthcare workers. Our findings suggest that healthcare workers experience substantial distress related to morally injurious events, which may affect their likelihood of NMUPD, cannabis use, use of other illicit drugs, and hazardous drinking, and that men in healthcare may be particularly at risk. Healthcare organizations should address systemic issues driving moral injury (e.g., resource shortages, lack of psychosocial support) to prevent substance-related harms among healthcare workers.
道德伤害（例如，实施、目睹、未能防止或成为违反自己道德信仰、价值观或伦理的行为的受害者）在很大程度上已经在与军队有关的人群中进行了研究，并且与一系列不良心理后果有关。新出现的文献表明，医疗保健工作者也会经历道德伤害，特别是在持续的 COVID-19 大流行背景下。然而，目前尚不清楚道德伤害是否会导致医疗保健工作者的物质使用，或者这些影响是否因性别、种族/民族或职业水平而异。2022 年 3 月，我们从美国多元化的医疗保健工作者样本中收集了自我报告的试点数据（N=200）。我们使用单独的逻辑回归模型检查了道德伤害与几种物质使用测量之间的横断面关系（即当前非医疗用途处方药物[NMUPD]、当前大麻使用、当前使用其他非法药物和危险饮酒）。接下来，我们使用单独的交互模型来检查这些关系是否因性别、种族/民族或职业水平而异。在主要效应模型中，报告道德伤害程度较高的医疗保健工作者当前 NMUPD 的可能性更大（调整后的优势比[aOR]=1.07；p<0.001）、当前使用其他非法药物的可能性更大（aOR=1.09；p<0.01）和危险饮酒的可能性更大（aOR=1.07；p<0.01）。这些关系不因种族/民族或职业水平而异（p>0.05）；然而，与女性医疗保健工作者相比，高道德伤害程度的男性更有可能报告当前 NMUPD 和危险饮酒（p<0.05）。我们的研究结果表明，医疗保健工作者经历了与道德伤害事件相关的大量痛苦，这可能会影响他们 NMUPD、大麻使用、使用其他非法药物和危险饮酒的可能性，而医疗保健领域的男性可能面临特别的风险。医疗保健组织应解决导致道德伤害的系统问题（例如，资源短缺、缺乏心理社会支持），以防止医疗保健工作者的物质相关伤害。
