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Research Article

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

, PhD, DKMORCID Icon, , PhDORCID Icon, , MSPHORCID Icon, , MPHORCID Icon, , PhD, MHS, , PhD, MPHORCID Icon, , PhD, MMORCID Icon, , MSWORCID Icon, , PhD, ScDORCID Icon, , PhD, MSN, RN, FAANORCID Icon, , PhDORCID Icon & , PhD, RB, MPH, MS, FAANORCID Icon show all
Pages 202-217 | Received 27 Sep 2022, Accepted 13 Jun 2023, Published online: 04 Dec 2023

References

  • Ahern, K. (2018). Institutional betrayal and gaslighting: Why whistle-blowers are so traumatized. The Journal of Perinatal & Neonatal Nursing, 32(1), 59–65. https://doi.org/10.1097/JPN.0000000000000306
  • Amanullah, S., & Shankar, R. R. (2020). The impact of COVID-19 on physician burnout globally: A review. Healthcare, 8(4), 421. https://doi.org/10.3390/healthcare8040421
  • American Hospital Association. (2021). Fact Sheet: Strengthening the Health Care Workforce. https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce
  • Brewer, M. B., & Gardner, W. (1996). Who is this “we”? Levels of collective identity and self representations. Journal of Personality and Social Psychology, 71(1), 83–93. https://doi.org/10.1037/0022-3514.71.1.83
  • DePrince, A. P., Chu, A. T., & Pineda, A. S. (2011). Links between specific posttrauma appraisals and three forms of trauma-related distress. Psychological Trauma: Theory, Research, Practice, & Policy, 3(4), 430–441. https://doi.org/10.1037/a0021576
  • Edwards, V. J., Freyd, J. J., Dube, S. R., Anda, R. F., & Felitti, V. J. (2012). Health outcomes by closeness of sexual abuse perpetrator: A test of betrayal trauma theory. Journal of Aggression, Maltreatment & Trauma, 21(2), 133–148. https://doi.org/10.1080/10926771.2012.648100
  • Evans, W. R., Stanley, M., Barrera, T., Exline, J. J., Pargament, K. I., & Teng, E. J. (2018). Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles. Psychological Trauma: Theory, Research, Practice, & Policy, 10(3), 360–367. https://doi.org/10.1037/tra0000347
  • French, L., Hanna, P., & Huckle, C. (2021). “If I die, they do not care”: U.K. National Health Service staff experiences of betrayal-based moral injury during COVID-19. Psychological Trauma: Theory, Research, Practice, & Policy, 14(3), 516–521. https://doi.org/10.1037/tra0001134
  • Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Harvard University Press.
  • Freyd, J. J., & Birrell, P. J. (2013). Blind to betrayal: Why we fool ourselves we aren’t being fooled. Wiley.
  • Freyd, J. J., DePrince, A. P., & Zurbriggen, E. L. (2001). Self-reported memory for abuse depends upon victim-perpetrator relationship. Journal of Trauma & Dissociation, 2(3), 5–15. https://doi.org/10.1300/J229v02n03_02
  • Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID‐19 pandemic: A systematic review and meta‐analysis. Journal of Advanced Nursing, 77(8), 3286–3302. https://doi.org/10.1111/jan.14839
  • Gibson, D., & Petrosko, J. (2014). Trust in leader and its effect on job satisfaction and intent to leave in a healthcare setting. New Horizons in Adult Education and Human Resource Development, 26(3), 3–19. https://doi.org/10.1002/nha3.20069
  • Gigler, M. E., Lathan, E. C., Cardarelli, O., Lewis, C. L., McCabe, S., & Langhinrichsen-Rohling, J. (2022). Young adults’ expectations for healthcare following institutional betrayal. Journal of Trauma & Dissociation, 7, 1–16. https://doi.org/10.1080/15299732.2022.2120151
  • Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ, 368, m1211. https://doi.org/10.1136/bmj.m1211
  • Kim, H., Hegde, S., LaFiura, C., Raghavan, M., Luong, E., Cheng, S., Rebholz, C. M., & Seidelmann, S. B. (2021). COVID-19 illness in relation to sleep and burnout. BMJ Nutrition, Prevention & Health, 4(1), bmjnph-2021–000228. https://doi.org/10.1136/bmjnph-2021-000228
  • Klest, B., Smith, C. P., May, C., McCall-Hosenfeld, J., & Tamaian, A. (2020). COVID-19 has united patients and providers against institutional betrayal in health care: A battle to be heard, believed, and protected. Psychological Trauma: Theory, Research, Practice, & Policy, 12(S1), S159–S161. https://doi.org/10.1037/tra0000855
  • Ksinan Jiskrova, G. (2022). Impact of COVID-19 pandemic on the workforce: From psychological distress to the great resignation. Journal of Epidemiology and Community Health, 76(6), 525–526. https://doi.org/10.1136/jech-2022-218826
  • Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
  • Löwe, B., Wahl, I., Rose, M., Spitzer, C., Glaesmer, H., Wingenfeld, K., Schneider, A., & Brähler, E. (2010). A 4-item measure of depression and anxiety: Validation and standardization of the patient health questionnaire-4 (PHQ-4) in the general population. Journal of Affective Disorders, 122(1–2), 86–95. https://doi.org/10.1016/j.jad.2009.06.019
  • Lu, W., Wang, H., Lin, Y., & Li, L. (2020). Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Research, 288, 112936. https://doi.org/10.1016/j.psychres.2020.112936
