Evidence map›Paper›PMID 35381899›Full record

ArticleJournal of general internal medicine2022

Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers.

Jason A Nieuwsma, Emily C O'Brien, Haolin Xu, Melissa A Smigelsky, VISN 6 MIRECC Workgroup, HERO Research Program, Keith G Meador

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of general internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 1 pooled it
12.5field-weighted citation impact, top 1% of its field
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 1 synthesis or guideline pooled it, 67 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Article
  6. Moral Injury and COVID-Related Stress Among Post-9/11 Veterans: Examining Longitudinal Associations.Stress and health : journal of the International Society for the Investigation of Stress · 2025
    Article
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  19. Metabolic and quality of life effects of growth hormone replacement in patients with TBI and AGHD: A pilot study.Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society · 2023
    Observational
  20. Trauma-informed patient and public-engaged research: Development and evaluation of an online training programme.Health expectations : an international journal of public participation in health care and health policy · 2023
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Jason A NieuwsmaIntegrative Mental Health, Department of Veterans Affairs, Durham, NC, USA. jason.nieuwsma@duke.edu.ORCID 0000-0003-0856-1913
Emily C O'BrienDuke Clinical Research Institute, Durham, NC, USA.
Haolin XuDuke Clinical Research Institute, Durham, NC, USA.
Melissa A SmigelskyIntegrative Mental Health, Department of Veterans Affairs, Durham, NC, USA.
VISN 6 MIRECC Workgroup
HERO Research Program
Keith G MeadorIntegrative Mental Health, Department of Veterans Affairs, Durham, NC, USA.
Clinical Research Institute · USDuke University · USVanderbilt University · US

Funding

Patient-Centered Outcomes Research Institute COVID-19-2020-001
6 · The paper itself

Abstract

backgroundMoral injury has primarily been studied in combat veterans but might also affect healthcare workers (HCWs) due to the COVID-19 pandemic.

objectiveTo compare patterns of potential moral injury (PMI) between post-9/11 military combat veterans and healthcare workers (HCWs) surveyed during the COVID-19 pandemic.

designCross-sectional surveys of veterans (2015-2019) and HCWs (2020-2021) in the USA.

participants618 military veterans who were deployed to a combat zone after September 11, 2001, and 2099 HCWs working in healthcare during the COVID-19 pandemic. MAIN MEASURES: Other-induced PMI (disturbed by others' immoral acts) and self-induced PMI (disturbed by having violated own morals) were the primary outcomes. Sociodemographic variables, combat/COVID-19 experience, depression, quality of life, and burnout were measured as correlates. KEY

results46.1% of post-9/11 veterans and 50.7% of HCWs endorsed other-induced PMI, whereas 24.1% of post-9/11 veterans and 18.2% of HCWs endorsed self-induced PMI. Different types of PMI were significantly associated with gender, race, enlisted vs. officer status, and post-battle traumatic experiences among veterans and with age, race, working in a high COVID-19-risk setting, and reported COVID-19 exposure among HCWs. Endorsing either type of PMI was associated with significantly higher depressive symptoms and worse quality of life in both samples and higher burnout among HCWs.

conclusionsThe potential for moral injury is relatively high among combat veterans and COVID-19 HCWs, with deleterious consequences for mental health and burnout. Demographic characteristics suggestive of less social empowerment may increase risk for moral injury. Longitudinal research among COVID-19 HCWs is needed. Moral injury prevention and intervention efforts for HCWs may benefit from consulting models used with veterans.

Indexed as

Burnout, ProfessionalCOVID-19Stress Disorders, Post-TraumaticVeteransCross-Sectional StudiesHealth PersonnelHumansPandemicsQuality of LifeburnoutCOVID-19healthcare workersmoral injuryveterans

Identifiers

PMID35381899
PMCPMC8982664
OpenAlexW4223597705

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.