Moral Injury in Chinese Health Professionals During COVID 19 Pandemic

Background: Caring for patients during the COVID-19 pandemic has placed considerable stress on healthcare professionals (HCPs), increasing their risk of moral injury (MI) and clinician burnout. The present study sought to examine the prevalence and correlates MI among physicians and nurses in mainland China during the pandemic. Methods: A cross-sectional study was performed via an online survey from March 27 to April 26, 2020. The 10-item Moral Injury Symptoms Scale-Health Professional (MISS-HP) was administered along with measures of clinician mental health and burnout. A total of 3,006 physicians and nurses who completed the questionnaire were included in the final analysis. Unconditional logistic regression modeling performed to determine the associations, including that between COVID-19 patient exposure and the risk of moral injury. Findings: MISS-HP score strongly and positively correlated with depression, anxiety, low well-being, and burnout symptoms. The estimated prevalence of MI in the total sample was 41.3% (95%CI: 39.3%-43.0%). HCPs providing medical care to COVID-19 patients experienced a 28% greater risk of MI than those providing medical care to patients without the coronavirus (OR=1.28, 95%CI=1.05-1.56, p=0.01). Interpretation: A significant proportion of HCPs in mainland China are at risk for significant MI symptoms as well as mental health problems and burnout during the COVID-19 pandemic. MI symptoms are strongly correlated with higher clinician burnout, greater psychological distress, and lower level of subjective well-being. Effective strategies are needed to address MI and other mental health problems in front line health care workers treating those with and without COVID-19 disease. Funding Statement: The study was funded by the China Medical Board (CMB) Foundation (grant number 16-254). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The institutional review board of the Ningxia Medical University approved the study (approval #2020-112).