Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Statistical Methods and Data Analysis
3. Results
3.1. Moral Distress and Perceived Community Views of Healthcare Workers
3.2. Predictors of Moral Distress
3.3. Predictors of Perceived Community Views Regarding HCWs
3.4. Relationship between Moral Distress, Perceived Community Views, and Mental Health Outcomes
4. Discussion
4.1. Prevalence and Predictors of Moral Distress and Community Perceptions
4.2. Moral Distress Is Associated with Adverse Mental Health Outcomes
4.3. Solutions and Interventions to Manage Moral Distress
4.4. Strengths, Limitations, and Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Frequency (n = 7846) | % |
---|---|---|
Age (years) | ||
20–30 | 1860 | 23.7 |
31–40 | 2250 | 28.7 |
41–50 | 1738 | 22.2 |
>50 | 1998 | 25.5 |
Gender | ||
Male | 1458 | 18.6 |
Female | 6344 | 80.9 |
Non-binary | 19 | 0.2 |
Prefer not to say | 25 | 0.3 |
Number of years working since graduating (n = 6637) | ||
0–5 | 1592 | 24.0 |
6–10 | 1377 | 20.7 |
11–15 | 943 | 14.2 |
≥ 15 | 2725 | 41.1 |
Number of people in the household | ||
Lives alone (1 person) | 1087 | 13.9 |
2 | 2492 | 31.8 |
3–4 | 3181 | 40.5 |
5–6 | 1024 | 13.1 |
≥ 7 | 62 | 0.8 |
Number of children < 16 years at home | ||
0 | 5102 | 65.0 |
1–2 | 2253 | 28.7 |
3–4 | 482 | 6.1 |
≥ 5 | 9 | 0.1 |
Lives with ≥ 1 elderly person/people at home | 697 | 8.9 |
Characteristic | Frequency | % |
---|---|---|
Indicators of Moral Distress | ||
Worried that some patients will not receive the care they need due to scarcity of resources | ||
Strongly agree | 1582 | 20.2 |
Somewhat agree | 2986 | 38.1 |
Neither agree not disagree | 1211 | 15.4 |
Somewhat disagree | 1299 | 16.6 |
Strongly disagree | 768 | 9.8 |
Wearing PPE means that they cannot properly provide care to people with COVID-19 | ||
Strongly agree | 702 | 8.9 |
Somewhat agree | 2027 | 25.8 |
Neither agree not disagree | 1861 | 23.7 |
Somewhat disagree | 1671 | 21.3 |
Strongly disagree | 1585 | 20.2 |
Being required to quarantine lets down co-workers who are already overworked and stressed | ||
Strongly agree | 1643 | 20.9 |
Somewhat agree | 2675 | 34.1 |
Neither agree not disagree | 1203 | 15.3 |
Somewhat disagree | 1128 | 14.4 |
Strongly disagree | 1197 | 15.3 |
Excluding family from the bedside of patients infected with COVID-19 goes against their values as a healthcare worker | ||
Strongly agree | 2000 | 25.5 |
Somewhat agree | 2720 | 34.7 |
Neither agree not disagree | 1607 | 20.5 |
Somewhat disagree | 951 | 12.1 |
Strongly disagree | 568 | 7.2 |
Perceived Attitudes to Healthcare Workers’ | ||
The community is worried that healthcare workers spread the virus to others | ||
Neither agree nor disagree | 1052 | 13.4 |
Strongly/somewhat disagree | 777 | 9.9 |
Strongly/somewhat agree | 6017 | 76.7 |
The community is appreciative of healthcare workers during this time | ||
Neither agree nor disagree | 665 | 8.5 |
Strongly/somewhat disagree | 397 | 5.1 |
Strongly/somewhat agree | 6784 | 86.5 |
