D'Alessandro-Lowe Andrea M, Scott Andrew M, Patel Herry, Easterbrook Bethany, Ritchie Kimberly, Brown Andrea, Pichtikova Mina, Karram Mauda, Sullo Emily, Mirabelli James, Schielke Hygge, Malain Ann, O'Connor Charlene, Remers Shannon, Lanius Ruth, McCabe Randi E, McKinnon Margaret C
Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada.
Homewood Research Institute, Guelph, Ontario, Canada.
J Trauma Stress. 2025 Apr;38(2):272-283. doi: 10.1002/jts.23122. Epub 2024 Dec 16.
Public safety personnel (PSP), such as police officers, firefighters, correctional workers, and paramedics, routinely face work stressors that increase their risk of developing posttraumatic stress disorder (PTSD). PSP may additionally face moral transgressions in the workplace (e.g., witnessing human suffering, working within broken systems), heightening the risk of moral injury (MI) in this population. Research among military personnel and health care workers shows an association between MI and PTSD; however, less is known about the association between these constructs among PSP. Canadian PSP completed an online survey between June 2022 and June 2023, including a demographic questionnaire and measures of PTSD, MI, dissociation, depression, anxiety, stress, and childhood adversity. Latent variable structural equation modeling (SEM) was performed to ascertain the impact of a latent MI construct (i.e., shame, trust violation, functional impairment) on a latent PTSD construct (i.e., intrusions, avoidance, negative alterations in cognition and mood, hyperreactivity, depersonalization, derealization). Sex, age, depression, anxiety, stress, and childhood adversity were included as covariates. A total of 314 PSP were included in the data analysis. A latent variable SEM regressing PTSD onto MI and including covariates accounted for 83.7% of the variance in PTSD. MI was the strongest predictor compared to all covariates and was significantly associated with PTSD symptoms, β = .506, p < .001, above and beyond the impacts of sex, age, depression, anxiety, stress, and childhood adversity. These findings are consistent with research among military members and health care providers and highlight the importance of further exploring MI among PSP.
公共安全人员（PSP），如警察、消防员、惩教人员和护理人员，经常面临工作压力源，这增加了他们患创伤后应激障碍（PTSD）的风险。PSP在工作场所可能还会面临道德违规行为（例如，目睹人类痛苦、在破败的系统中工作），这增加了该人群遭受道德伤害（MI）的风险。对军事人员和医护人员的研究表明，MI与PTSD之间存在关联；然而，对于PSP中这些构念之间的关联，人们了解较少。加拿大的PSP在2022年6月至2023年6月期间完成了一项在线调查，包括一份人口统计学问卷以及PTSD、MI、解离、抑郁、焦虑、压力和童年逆境的测量。进行了潜在变量结构方程建模（SEM），以确定潜在的MI构念（即羞耻、信任违背、功能损害）对潜在的PTSD构念（即闯入、回避、认知和情绪的负面改变、过度反应、人格解体、现实解体）的影响。将性别、年龄、抑郁、焦虑、压力和童年逆境作为协变量纳入。共有314名PSP纳入数据分析。将PTSD回归到MI并包括协变量的潜在变量SEM解释了PTSD中83.7%的方差。与所有协变量相比，MI是最强的预测因素，并且与PTSD症状显著相关，β = 0.506，p < 0.001，超出了性别、年龄、抑郁、焦虑、压力和童年逆境的影响。这些发现与对军人和医疗保健提供者的研究一致，并强调了进一步探索PSP中MI的重要性。
