A mixed-methods analysis of moral injury among healthcare workers during the COVID-19 pandemic.

During the COVID-19 pandemic, healthcare workers faced grave responsibilities amidst rapidly changing policies and material and staffing shortages. Moral injury, psychological distress following events where actions transgress moral beliefs/ expectations, increased among healthcare workers. We used a sequential mixed methods approach to examine workplace and contextual factors related to moral injury early in the pandemic. Using a Total Worker Health® framework, we 1) examined factors associated with moral injury among active healthcare professionals (N = 14,145) surveyed between May-August 2020 and 2) qualitatively analyzed open-ended responses from 95 randomly selected participants who endorsed moral injury on the survey. Compared to inpatient hospital, outpatient (OR = 0.74 [0.65, 0.85]) or school clinic settings (OR = 0.37 [0.18, 0.75]) were associated with lower odds of moral injury; while group care settings increased odds (OR = 1.36 [1.07, 1.74]). Working with COVID+ patients (confirmed+ OR = 1.27 [1.03, 1.55]), PPE inadequacy (OR = 1.54 [1.27, 1.87]), and greater role conflict (OR = 1.57 [1.53, 1.62]) were associated with greater odds of moral injury. Qualitative findings illustrate how outside factors as well as organizational policies and working conditions influenced moral injury. Moral injury experiences affected staff turnover and patient care, potentially producing additional morally injurious effects. Worker- and patient-centered organizational policies are needed to prevent moral injury among healthcare workers. The generalizability of these findings may be limited by our predominantly white and female sample. Further research is indicated to replicate these findings in minoritized samples.

Social Support and Associated Factors Among Men and Women in Pre-COVID Substance Use Treatment.

Low levels of social support are related to negative health outcomes, representing further obstacles to recovery from substance use disorder (SUD). This study examined relationships among stressors, symptoms and social support in 124 women and 102 men engaged in two outpatient public sector substance use treatment programs. Multiple linear regression analyses were utilized to assess relationships between variables of interest and social support. Men reported significantly lower social support than women. Food insecurity was associated with lower social support for men (ß= -13.6 [95% CI -26.7, -0.4], p = 0.04). When examining emotional support and tangible aid, victimization history was related to lower support (both types) for women while food insecurity was associated with lower support (both types) for men. Depression was related to lower emotional support among both men and women. Substance use treatment programs should explicitly target social support and related stressors to facilitate recovery for the individuals they serve.