Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Tuesday, January 9, 2024

Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients

Soim Park, Johannes Thrul, et al. (2023)
Journal of Trauma & Dissociation


One factor potentially driving healthcare and hospital worker (HHW)’s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others’ pandemic-related responses and behaviors. We investigated whether HHWs’ betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

Here is my take for psychologists:

The article identifies betrayal-based moral injury as a significant factor contributing to mental health problems among healthcare workers during the COVID-19 pandemic. The research demonstrates a strong association between feelings of betrayal and both mental distress and PTSD symptoms. This suggests that interventions aimed at addressing betrayal-based moral injury could play a crucial role in improving the mental well-being of healthcare workers.

The article provides valuable insights into specific sources of betrayal experienced by healthcare workers. The study highlights that betrayal can stem from institutional leaders, coworkers, and even individuals outside of the healthcare system. This understanding can inform targeted interventions aimed at rebuilding trust and repairing ruptures within healthcare institutions and the broader community.

By understanding the impact of betrayal-based moral injury and its sources, clinical psychologists can develop more effective interventions to support healthcare workers' mental health. These efforts can improve the well-being of individuals working on the frontlines, potentially leading to better patient care and a more sustainable healthcare system.