Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients

ABSTRACT

One factor potentially driving healthcare and hospital worker (HHW)’s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others’ pandemic-related responses and behaviors. We investigated whether HHWs’ betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

KEYWORDS:

• Betrayal-based moral injury
• mental distress
• PTSD symptoms
• healthcare and hospital workers
• Urban US health system

Acknowledgments

We thank the study participants and the leaders of the six hospitals within the Johns Hopkins Health System for their help with the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data sets analyzed for the current study are not publicly available, but may be available on reasonable request after IRB review and approval.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/15299732.2023.2289195

Additional information

Funding

This work was supported by the Johns Hopkins University, Grant/Award Number: COVID-19 Research Response Program; National Institute of Mental Health, Grant/Award Numbers: F31MH124582(ECC), F31MH124583(KA); Capital Group COVID-19 Response Fund Grant (JT)