Properties of the modified self-forgiveness dual-process scale in populations at risk for moral injury.

Despite theory suggesting that self-forgiveness facilitates recovery from moral injury, no measure of self-forgiveness has been validated with individuals exposed to potentially morally injurious events (PMIEs). Military veterans, healthcare workers, and first responders who reported PMIE exposure (n = 924) completed the Self-Forgiveness Dual-Process Scale, which assesses two dimensions of the self-forgiveness process. The first dimension, value affirmation, refers to appraising personal responsibility and being willing to make amends for one's involvement in a PMIE. The second dimension, esteem restoration, refers to accepting oneself as valuable and capable of growth despite one's failures and imperfections. Exploratory and Confirmatory Factor Analyses replicated the original scale's two-factor structure in 10 items modified to apply to the diverse contexts in which PMIEs occur. Next, we found that the factor structure, item loadings, and item intercepts were fully or partially invariant across professions, genders, races, ages, and religious affiliations in a series of Multi-Group Confirmatory Factor Analyses. Finally, diverging patterns of associations between value affirmation and esteem restoration with moral distress, posttraumatic stress, depression, insomnia, functional impairment, and posttraumatic growth provide evidence of convergent and discriminant validity between the subscales. The modified self-forgiveness dual process scale is the first measure of self-forgiveness to be validated with individuals exposed to a PMIE. Researchers and clinicians can use the scale to examine how self-forgiveness (or difficulties with forgiving oneself) relates to moral injury.

The Impact of Adjustment on Workplace Attitudes and Behaviors Among Health Care Workers During the COVID-19 Pandemic.

OBJECTIVE: We examined the impact of health care workers' (HCWs) adjustment to the COVID-19 pandemic on their work-related attitudes and behaviors. METHODS: HCWs ( n = 1468) participated in an observational longitudinal study in which they completed surveys of anxiety and occupational health between 2020 and 2021. RESULTS: Most HCWs reported anxiety that was consistently below the diagnostic threshold (68%) or fell below the threshold within a year (16%). Others reported consistently high (14%) or increasing (2%) anxiety, especially women, younger HCWs, those with a weakened immune system, and allied health professionals. Consistently high or increasing anxiety was associated with poorer job satisfaction, work engagement, perceived supervisor support, burnout, and turnover intentions. CONCLUSIONS: Resources to support HCWs may be focused on those who report consistently high or increasing anxiety to minimize the effects of crises and disasters on the workforce.

Perceived meaning, pandemic self-efficacy, social support, and discrimination predict trajectories of peri-pandemic growth and distress for international students.

OBJECTIVE: International students face unique COVID-19-related stressors, such as financial aid loss, limited social support, and discrimination (e.g., verbal harassment, physical assault). Additionally, pandemic and chronic stress research is largely cross-sectional, and trajectories over time remain unclear for psychological and environmental factors predicting distress and peri-pandemic growth. Accordingly, the current study examined trajectories of psychological distress and growth, as well as weekly psychological and environmental predictors of psychological distress and growth, in international students during the early stages of the pandemic. METHOD: International students (N = 42) at a U.S. university were surveyed weekly for 14 weeks. RESULTS: Latent growth mixture modeling resulted in three trajectories over time of distress (Minimal Impact, Emergent Resilience, and Increasing Distress) and peri-pandemic growth (Limited PrTG, Decreasing PrTG, and Increasing PrTG). For multilevel models, within-person increases in meaning and self-efficacy as well as between-person changes in discrimination and emotional social support predicted distress. Within-person changes in meaning and self-efficacy and between-person changes in self-efficacy and discrimination predicted peri-pandemic growth. CONCLUSIONS: Despite the stressors they face, many international students demonstrated a trajectory of resilience. Positive coping factors and environmental factors predicted distress or peri-pandemic growth, which can inform interventions and studies examining trajectories of distress during prolonged adversity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Collective Efficacy and Perceived COVID-19 Severity Predict Preparedness and Response Behaviors: A Longitudinal Study of Intersectionally Vulnerable University Students.

