Exposure to Potentially Morally Injurious Events and Mental Health Outcomes Among Frontline Workers Affected by the Coronavirus Pandemic

Objective: The current studies explored associations between exposure to potentially morally injurious events (PMIEs) and mental health outcomes among frontline workers affected by the coronavirus pandemic. Method: We administered online self-report surveys to emergency responders (N = 473) and hospital personnel (N = 854) in the Rocky Mountain region of the United States between April and June of 2020. Surveys assessed frequency and intensity of exposure to PMIEs alongside psychological and functional outcomes. Results: Between 20% and 30% of frontline workers reported exposure to PMIEs of at least moderate frequency and intensity. Exposure to more intense PMIEs was associated with greater psychological symptoms (i.e., stress, depression, and anxiety) and functional impairment (i.e., professional burnout), especially among emergency responders who reported frequent exposure but also hospital workers who reported few exposures. Conclusion: Efforts to facilitate and maintain the well-being of the public health workforce should specifically address critical incidents encountered by frontline workers that have embedded moral and ethical challenges. Clinical Impact Statement This study suggests that up to 30% of emergency responders and hospital personnel encounter perceived transgressions of their internalized moral beliefs in the context of providing care during disasters and crises. Those exposed to more frequent and intense ethical challenges are more likely than those not exposed to report symptoms of burnout, depression, anxiety, and stress. Efforts to maintain the well-being of essential personnel should therefore address critical incidents encountered by frontline workers that have embedded moral and ethical challenges.