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Wednesday, March 23, 2022

Moral Injury, Traumatic Stress, and Threats to Core Human Needs in Health-Care Workers: The COVID-19 Pandemic as a Dehumanizing Experience

Hagerty, S. L., & Williams, L. M. (2022)
Clinical Psychological Science. 


The pandemic has threatened core human needs. The pandemic provides a context to study psychological injury as it relates to unmet basic human needs and traumatic stressors, including moral incongruence. We surveyed 1,122 health-care workers from across the United States between May 2020 and August 2020. Using a mixed-methods design, we examined moral injury and unmet basic human needs in relation to traumatic stress and suicidality. Nearly one third of respondents reported elevated symptoms of psychological trauma, and the prevalence of suicidal ideation among health-care workers in our sample was roughly 3 times higher than in the general population. Moral injury and loneliness predict greater symptoms of traumatic stress and suicidality. We conclude that dehumanization is a driving force behind the psychological injury resulting from moral incongruence in the context of the pandemic. The pandemic most frequently threatened basic human motivations at the foundational level of safety and security relative to other higher order needs.

From the General Discussion

A subset of respondents added context to their experiences of moral injury in the form of narrative responses. These powerful accounts of the lived experiences of health-care workers provided us with a richer understanding of the construct of moral injury, especially as it relates to the novel context of the pandemic. Although betrayal is a known facet of moral injury from prior work (Bryan et al., 2016), our qualitative analysis suggests that dehumanization may also be a key phenomenon that underlies pandemic-related moral injury. Given our findings, we suggest that it may be important to attend to both betrayal and dehumanization when researching or intervening on the psychological sequelae of the pandemic. Our results support this because experiences of dehumanization in our sample were associated with greater symptoms of traumatic stress.

Another lens through which to view the experiences of health-care workers in the pandemic is through unsatisfied basic human motivations. Given the obvious barriers the pandemic presents to human connection (Hagerty & Williams, 2020), we had an a priori interest in studying loneliness. Our results indeed suggest that need of social connection appears relevant to the mental-health experiences of health-care workers during the pandemic such that loneliness was associated with greater traumatic stress, moral injury, and suicidal ideation. Echoing the importance of this social factor are findings from prior research suggesting that social connectedness buffers the association between moral injury and suicidality (Kelley et al., 2019) and buffers the impact of PTSD symptoms on suicidal behavior (Panagioti et al., 2014). Thus, our work further highlights lack of social connection as possible risk factor among individuals who face moral injury and traumatic stress and demonstrates its relevance to the mental health of health-care workers during the pandemic.