  • Mantri, S., Song, Y. K., Lawson, J. M., Berger, E. J., & Koenig, H. G. (2021). Moral injury and burnout in health care professionals during the COVID-19 pandemic. The Journal of Nervous and Mental Disease, 209(10), 720–726. https://doi.org/10.1097/NMD.0000000000001367
  • Matsuishi, K., Kawazoe, A., Imai, H., Ito, A., Mouri, K., Kitamura, N., Miyake, K., Mino, K., Isobe, M., Takamiya, S., Hitokoto, H., & Mita, T. (2012). Psychological impact of the pandemic (H1N1) 2009 on general hospital workers in Kobe. Psychiatry and Clinical Neurosciences, 66(4), 353–360. https://doi.org/10.1111/j.1440-1819.2012.02336.x
  • Mcalonan, G. M., Lee, A. M., Cheung, V., Cheung, C., Tsang, K. W., Sham, P. C., Chua, S. E., & Wong, J. G. (2007). Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. The Canadian Journal of Psychiatry, 52(4), 241–247. https://doi.org/10.1177/070674370705200406
  • Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646–652. https://doi.org/10.7205/MILMED-D-13-00017
  • Nelson, K. E., Hanson, G. C., Boyce, D., Ley, C. D., Swavely, D., Reina, M., & Rushton, C. H. (2022). Organizational impact on health care workers’ moral injury during COVID-19: A mixed-methods analysis. Journal of Nursing Administration, 52(1), 57–66. https://doi.org/10.1097/NNA.0000000000001103
  • Rachman, S. (2010). Betrayal: A psychological analysis. Behaviour Research and Therapy, 48(4), 304–311. https://doi.org/10.1016/j.brat.2009.12.002
  • Rushton, C. H., Nelson, K. E., Antonsdottir, I., Hanson, G. C., & Boyce, D. (2022). Perceived organizational effectiveness, moral injury, and moral resilience among nurses during the COVID-19 pandemic. Nursing Management, 53(7), 12–22. https://doi.org/10.1097/01.NUMA.0000834524.01865.cc
  • Rushton, C. H., Thomas, T. A., Antonsdottir, I. M., Nelson, K. E., Boyce, D., Swavely, D., Ley, C. D., Hanson, G. C., & Hanson, G. C. (2021). Moral injury, ethical concerns and moral resilience in health care workers during COVID-19 pandemic. Journal of Palliative Medicine, 25(5), 712–719. https://doi.org/10.1089/jpm.2021.0076
  • Shapiro, G. K., Schulz-Quach, C., Matthew, A., Mosher, P., Rodin, G., de Vries, F., Hales, S., Korenblum, C., Black, S., Beck, L., Miller, K., Morita, J., Li, M., & Elliott, M. (2021). A community partnership to House and care for complex patients with unstable housing. NEJM Catalyst, 2(8). https://doi.org/10.1056/CAT.20.0684
  • Shay, J. (2002). Odysseus in America: Combat trauma and the trials of homecoming. Scribner.
  • Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182–191. https://doi.org/10.1037/a0036090
  • Smith, C. P. (2017). First, do no harm: Institutional betrayal and trust in health care organizations. Journal of Multidisciplinary Healthcare, 10, 133–144. https://doi.org/10.2147/JMDH.S125885
  • Smith, C. P., & Freyd, J. J. (2014). Institutional Betrayal. American Psychologist, 69(6), 575–587. https://doi.org/10.1037/a0037564
  • Spilg, E. G., Rushton, C. H., Phillips, J. L., Kendzerska, T., Saad, M., Gifford, W., Gautam, M., Bhatla, R., Edwards, J. D., Quilty, L., Leveille, C., & Robillar, R. (2022). The new frontline: Exploring the links between moral distress, moral resilience, and mental health in healthcare workers during the COVID-19 pandemic. BMC Psychiatry, 22(1), 19. https://doi.org/10.1186/s12888-021-03637-w
  • Tamaian, A., Klest, B., & Mutschler, C. (2017). Patient dissatisfaction and institutional betrayal in the Canadian medical system: A qualitative study. Journal of Trauma & Dissociation, 18(1), 38–57. https://doi.org/10.1080/15299732.2016.1181134
  • Tan, B. Y. Q., Chew, N. W. S., Lee, G. K. H., Jing, M., Goh, Y., Yeo, L. L. L., Zhang, K., Chin, H.-K., Ahmad, A., Khan, F. A., Shanmugam, G. N., Chan, B. P. L., Sunny, S., Chandra, B., Ong, J. J. Y., Paliwal, P. R., Wong, L. Y. H., Sagayanathan, R., Chen, J. T. … Sharma, V. K. (2020). Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Annals of Internal Medicine, 173(4), 317–320. https://doi.org/10.7326/M20-1083
  • Vizheh, M., Qorbani, M., Arzaghi, S. M., Muhidin, S., Javanmard, Z., & Esmaeili, M. (2020). The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. Journal of Diabetes & Metabolic Disorders, 19(2), 1967–1978. https://doi.org/10.1007/s40200-020-00643-9
  • Weiss, D. S. (2007). The impact of event scale: Revised. In J. P. Wilson & C. S. Tang (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 219–238). Springer.
  • Williamson, V., Murphy, D., & Greenberg, N. (2020). COVID-19 and experiences of moral injury in front-line key workers. Occupational Medicine, 70(5), 317–319. https://doi.org/10.1093/occmed/kqaa052
  • Williamson, V., Stevelink, S. A. M., & Greenberg, N. (2018). Occupational moral injury and mental health: Systematic review and meta-analysis. British Journal of Psychiatry, 212(6), 339–346. https://doi.org/10.1192/bjp.2018.55
  • Zhizhong, W., Koenig Harold, G., Yan, T., Jing, W., Mu, S., Hongyu, L., & Guangtian, L. (2020). Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic. BMC Psychiatry, 20, 556. https://doi.org/10.1186/s12888-020-02954-w

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