Moral Distress | Perceived Community Views | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Worried That Some Patients Will Not Receive the Care They Need Due to Scarcity of Resources | Wearing PPE Means That They Cannot Properly Provide Care to People with COVID-19 | Being Required to Quarantine Lets Down Co-Workers Who Are Already Overworked and Stressed | Excluding Family from the Bedside of Patients Infected with COVID-19 Goes against Their Values as a Healthcare Worker | the Community Is Worried That Healthcare Workers Spread the Virus to Others | the Community Is Appreciative of Healthcare Workers during This Time | |||||||
OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | |
Personal Predictors | ||||||||||||
Age (y) | ||||||||||||
31–40 | 1.23 (0.91–1.64) | 0.176 | 0.85 (0.64–1.14) | 0.281 | 1.21 (0.91–1.62) | 0.186 | 0.92 (0.71–1.20) | 0.559 | 2.20 (1.56–3.09) | 0.001 | 0.57 (0.37–0.88) | 0.010 |
41–50 | 1.11 (0.87–1.43) | 0.397 | 0.81 (0.63–1.03) | 0.088 | 1.11 (0.87–1.42) | 0.386 | 0.84 (0.67–1.05) | 0.133 | 1.46 (1.10–1.93) | 0.008 | 0.69 (0.47–1.02) | 0.062 |
50 + | 0.91 (0.75–1.10) | 0.329 | 0.92 (0.77–1.12) | 1.411 | 0.96 (0.79–1.16) | 0.672 | 0.95 (0.79–1.13) | 0.550 | 1.26 (1.01–1.57) | 0.037 | 0.74 (0.54–1.02) | 0.069 |
Gender | N/A | - | N/A | - | N/A | - | 2.01 (1.74–2.33) | 0.001 | N/A | - | N/A | - |
State (VIC) | 0.85 (0.69–1.06) | 0.144 | 1.42 (1.14–1.76) | 0.002 | 0.84 (0.69–1.04) | 0.103 | N/A | - | 1.01 (0.80–1.29) | 0.907 | N/A | - |
Pre-existing mental health condition | 1.26 (1.09–1.45) | 0.002 | N/A | - | 1.25 (1.09–1.44) | 0.002 | 1.29 (1.14–1.47) | 0.001 | N/A | - | 1.01 (0.82–1.24) | 0.928 |
Workplace Predictors | ||||||||||||
Occupation | ||||||||||||
Nursing | 0.58 (0.49–0.68) | 0.001 | 0.66 (0.57–0.77) | 0.001 | 0.58 (0.49–0.67) | 0.001 | 0.64 (0.56–0.74) | 0.001 | 1.07 (0.89–1.29) | 0.461 | 0.62 (0.50–0.78) | 0.001 |
Allied health | 0.78 (0.62–0.98) | 0.031 | 0.73 (0.58–0.91) | 0.005 | 0.80 (0.64–1.00) | 0.048 | 0.80 (0.65–0.97) | 0.023 | 0.88 (0.68–1.14) | 0.316 | 0.89 (0.64–1.24) | 0.496 |
Other role | 0.68 (0.46–1.02) | 0.063 | 0.42 (0.28–0.66) | 0.001 | 0.70 (0.48–1.02) | 0.063 | 0.52 (0.38–0.73) | 0.001 | 0.53 (0.36–0.80) | 0.002 | 1.57 (1.07–2.29) | 0.020 |
Frontline Area | ||||||||||||
ICU | 0.66 (0.53–0.83) | 0.001 | 0.84 (0.67–1.04) | 0.116 | 0.64 (0.51–0.79) | 0.001 | 0.76 (0.62–0.93) | 0.009 | 1.18 (0.90–1.55) | 0.226 | N/A | - |
Anaesthetics and surgery | 1.02 (0.80–1.31) | 0.848 | 0.82 (0.64–1.04) | 0.106 | 1.01 (0.80–1.27) | 0.944 | 0.54 (0.44–0.66) | 0.001 | 0.81 (0.61–1.24) | 0.122 | N/A | - |
Medical specialty areas | 1.07 (0.88–1.29) | 0.503 | 1.02 (0.84–1.22) | 0.877 | 1.05 (0.88–1.25) | 0.611 | 0.81 (0.69–0.96) | 0.012 | 1.12 (0.90–1.40) | 0.322 | N/A | - |
Primary care, community and aged care | 1.52 (1.14–2.04) | 0.005 | 1.00 (0.76–1.34) | 0.976 | 1.46 (1.11–1.91) | 0.007 | 0.87 (0.68–1.10) | 0.239 | 1.10 (0.80–1.55) | 0.539 | N/A | - |
Other frontline area * | 0.84 (0.61–1.14) | 0.259 | 0.84 (0.60–1.15) | 0.272 | 0.85 (0.63–1.15) | 0.294 | 0.62 (0.47–0.82) | 0.001 | 0.87 (0.61–1.24) | 0.447 | N/A | - |
Works in a metropolitan area | 1.28 (1.06–1.56) | 0.012 | 0.99 (0.82–1.20) | 0.922 | 1.23 (1.02–1.48) | 0.027 | 1.17 (1.00–1.38) | 0.056 | 0.96 (0.77–1.18) | 0.672 | N/A | - |
