An investigation into moral injury, trauma, adverse childhood experiences, psychological distress and compassion in high risk occupations: A compassionate mind training for moral injury, trauma and psychological distress in frontline healthcare staff

Abstract

The first chapter details a meta-analysis exploring the relationship between moral injury (MI) and adverse childhood experiences (ACEs) among people who work in occupations that are at an increased risk of MI. Searches were conducted using PsychINFO, PubMed, Web of Science, SCOPUS, COCHRANE, EMBASE and Google Scholar. Eleven studies were included in the review. A three level meta-analyses investigated the associations between MI and ACEs. The results revealed a significant positive relationship between MI and ACEs (r =.17, p <.0001). Exploratory moderator analysis indicated that the relationship between MI and ACEs was stronger when studies measured Moral injury outcomes only, compared with studies that included measurements of both exposure and outcomes. Overall, the meta-analysis supports a tentative relationship between MI and ACEs, however as most studies examined MI and ACEs in military samples, future high-quality research is needed in nonmilitary occupations that are at an increased risk of MI e.g., Healthcare workers.
The second chapter is an empirical paper investigating the relationship between moral injury
(MI), psychological distress, post-traumatic stress disorder (PTSD), adverse childhood experiences
(ACEs) and the three flows of compassion in healthcare professionals (HCPs) who worked during the COVID-19 pandemic. Since the COVID-19 pandemic, HCPs faced several potentially morally injurious events (PMIEs) which can result in MI and psychological distress. Research suggests those who have experienced ACEs are at an increased risk of MI (Battaglia et al., 2019). Theoretically, increases in psychological distress during this period, may have led to activation the threat system thus increasing MI, PTSD and psychological distress and reducing the three flows of compassion in HCPs. The study also explored the effectiveness of a Compassionate Mind Training (CMT; Gilbert, 2000).
In Part A, 157 HCPs completed an online survey. Results revealed that psychological distress, PTSD, SC, emotional and sexual abuse in childhood, receiving supervision and compassion focused continuing professionals’ development (CPD) were significantly related to MI in HCPs. Mediation analysis revealed that SC significantly mediated the relationship between MI and PTSD.
Part B consisted of a randomised, waitlist-controlled study with 33 HCPs (training group, n = 21; waitlist group, n = 12). Results revealed no significant differences in the flows of compassion, psychological distress, PTSD, or MI from pre to post timepoints, in neither the training nor waitlist group. Overall, the results provide further insight into important predictors and potential resilience factors associated with MI in HCPs. Additionally, the relationship between MI, PTSD and SC is promising and warrants further consideration through future research which may help to inform potential service provisions and prevention and intervention efforts.

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