OBJECTIVE: To promote equity for intersectionally disaster-vulnerable individuals and address three literature gaps: (1) incremental effects of collective and self-efficacy as preparedness predictors, (2) differentiation of fear and perceived severity of a disaster, and (3) clarification of the relationship between fear and preparedness. METHODS: Due to infection risks associated with communal housing, early in the coronavirus disease (COVID-19) pandemic, many universities permitted students to remain in campus housing only if they were housing insecure, including many international students. We surveyed intersectionally-vulnerable students and their partners at a southeast US university, N = 54, who were international (77.8%), Asian (55.6%), and/or housing insecure at baseline (79.6%). In 14 waves from May-October 2020, we assessed pandemic preparedness/response behaviors (PPRBs) and potential PPRB predictors. RESULTS: We examined within- and between-person effects of fear, perceived severity, collective efficacy, and self-efficacy on PPRBs. Within-person perceived severity and collective efficacy both significantly, positively predicted greater PPRBs. All effects of fear and self-efficacy were not significant. CONCLUSIONS: Perceived severity and confidence that one's actions positively impact one's community fluctuated throughout the pandemic and are linked to greater PPRB engagement. Public health messages and interventions to improve PPRB may benefit from emphasizing collective efficacy and accuracy over fear.

Predicting Post-Traumatic Stress Disorder Treatment Response Using Heart Rate Variability to Virtual Reality Environment and Modified Stroop Task: An Exploratory Study.

Predicting treatment response can inform treatment decisions, expectations, and optimize use of mental health treatment resources. This study examined heart rate (HR), heart rate variability (HRV), and a modified Stroop task (mStroop) to predict post-traumatic stress disorder (PTSD) treatment response. We report on an observational, longitudinal study with 45 U.S. veterans in outpatient PTSD care, who had deployed to Iraq or Afghanistan. HR and HRV were collected before, during, and after virtual reality (VR) combat and civilian scenes. HRV recovery was defined as HRV after a 3-minute VR simulation minus HRV during a VR scene. mStroop threat variables included index scores for combat and general threat. Self-report data were collected at baseline and 6 months later. The outcome variable was the 17-item Clinician Administered PTSD Scale (CAPS). Controlling for baseline CAPS and number of combat experiences, the following baseline HRV recovery variables were significant predictors of 6-month CAPS: standard deviation of normal beat to beat interval (SDNN) after combat scene minus SDNN during combat scene and low-frequency (LF HRV) after civilian scene minus LF during civilian scene. HRV at rest, HR reactivity, HR recovery, and mStroop scores did not predict treatment response. In conclusion, HRV recovery variables in the context of a standardized VR stressor were significant predictors of PTSD treatment response after controlling for baseline CAPS and number of combat experiences. The direction of this relationship indicates that greater baseline HRV recovery predicts lower 6-month PTSD symptom severity. This was an exploratory study in need of replication.

Moral injury and psychosocial functioning in health care workers during the COVID-19 pandemic.

Studies of moral injury among nonmilitary samples are scarce despite repeated calls to examine the prevalence and outcomes of moral injury among civilian frontline workers. The purpose of this study was to describe the prevalence of moral injury and to examine its association with psychosocial functioning among health care workers during the COVID-19 pandemic. We surveyed health care workers (N = 480), assessing exposure to potentially morally injurious events (PMIEs) and psychosocial functioning. Data were analyzed using latent class analysis (LCA) to explore patterns of PMIE exposure (i.e., classes) and corresponding psychosocial functioning. The minimal exposure class, who denied PMIE exposure, accounted for 22% of health care workers. The moral injury-other class included those who had witnessed PMIEs for which others were responsible and felt betrayed (26%). The moral injury-self class comprised those who felt they transgressed their own values in addition to witnessing others' transgressions and feeling betrayed (11%). The betrayal-only class included those who felt betrayed by government and community members but otherwise denied PMIE exposure (41%). Those assigned to the moral injury-self class were the most impaired on a psychosocial functioning composite, followed by those assigned to the moral injury-other and betrayal-only classes, and finally the minimal exposure class. Moral injury is prevalent and impairing for health care workers, which establishes a need for interventions with health care workers in organized care settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).