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. 2021 Oct 15;9(10):1377.
doi: 10.3390/healthcare9101377.

Association of Moral Distress with Anxiety, Depression, and an Intention to Leave among Nurses Working in Intensive Care Units during the COVID-19 Pandemic

Cristina Petrișor  1   2 , Caius Breazu  3   4 , Mădălina Doroftei  2 , Ioana Mărieș  1   2 , Codruța Popescu  5
Affiliations

Association of Moral Distress with Anxiety, Depression, and an Intention to Leave among Nurses Working in Intensive Care Units during the COVID-19 Pandemic

Cristina Petrișor et al. Healthcare (Basel). .

Abstract

Background: Wide geographical variations in depression and anxiety rates related to the ethical climate have been reported during the COVID-19 pandemic in intensive care units (ICUs). The objective was to investigate whether moral distress is associated and has predictive values for depression, anxiety, and intention to resign.

Methods: 79 consenting ICU nurses completed MMD-HP and PHQ-4 scales in this cross-sectional study between October 2020-February 2021, after ethical approval. The association between MMD-HP and PHQ-4, and the predictive value of MMD-HP for anxiety, depression, and an intention to leave were analyzed (linear regression and receiver operating characteristics curve analysis).

Results: From MMD-HP items, system related factors had highest scores (Kruskal-Wallis test, p < 0.0001). MMD-HP and PHQ-4 were weakly correlated (r = 0.41 [0.21-0.58]). MMD-HP and its system-related factors discriminate between nurses with and without depression or anxiety, while system-related factors differentiate those intending to resign (p < 0.05). The MMD-HP score had 50 [37.54-62.46] sensitivity with 80.95 [60-92.33] specificity to predict the intention to leave, and 76.12 [64.67-84.73] sensitivity with 58.33 [31.95-80.67] specificity to detect anxiety or depression symptoms.

Conclusions: During the COVID-19 pandemic, system-associated factors seem to be the most important root factors inducing moral distress. Moral distress is associated with negative psychological outcomes.

Keywords: COVID-19; ethics; moral distress; pandemics.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Individual analysis of each item of the MMD-HP score, as grouped in patient-related, team-related, and system-related factors. Results are displayed graphically using means and standard deviation.
Figure 2
Figure 2
Box plot for distribution of average values for items’ means in patient-related, team-related, and system-related causes of moral distress in our cohort of ICU nurses.
Figure 3
Figure 3
ROC curve of MMD-HP score versus present an intention to leave the current workplace in the ICU.
Figure 4
Figure 4
ROC curve of the MMD-HP score versus depression and/or anxiety symptoms in ICU nurses.
See this image and copyright information in PMC

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