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Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning.
Depress Anxiety. 2021 Jul 22 [Online ahead of print]DA

Abstract

INTRODUCTION

Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties.

METHOD

Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample.

RESULTS

The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes.

CONCLUSION

Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties.

Authors+Show Affiliations

Executive Division, U.S. Department of Veterans Affairs National Center for PTSD, Wasington, D.C., USA. Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA.Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Executive Division, U.S. Department of Veterans Affairs National Center for PTSD, Wasington, D.C., USA. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Executive Division, U.S. Department of Veterans Affairs National Center for PTSD, Wasington, D.C., USA.Department of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Well-Being and Resilience, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Executive Division, U.S. Department of Veterans Affairs National Center for PTSD, Wasington, D.C., USA. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34293236

Citation

Norman, Sonya B., et al. "Moral Distress in Frontline Healthcare Workers in the Initial Epicenter of the COVID-19 Pandemic in the United States: Relationship to PTSD Symptoms, Burnout, and Psychosocial Functioning." Depression and Anxiety, 2021.
Norman SB, Feingold JH, Kaye-Kauderer H, et al. Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depress Anxiety. 2021.
Norman, S. B., Feingold, J. H., Kaye-Kauderer, H., Kaplan, C. A., Hurtado, A., Kachadourian, L., Feder, A., Murrough, J. W., Charney, D., Southwick, S. M., Ripp, J., Peccoralo, L., & Pietrzak, R. H. (2021). Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depression and Anxiety. https://doi.org/10.1002/da.23205
Norman SB, et al. Moral Distress in Frontline Healthcare Workers in the Initial Epicenter of the COVID-19 Pandemic in the United States: Relationship to PTSD Symptoms, Burnout, and Psychosocial Functioning. Depress Anxiety. 2021 Jul 22; PubMed PMID: 34293236.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. AU - Norman,Sonya B, AU - Feingold,Jordyn H, AU - Kaye-Kauderer,Halley, AU - Kaplan,Carly A, AU - Hurtado,Alicia, AU - Kachadourian,Lorig, AU - Feder,Adriana, AU - Murrough,James W, AU - Charney,Dennis, AU - Southwick,Steven M, AU - Ripp,Jonathan, AU - Peccoralo,Lauren, AU - Pietrzak,Robert H, Y1 - 2021/07/22/ PY - 2021/04/21/revised PY - 2020/10/05/received PY - 2021/06/11/accepted PY - 2021/7/22/entrez PY - 2021/7/23/pubmed PY - 2021/7/23/medline KW - COVID-19 KW - PTSD KW - burnout KW - functioning KW - mental health KW - moral distress JF - Depression and anxiety JO - Depress Anxiety N2 - INTRODUCTION: Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties. METHOD: Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample. RESULTS: The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes. CONCLUSION: Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties. SN - 1520-6394 UR - https://www.unboundmedicine.com/medline/citation/34293236/Moral_distress_in_frontline_healthcare_workers_in_the_initial_epicenter_of_the_COVID-19_pandemic_in_the_United_States:_Relationship_to_PTSD_symptoms,_burnout,_and_psychosocial_functioning. L2 - https://doi.org/10.1002/da.23205 DB - PRIME DP - Unbound Medicine ER -