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Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic

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  • Natasha Smallwood

    (Department of Respiratory Medicine, The Alfred Hospital, Prahan, VIC 3004, Australia
    Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC 3004, Australia)

  • Amy Pascoe

    (Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC 3004, Australia)

  • Leila Karimi

    (School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3083, Australia
    School of Medicine and Healthcare Management, Caucasus University, Tbilisi 0102, Georgia)

  • Karen Willis

    (School of Public Health, College of Health and Biomedicine, Victoria University, Footscray Park, Melbourne, VIC 3011, Australia
    Division of Critical Care and Investigative Services, Royal Melbourne Hospital, Grattan Street Parkville, Melbourne, VIC 3050, Australia)

Abstract

Background: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. Methods: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations, or colleges, universities, government contacts, and national media. Results: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%), or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with increased risk of anxiety, depression, post-traumatic stress disorder, and burnout. Conversely, feeling appreciated by the community protected against these risks in healthcare workers. Conclusions: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.

Suggested Citation

  • Natasha Smallwood & Amy Pascoe & Leila Karimi & Karen Willis, 2021. "Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(16), pages 1-15, August.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8723-:d:616927
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    References listed on IDEAS

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    1. Stella E. Hines & Katherine H. Chin & Danielle R. Glick & Emerson M. Wickwire, 2021. "Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(2), pages 1-11, January.
    2. Bu, Feifei & Steptoe, Andrew & Fancourt, Daisy, 2020. "Loneliness during a strict lockdown: Trajectories and predictors during the COVID-19 pandemic in 38,217 United Kingdom adults," Social Science & Medicine, Elsevier, vol. 265(C).
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    1. Mihaela Alexandra Gherman & Laura Arhiri & Andrei Corneliu Holman & Camelia Soponaru, 2022. "The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic P," IJERPH, MDPI, vol. 19(13), pages 1-22, June.
    2. Jonathan Tran & Karen Willis & Margaret Kay & Kathryn Hutt & Natasha Smallwood, 2022. "The Workplace and Psychosocial Experiences of Australian Senior Doctors during the COVID-19 Pandemic: A Qualitative Study," IJERPH, MDPI, vol. 19(5), pages 1-16, March.
    3. Daniela Lemmo & Roberta Vitale & Carmela Girardi & Roberta Salsano & Ersilia Auriemma, 2022. "Moral Distress Events and Emotional Trajectories in Nursing Narratives during the COVID-19 Pandemic," IJERPH, MDPI, vol. 19(14), pages 1-12, July.
    4. Amy Pascoe & Eldho Paul & Douglas Johnson & Mark Putland & Karen Willis & Natasha Smallwood, 2021. "Differences in Coping Strategies and Help-Seeking Behaviours among Australian Junior and Senior Doctors during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(24), pages 1-17, December.
    5. Rodriquez, Jason, 2023. "Reconfiguring the social organization of work in the intensive care unit: Changed relationships and new roles during COVID-19," Social Science & Medicine, Elsevier, vol. 317(C).
    6. Oliver S. Holmes & Steven Ellen & Natasha Smallwood & Karen Willis & Clare Delaney & Leon J. Worth & Shelley Dolan & Lisa Dunlop & Geraldine McDonald & Leila Karimi & Megan Rees & Maria Ftanou, 2023. "The Psychological and Wellbeing Impacts of Quarantine on Frontline Workers during COVID-19 and Beyond," IJERPH, MDPI, vol. 20(10), pages 1-11, May.
    7. Marina Maffoni & Elena Fiabane & Ilaria Setti & Sara Martelli & Caterina Pistarini & Valentina Sommovigo, 2022. "Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy," IJERPH, MDPI, vol. 19(15), pages 1-23, August.
    8. Mehwish Majeed & Muhammad Irshad & Jos Bartels, 2021. "The Interactive Effect of COVID-19 Risk and Hospital Measures on Turnover Intentions of Healthcare Workers: A Time-Lagged Study," IJERPH, MDPI, vol. 18(20), pages 1-15, October.
    9. William E. Rosa & Kailey E. Roberts & Amelia E. Schlak & Allison J. Applebaum & William S. Breitbart & Emily H. Kantoff & Hayley Pessin & Wendy G. Lichtenthal, 2022. "The Critical Need for a Meaning-Centered Team-Level Intervention to Address Healthcare Provider Distress Now," IJERPH, MDPI, vol. 19(13), pages 1-9, June.
    10. Esther Alonso-Prieto & Holly Longstaff & Agnes Black & Alice K. Virani, 2022. "COVID-19 Outbreak: Understanding Moral-Distress Experiences Faced by Healthcare Workers in British Columbia, Canada," IJERPH, MDPI, vol. 19(15), pages 1-14, August.
    11. Giulia Lamiani & Davide Biscardi & Elaine C. Meyer & Alberto Giannini & Elena Vegni, 2021. "Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study," IJERPH, MDPI, vol. 18(24), pages 1-10, December.
    12. Karen Willis & Paulina Ezer & Sophie Lewis & Marie Bismark & Natasha Smallwood, 2021. "“Covid Just Amplified the Cracks of the System”: Working as a Frontline Health Worker during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(19), pages 1-15, September.
    13. Priya-Lena Riedel & Alexander Kreh & Vanessa Kulcar & Angela Lieber & Barbara Juen, 2022. "A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19," IJERPH, MDPI, vol. 19(3), pages 1-20, February.

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