Currently works with COVID-19 patients | 1.01 (0.86–1.18) | 0.932 | 1.44 (1.23–1.68) | 0.001 | N/A | - | N/A | - | 1.02 (0.85–1.22) | 0.830 | 0.76 (0.62–0.93) | 0.009 |
Received PPE training | 1.00 (0.80–1.24) | 0.978 | 1.24 (0.99–1.54) | 0.058 | N/A | - | N/A | - | 0.99 (0.78–1.27) | 0.959 | 1.40 (1.06–1.86) | 0.020 |
Confident using PPE | 1.79 (0.62–1.01) | 0.063 | 0.76 (0.60–0.96) | 0.020 | N/A | - | N/A | - | N/A | - | 1.44 (1.05–1.96) | 0.023 |
Desires more training regarding PPE or managing COVID-19 | 1.66 (1.44–1.90) | 0.001 | 1.25 (1.08–1.43) | 0.002 | 1.68 (1.47–1.91) | 0.001 | 1.15 (1.03–1.30) | 0.016 | N/A | - | 0.92 (0.75–1.13) | 0.443 |
Characteristics | GAD-7 | PHQ-9 | IES-6 | Burnout-DP | Burnout-EE | Burnout-PA | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | OR (95% CI) | p | |
Predictors | ||||||||||||
Worried that some patients will not receive the care they need due to resource scarcity | 1.09 (0.98–1.21) | 0.136 | 0.97 (0.87–1.09) | 0.647 | 1.15 (1.05–1.27) | 0.005 | 1.17 (1.06–1.29) | 0.002 | 1.18 (1.07–1.31) | 0.002 | 1.17 (1.06–1.30) | 0.002 |
Wearing PPE means that they cannot properly provide care to people with COVID-19 | 1.28 (1.14–1.42) | <0.0001 | 1.13 (1.01–1.27) | 0.031 | 1.30 (1.17–1.44) | <0.0001 | 1.48 (1.33–1.63) | <0.0001 | 1.28 (1.14–1.43) | <0.0001 | N/A | - |
Being required to quarantine lets down co-workers who are already overworked and stressed | 2.00 (1.79–2.23) | <0.0001 | 1.73 (1.55–1.94) | <0.0001 | 1.91 (1.73–2.10) | <0.0001 | 1.29 (1.17–1.42) | <0.0001 | 1.79 (1.61–1.99) | <0.0001 | N/A | - |
Excluding family from the bedside goes against their values | 1.15 (1.03–1.28) | 0.014 | 1.18 (1.05–1.33) | 0.004 | 1.23 (1.11–1.36) | <0.0001 | N/A | - | 1.13 (1.02–1.26) | 0.019 | 1.30 (1.18–1.44) | <0.0001 |
The community is worried that HCWs spread the virus to others | 1.28 (1.13–1.46) | <0.0001 | 1.12 (0.99–1.28) | 0.081 | 1.50 (1.33–1.70) | <0.0001 | 1.37 (1.22–1.53) | <0.0001 | 1.49 (1.33–1.67) | <0.0001 | N/A | - |
The community is appreciative of HCWs during this time | 0.44 (0.38–0.50) | <0.0001 | 0.60 (0.52–0.70) | <0.0001 | 0.53 (0.46–0.61) | <0.0001 | 0.59 (0.52–0.70) | <0.0001 | 0.58 (0.49–0.68) | <0.0001 | 1.62 (1.41–1.86) | <0.0001 |
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Smallwood, N.; Pascoe, A.; Karimi, L.; Willis, K. Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2021, 18, 8723. https://doi.org/10.3390/ijerph18168723
Smallwood N, Pascoe A, Karimi L, Willis K. Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2021; 18(16):8723. https://doi.org/10.3390/ijerph18168723
Chicago/Turabian StyleSmallwood, Natasha, Amy Pascoe, Leila Karimi, and Karen Willis. 2021. "Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic" International Journal of Environmental Research and Public Health 18, no. 16: 8723. https://doi.org/10.3390/ijerph18168723
APA StyleSmallwood, N., Pascoe, A., Karimi, L., & Willis, K. (2021). Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 18(16), 8723. https://doi.org/10.3390/ijerph18168723