IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v18y2021i16p8723-d616927.html
   My bibliography  Save this article

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/18/16/8723/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/18/16/8723/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. 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).
    2. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Nicola Magnavita & Paolo Maurizio Soave & Massimo Antonelli, 2021. "Prolonged Stress Causes Depression in Frontline Workers Facing the COVID-19 Pandemic—A Repeated Cross-Sectional Study in a COVID-19 Hub-Hospital in Central Italy," IJERPH, MDPI, vol. 18(14), pages 1-13, July.
    2. Nolan, Anne & Smyth, Emer, 2022. "Disrupted transitions: young adults during the COVID-19 pandemic," Research Series, Economic and Social Research Institute (ESRI), number RS142.
    3. Yuri Kwon & Sooyoun Kristina Zong & Namhee Kim & Yuhyun Choi & Incheol Choi, 2025. "Social Class and Well-being Trajectories during COVID-19: A 4-year Longitudinal Study Revealed a Steeper Decline among Higher-class Individuals in South Korea," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 176(3), pages 1021-1042, February.
    4. Kung, Claryn S.J. & Kunz, Johannes S. & Shields, Michael A., 2023. "COVID-19 lockdowns and changes in loneliness among young people in the U.K," Social Science & Medicine, Elsevier, vol. 320(C).
    5. Georgia Libera Finstad & Gabriele Giorgi & Lucrezia Ginevra Lulli & Caterina Pandolfi & Giulia Foti & José M. León-Perez & Francisco J. Cantero-Sánchez & Nicola Mucci, 2021. "Resilience, Coping Strategies and Posttraumatic Growth in the Workplace Following COVID-19: A Narrative Review on the Positive Aspects of Trauma," IJERPH, MDPI, vol. 18(18), pages 1-25, September.
    6. Latikka, Rita & Koivula, Aki & Oksa, Reetta & Savela, Nina & Oksanen, Atte, 2022. "Loneliness and psychological distress before and during the COVID-19 pandemic: Relationships with social media identity bubbles," Social Science & Medicine, Elsevier, vol. 293(C).
    7. Morrish, N. & Medina-Lara, A., 2021. "Does unemployment lead to greater levels of loneliness? A systematic review," Social Science & Medicine, Elsevier, vol. 287(C).
    8. Costa-Font, Joan & Knapp, Martin & Vilaplana-Prieto, Cristina, 2023. "The ‘welcomed lockdown’ hypothesis? Mental wellbeing and mobility restrictions," LSE Research Online Documents on Economics 115323, London School of Economics and Political Science, LSE Library.
    9. Davis Cooper-Bribiesca & Dulce María Rascón-Martínez & José Adan Miguel-Puga & María Karen Juárez-Carreón & Luis Alejandro Sánchez-Hurtado & Tania Colin-Martinez & Juan Carlos Anda-Garay & Eliseo Espi, 2023. "Physicians’ Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions," IJERPH, MDPI, vol. 20(5), pages 1-19, February.
    10. 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.
    11. García-Prado, Ariadna & González, Paula & Rebollo-Sanz, Yolanda F., 2022. "Lockdown strictness and mental health effects among older populations in Europe," Economics & Human Biology, Elsevier, vol. 45(C).
    12. Holly Blake & Alisha Gupta & Mahnoor Javed & Ben Wood & Steph Knowles & Emma Coyne & Joanne Cooper, 2021. "COVID-Well Study: Qualitative Evaluation of Supported Wellbeing Centres and Psychological First Aid for Healthcare Workers during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(7), pages 1-27, March.
    13. Devaraj, Srikant & Patel, Pankaj C., 2021. "Change in psychological distress in response to changes in reduced mobility during the early 2020 COVID-19 pandemic: Evidence of modest effects from the U.S," Social Science & Medicine, Elsevier, vol. 270(C).
    14. Arin, K. Peren & Lacomba, Juan A. & Lagos, Francisco & Moro-Egido, Ana I. & Thum, Marcel, 2022. "Exploring the hidden impact of the Covid-19 pandemic: The role of urbanization," Economics & Human Biology, Elsevier, vol. 46(C).
    15. Brugiavini, Agar & Di Novi, Cinzia & Orso, Cristina Elisa, 2022. "Visiting parents in times of COVID-19: The impact of parent-adult child contacts on the psychological health of the elderly," Economics & Human Biology, Elsevier, vol. 46(C).
    16. Beáta Dávid & Boglárka Herke & Éva Huszti & Gergely Tóth & Emese Túry-Angyal & Fruzsina Albert, 2023. "Reshaping Social Capital During the Pandemic Crisis: Age Group Differences in Face‐to‐Face Contact Network Structures," Social Inclusion, Cogitatio Press, vol. 11(1), pages 295-309.
    17. Joan Costa-Font & Martin Knapp & Cristina Vilaplana-Prieto, 2023. "The ‘welcomed lockdown’ hypothesis? Mental wellbeing and mobility restrictions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(5), pages 679-699, July.
    18. Stokar, Yaffa Naomi, 2024. "Sense of failure in end of life care: Perspectives from physicians and nurses," Social Science & Medicine, Elsevier, vol. 348(C).
    19. Rebechi, Alessio & Lepinteur, Anthony & Clark, Andrew E. & Rohde, Nicholas & Vögele, Claus & D’Ambrosio, Conchita, 2024. "Loneliness during the COVID-19 pandemic: Evidence from five European countries," Economics & Human Biology, Elsevier, vol. 55(C).
    20. Barjaková, Martina & Garnero, Andrea & d’Hombres, Béatrice, 2023. "Risk factors for loneliness: A literature review," Social Science & Medicine, Elsevier, vol. 334(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8723-:d:616927. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.