Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP
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Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale‑HP Sneha Mantri1 · Jennifer Mah Lawson2 · ZhiZhong Wang3 · Harold G. Koenig4,5,6,7
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This study aims to develop and assess the psychometric properties of a measure of moral injury (MI) symptoms for identifying clinically significant MI in health professionals (HPs), one that might be useful in the current COVID-19 pandemic and beyond. A total of 181 HPs (71% physicians) were recruited from Duke University Health Systems in Durham, North Carolina. Internal reliability of the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP) was examined, along with factor analytic, discriminant, and convergent validity. A cutoff score was identified from a receiver operator curve (ROC) that best identified individuals with significant impairment in social or occupational functioning. The 10-item MISSHP measures 10 theoretically grounded dimensions of MI assessing betrayal, guilt, shame, moral concerns, religious struggle, loss of religious/spiritual faith, loss of meaning/purpose, difficulty forgiving, loss of trust, and self-condemnation (score range 10–100). Internal reliability of the MISS-HP was 0.75. PCA identified three factors, which was confirmed by CFA, explaining 56.8% of the variance. Discriminant validity was demonstrated by modest correlations (r’s = 0.25–0.37) with low religiosity, depression, and anxiety symptoms, whereas convergent validity was evident by strong correlations with clinician burnout (r = 0.57) and with another multiitem measure of MI symptoms (r = 0.65). ROC characteristics indicated that a score of 36 or higher was 84% sensitive and 93% specific for identifying MI symptoms causing moderate to extreme problems with family, social, and occupational functioning. The MISS-HP is a reliable and valid measure of moral injury symptoms in health professionals that can be used in clinical practice to screen for MI and monitor response to treatment, as well as when conducting research that evaluates interventions to treat MI in HPs. Keywords Moral injury · Internal conflict · Health professionals · Burnout · Depression · Religiosity * Harold G. Koenig [email protected] Extended author information available on the last page of the article
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Vol.:(0123456789)
Journal of Religion and Health
Background Over the past 10 years, moral injury (MI) has been increasingly recognized as a common syndrome seen among veterans and active duty military experiencing trauma symptoms from war (Koenig et al. 2019a). MI has been described as “a deep sense of transgression including feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs” (Brock and Lettini 2012) and also, as “a betrayal of what’s right, by someone who holds legitimate authority, in a ‘high-stakes situation’” (Shay 1994, 2014). In addition to the psychological symptoms above, MI includes symptoms of struggle with religious faith (an
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