Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning

Sonya B Norman, Jordyn H Feingold, Halley Kaye-Kauderer, Carly A Kaplan, Alicia Hurtado, Lorig Kachadourian, Adriana Feder, James W Murrough, Dennis Charney, Steven M Southwick, Jonathan Ripp, Lauren Peccoralo, Robert H Pietrzak, Sonya B Norman, Jordyn H Feingold, Halley Kaye-Kauderer, Carly A Kaplan, Alicia Hurtado, Lorig Kachadourian, Adriana Feder, James W Murrough, Dennis Charney, Steven M Southwick, Jonathan Ripp, Lauren Peccoralo, Robert H Pietrzak

Abstract

Introduction: Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties.

Method: Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample.

Results: The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes.

Conclusion: Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties.

Keywords: COVID-19; PTSD; burnout; functioning; mental health; moral distress.

Conflict of interest statement

The authors declare that there are no conflict of interests.

© 2021 Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Relative importance of moral distress items associated with COVID‐19‐related PTSD symptoms in frontline health care workers. Error bars represent 95% confidence intervals. COVID‐19, coroanvirus disease 2019; PTSD, posttraumatic stress disorder
Figure 2
Figure 2
Relative importance of moral distress items associated with positive screen for positive screen for COVID‐19‐related PTSD in frontline health care workers. Error bars represent 95% confidence intervals. COVID‐19, coroanvirus disease 2019; PTSD, posttraumatic stress disorder
Figure 3
Figure 3
Relative importance of moral distress items associated with positive screen for burnout in frontline health care workers. Error bars represent 95% confidence intervals. COVID‐19, coroanvirus disease 2019
Figure 4
Figure 4
Relative importance of moral distress items associated with work difficulties in frontline health care workers. Error bars represent 95% confidence intervals. COVID‐19, coroanvirus disease 2019
Figure 5
Figure 5
Relative importance of moral distress items associated with interpersonal difficulties in frontline health care workers. Note. Error bars represent 95% confidence intervals. COVID‐19, coroanvirus disease 2019

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