Maguen Shira, Griffin Brandon J, Pietrzak Robert H, McLean Carmen P, Hamblen Jessica L, Norman Sonya B
Mental Health Service, San Francisco VA Health Care System, San Francisco, USA.
Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, USA.
J Gen Intern Med. 2025 Jan 29. doi: 10.1007/s11606-024-09337-x.
Moral injury affects a variety of populations who make ethically complex decisions involving their own and others' well-being, including combat veterans, healthcare workers, and first responders. Yet little is known about occupational differences in the prevalence of morally injurious exposures and outcomes in nationally representative samples of such populations.
To examine prevalence of potentially morally injurious event (PMIE) exposure and clinically meaningful moral injury in three high-risk groups.
Cross-sectional survey with responses weighted to national geodemographic benchmarks.
Combat veterans, healthcare workers, and first responders (N=1232) in the USA.
Moral Injury and Distress Scale (MIDS).
Many combat veterans (49.3%), healthcare workers (50.8%), and first responders (41.6%) endorsed exposure to a PMIE. Clinically meaningful moral injury symptoms were endorsed by 6.5% of combat veterans, 7.3% of healthcare workers, and 4.1% of first responders. After adjusting for age, gender, race, and ethnicity, relative to first responders, combat veterans were more likely to endorse transgressing their values by what they did and healthcare workers were more likely to endorse witnessing others' wrongful acts. Additionally, combat veterans (adjusted risk ratio (aRR) = 2.18, 95% confidence interval (95% CI) = 1.09, 2.16) and healthcare workers (aRR = 2.02, 95% CI = 1.03, 3.83) were over twice as likely to screen positive for clinically meaningful moral injury in comparison to first responders. No differences in exposures or outcomes emerged between combat veterans and healthcare workers.
Results from these nationally representative samples of three high-risk populations suggest that exposure to PMIEs is common and a sizable minority report clinically meaningful moral injury.
道德伤害影响着各类做出涉及自身及他人福祉的复杂伦理决策的人群，包括退伍军人、医护人员和急救人员。然而，对于这些人群具有全国代表性样本中道德伤害暴露及后果的患病率的职业差异，我们知之甚少。
研究三个高危群体中潜在道德伤害事件（PMIE）暴露及具有临床意义的道德伤害的患病率。
横断面调查，将回复加权至全国地理人口统计学基准。
美国的退伍军人、医护人员和急救人员（N = 1232）。
道德伤害与痛苦量表（MIDS）。
许多退伍军人（49.3%）、医护人员（50.8%）和急救人员（41.6%）认可曾暴露于潜在道德伤害事件。6.5%的退伍军人、7.3%的医护人员和4.1%的急救人员认可有具有临床意义的道德伤害症状。在调整年龄、性别、种族和民族因素后，与急救人员相比，退伍军人更有可能认可因其行为违背自身价值观，而医护人员更有可能认可目睹他人的不当行为。此外，与急救人员相比，退伍军人（调整风险比（aRR）= 2.18，95%置信区间（95%CI）= 1.09，2.16）和医护人员（aRR = 2.02，95%CI = 1.03，3.83）筛查出具有临床意义的道德伤害呈阳性的可能性高出两倍多。退伍军人和医护人员在暴露或结果方面未发现差异。
来自这三个高危人群的全国代表性样本的结果表明，暴露于潜在道德伤害事件很常见，且有相当一部分少数人报告有具有临床意义的道德伤害。
