Moral Injury in Chinese Health Professionals During the COVID-19 Pandemic

Clinical Impact Statement Moral injury (MI) symptoms are correlated with higher clinician burnout, greater psychological distress, and lower level of subjective well-being. Strategies shown to be effective for MI in former military personnel might be used to address burnout and mental health problems in frontline health care workers tasked with treating those with and without COVID-19 disease. Our findings provide a profile of HCPs who are at risk for MI symptoms and may help to identify those at risk of downstream effects in terms of psychological health and patient safety. Objective: Caring for patients during the COVID-19 pandemic has placed considerable stress on health care professionals (HCPs), increasing their risk of moral injury (MI) and clinician burnout. The present study sought to examine the prevalence and correlates of MI among physicians and nurses in mainland China during the pandemic. Method: A cross-sectional study was performed via an online survey conducted from March 27, 2020 to April 26, 2020. The 10-item Moral Injury Symptoms Scale-Health Professional version (MISS-HP) was administered along with measures of clinician mental health and burnout. A total of 3,006 physicians and nurses who completed the questionnaire were included in the final analysis. Unconditional logistic regression modeling was performed to determine the associations, including that between COVID-19 patient exposure and the risk of moral injury. Results: MISS-HP scores strongly and positively correlated with depression, anxiety, low well-being, and burnout symptoms. The estimated prevalence of MI in the total sample was 41.3%, 95% confidence interval (CI) [39.3%, 43.0%]. HCPs providing medical care to COVID-19 patients experienced a 28% greater risk of MI than those providing medical care to patients without the coronavirus (odds ratio = 1.28, 95% CI [1.05, 1.56], p = .01). Conclusions: A significant proportion of HCPs in mainland China are at risk for significant MI symptoms as well as mental health problems and burnout during the COVID-19 pandemic. MI symptoms are strongly correlated with higher clinician burnout, greater psychological distress, and lower level of subjective well-being. Effective strategies are needed to address MI and other mental health problems in frontline health care workers treating those with and without COVID-19 disease.

Automated summary

During the COVID-19 pandemic, healthcare professionals in mainland China face a significant risk of moral injury symptoms, mental health issues, and burnout. The symptoms of moral injury are strongly associated with clinician burnout, psychological distress, and subjective well-being. Effective strategies are essential to address moral injury and mental health problems in frontline healthcare workers caring for patients with and without COVID-19.