Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;37(8):2033-2040.
doi: 10.1007/s11606-022-07487-4. Epub 2022 Apr 5.

Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers

Jason A Nieuwsma  1   2   3 , Emily C O'Brien  4 , Haolin Xu  4 , Melissa A Smigelsky  5   6 ; VISN 6 MIRECC Workgroup; HERO Research Program; Keith G Meador  5   6   7
Affiliations

Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers

Jason A Nieuwsma et al. J Gen Intern Med. 2022 Jun.

Abstract

Background: Moral injury has primarily been studied in combat veterans but might also affect healthcare workers (HCWs) due to the COVID-19 pandemic.

Objective: To compare patterns of potential moral injury (PMI) between post-9/11 military combat veterans and healthcare workers (HCWs) surveyed during the COVID-19 pandemic.

Design: Cross-sectional surveys of veterans (2015-2019) and HCWs (2020-2021) in the USA.

Participants: 618 military veterans who were deployed to a combat zone after September 11, 2001, and 2099 HCWs working in healthcare during the COVID-19 pandemic.

Main measures: Other-induced PMI (disturbed by others' immoral acts) and self-induced PMI (disturbed by having violated own morals) were the primary outcomes. Sociodemographic variables, combat/COVID-19 experience, depression, quality of life, and burnout were measured as correlates.

Key results: 46.1% of post-9/11 veterans and 50.7% of HCWs endorsed other-induced PMI, whereas 24.1% of post-9/11 veterans and 18.2% of HCWs endorsed self-induced PMI. Different types of PMI were significantly associated with gender, race, enlisted vs. officer status, and post-battle traumatic experiences among veterans and with age, race, working in a high COVID-19-risk setting, and reported COVID-19 exposure among HCWs. Endorsing either type of PMI was associated with significantly higher depressive symptoms and worse quality of life in both samples and higher burnout among HCWs.

Conclusions: The potential for moral injury is relatively high among combat veterans and COVID-19 HCWs, with deleterious consequences for mental health and burnout. Demographic characteristics suggestive of less social empowerment may increase risk for moral injury. Longitudinal research among COVID-19 HCWs is needed. Moral injury prevention and intervention efforts for HCWs may benefit from consulting models used with veterans.

Keywords: COVID-19; burnout; healthcare workers; moral injury; veterans.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

References

    1. Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, et al. Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clin Psychol Rev. 2009;29(8):695–706. doi: 10.1016/j.cpr.2009.07.003. - DOI - PubMed
    1. Brock RN. Soul Repair: Recovering from Moral Injury after War. Boston, MA: Beacon Press; 2013.
    1. Maguen S, Burkman K, Madden E, Dinh J, Bosch J, Keyser J, et al. Impact of killing in war: A randomized, controlled pilot trial. J Clin Psychol. 2017;73(9):997–1012. doi: 10.1002/jclp.22471. - DOI - PubMed
    1. Currier JM, Drescher KD, Nieuwsma JA. American Psychological Association. Addressing Moral Injury in Clinical Practice. Washington, D.C.: American Psychological Association; 2020.
    1. Nieuwsma JA, Brancu M, Wortmann J, Smigelsky MA, King HA. VISN 6 MIRECC Workgroup, et al. Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis. Clin Psychol Psychother. 2021;28(1):239–50. doi: 10.1002/cpp.2503. - DOI - PubMed

MeSH terms