ArticleJournal of religion and health2020
Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP.
Article in Journal of religion and health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 112 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Addressing Stress Responses on the Frontline-Further Development of RESTORE (Recovering From Extreme Stressors Through Online Resources and E-health)
Better Together Physician Coaching: An Innovative Solution to Medical Trainee Burnout
Effect of a Novel Online Physician Group-Coaching Program to Reduce Burnout in Trainees: A Randomized Controlled Trial
Better Together Physician Coaching: Addressing Burnout Amongst Male-Identifying Medicine Trainees
Better Together Physician Coaching: Addressing Burnout Amongst Clinicians
Who cites it
112 citing papers in PubMed, 6 syntheses or guidelines pooled it, 294 citations in OpenAlex.
- Evaluating the association between potentially morally injurious events (PMIEs) and types of psychological distress. A systematic review.European journal of psychotraumatology · 2026Pooled it
- Severity and associated factors of moral injury in healthcare workers during the coronavirus pandemic: a comprehensive meta-analysis.Archives of public health = Archives belges de sante publique · 2025Pooled it
- Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis.BMJ open · 2024Pooled it
- Systematic review of the relationship between burn-out and spiritual health in doctors.BMJ open · 2023Pooled it
- The Association of Moral Injury and Healthcare Clinicians' Wellbeing: A Systematic Review.International journal of environmental research and public health · 2023Pooled it
- Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis.European journal of psychotraumatology · 2023Pooled it
- Trial
- Online Well-Being Group Coaching Program for Women Physician Trainees: A Randomized Clinical Trial.JAMA network open · 2023Trial
- Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial.JAMA network open · 2022Trial
- Cumulative trauma, neural circuits, and burnout: an integrative model of healthcare worker post-traumatic stress syndromes.European journal of psychotraumatology · 2026Review
- Moral Injury Beyond Burnout: A Scientometric Review of Clinician Distress and Its Blind Spots in Critical Care.Healthcare (Basel, Switzerland) · 2026Review
- Resting-State Neural Signatures of Moral Injury: Associations With Rumination.Biological psychiatry. Cognitive neuroscience and neuroimaging · 2026Article
- Associations of Health Care System Deficiency-Related Patient Deterioration With Burnout, Depressive Symptoms, and Sleep Problems Among Emergency Medical Service Providers: Cross-Sectional Study.JMIR public health and surveillance · 2026Article
- The Marginalization of Spiritual Dimensions in Nursing Moral Injury Research: A Bibliometric Analysis, 2018-2025.Journal of religion and health · 2026Article
- Systemic Burnout in Healthcare: A Conceptual Multilevel Framework of Workforce Erosion and Institutional Fragility.Healthcare (Basel, Switzerland) · 2026Article
- Article
- Moral injury severity profiles and their pathways to negative emotions in medical staff: the differential mediating role of emotion regulation.BMC psychology · 2026Article
- Presence and detectability of the second victim phenomenon in German-speaking medical professionals involved in dysphagia and respiratory therapy: cross-sectional survey research (SeViD-V).BMC health services research · 2026Article
- Moral Injury as a Wound of Meaning and Conscience: An Introductory Synthesis of Conceptual Foundations, Spiritual Dimensions, and Clinical Implications.Journal of religion and health · 2026Article
- Mediating Effect of Thriving from Work in the Relationship Between Moral Injury and Post-Traumatic Growth Among Healthcare Workers in China.Journal of religion and health · 2026Article
52 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
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 MISS-HP 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 multi-item 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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.