Moral distress as a persistent risk factor for impaired mental health among healthcare workforce

Abstract

Background: Moral distress among healthcare workers (HCWs) has dramatically increased during Covid-19 emergency however most evidence relies on cross-sectional data collected during Covid-19 early stages. Aims: This longitudinal cohort study aims to provide a better insight into the occurrence and associations of moral distress, focusing on both its short and long-term impact on HCWs’ mental health. Methods: A total of 990 healthcare workers completed a mental health evaluation between July 2020-July 2021 (Time 1) reporting frequencies of moral distress and psychological distress (GHQ-12), post-traumatic (IES-R) and anxiety (GAD-7) symptoms; after one year (July 2021-July 2022; Time 2), 310 participants repeated the psychological evaluation. We investigated differences considering socio-demographic and occupational characteristics. Two logistic regression models examined the potential role of moral distress as a risk factor for scorings above scales’ cut-offs at Time 1 and at Time 2. Results: Frequent episodes of moral distress were mostly reported by nurses (24 %), physicians (22 %), younger workers (<40y; 23 %) and workers engaged in Covid-19 area; HCWs from Emergency/Intensive Care Departments reported the highest occurrence of moral distress (29 %). Results showed increases in all psychological symptoms as episodes of moral distress became more frequent. Moral distress experienced at Time 1 resulted as a persistent risk for mental health impairment in the following year, with stable ORs for post-traumatic symptoms (Time1 OR=7.8, 95 %CI=(5.3,11.6) and Time2 OR=6.6, 95 %CI=(2.9,15.7). Conclusions: Our findings support long-term consequences of moral distress; preventive strategies may be addressed with priority to younger HCWs and nurses/physicians from Emergency and Intensive Care Departments.

Keywords

• Moral injury
• Psychological distress
• Anxiety
• Post-traumatic stress
• Crescendo effect
• Covid-19