Department of Psychology, University of Nevada, Reno.
Psychol Trauma. 2024 Oct;16(7):1179-1188. doi: 10.1037/tra0001594. Epub 2023 Oct 12.
The COVID-19 pandemic strained the healthcare system and resulted in higher rates of potentially morally injurious events. These events are perceived as violating one's own moral code, so a more precise construct label could be moral injury perceptions (MIPs). MIPs may exacerbate stress-related symptoms. However, consistent with the broader literature on mood-congruent cognitive bias, stress symptoms may also exacerbate MIPs. To test this bidirectional hypothesis, we examined the relationship between MIPs and stress symptoms among healthcare workers during the first year of the pandemic.
Online questionnaires for MIPs and stress-related symptoms (i.e., pandemic-related posttraumatic stress [PTSS], perceived stress, depression, and anxiety) were completed in April/May 2020 (time point one [T1]; = 184), 1 month later (time point 2 [T2]; = 135), and 6 months later (time point three [T3]; = 112).
Findings from cross-lagged panel modeling favored unidirectional models, but the direction of the relationship varied by symptom type. Perceived stress, PTSS, and depression, all predicted increased MIPs at a later time point. However, in a reversal of direction, MIPs predicted increased anxiety.
Results suggest that MIPs may function as both a predictor and an outcome of stress-related symptoms. Mood-congruent cognitive biases could account for why depression, PTSS, and perceived stress predicted subsequent MIPs, whereas MIPs may have exacerbated more generalized anxiety about the future. Broadly, these findings highlight the importance of early access to mental health services for healthcare workers during public health crises to disrupt the relationship between MIPs and stress-related symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
新冠疫情使医疗系统紧张，导致潜在道德伤害事件的发生率上升。这些事件被认为是违反自己的道德准则的，因此一个更准确的结构标签可以是道德伤害感知（MIPs）。MIPs 可能会加剧与压力相关的症状。然而，与更广泛的情绪一致的认知偏差文献一致，压力症状也可能加剧 MIPs。为了检验这一双向假设，我们研究了大流行第一年期间医护人员的 MIPs 与压力症状之间的关系。
在 2020 年 4 月/5 月（时间点 1 [T1]；=184）、1 个月后（时间点 2 [T2]；=135）和 6 个月后（时间点 3 [T3]；=112）进行了 MIPs 和与压力相关的症状（即大流行相关创伤后应激 [PTSS]、感知压力、抑郁和焦虑）的在线问卷调查。
交叉滞后面板模型的结果支持单向模型，但关系的方向因症状类型而异。感知压力、PTSS 和抑郁均预测稍后时间点的 MIPs 增加。然而，方向相反，MIPs 预测焦虑增加。
结果表明，MIPs 可能既是压力相关症状的预测因子，也是其结果。情绪一致的认知偏差可以解释为什么抑郁、PTSS 和感知压力预测随后的 MIPs，而 MIPs 可能加剧了对未来的更普遍的焦虑。总体而言，这些发现强调了在公共卫生危机期间为医护人员提供早期心理健康服务的重要性，以打破 MIPs 与压力相关症状之间的关系。
