ArticlePloS one2022
A national study of moral distress among U.S. internal medicine physicians during the COVID-19 pandemic.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- 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
- Pooled it
- Moral Distress and Occupational Burnout in US Physicians.JAMA network open · 2026Article
- Hard then, harder now: internal medicine residents' moral distress pre and amidst COVID-19.BMC medical ethics · 2025Observational
- Article
- Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure.The American journal of bioethics : AJOB · 2024Article
- Moral distress and protective work environment for healthcare workers during public health emergencies.BMC medical ethics · 2024Article
- Moral distress thermometer: Swedish translation, cultural adaptation and validation.Nursing ethics · 2024Article
- Article
- The Psychoneuroimmunological Model of Moral Distress and Health in Healthcare Workers: Toward Individual and System-Level Solutions.Comprehensive psychoneuroendocrinology · 2024Review
- COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study.BMC primary care · 2023Article
- A New Health Care Paradigm: The Power of Digital Health and E-Patients.Mayo Clinic proceedings. Digital health · 2023Review
- Psychological distress among healthcare providers in oncology during the COVID-19 pandemic in Japan: The mediating role of moral distress and resilience.Frontiers in psychology · 2023Article
- Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study.BMJ open · 2022Article
- Understanding the mediated relationship between moral distress, depression, and suicide risk in undergraduate nursing students.Nursing outlookArticle
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere have been no studies to date of moral distress during the COVID-19 pandemic in national samples of U.S. health workers. The purpose of this study was to determine, in a national sample of internal medicine physicians (internists) in the U.S.: 1) the intensity of moral distress; 2) the predictors of moral distress; 3) the outcomes of moral distress.
methodsWe conducted a national survey with an online panel of internists, representative of the membership of the American College of Physicians, the largest specialty organization of physicians in the United States, between September 21 and October 8, 2020. Moral distress was measured with the Moral Distress Thermometer, a one-item scale with a range of 0 ("none") to 10 ("worst possible"). Outcomes were measured with short screening scales.
resultsThe response rate was 37.8% (N = 810). Moral distress intensity was low (mean score = 2.4, 95% CI, 2.2-2.6); however, 13.3% (95% CI, 12.1% - 14.5%) had a moral distress score greater than or equal to 6 ("distressing"). In multiple linear regression models, perceived risk of death if infected with COVID-19 was the strongest predictor of higher moral distress (β (standardized regression coefficient) = 0.26, p < .001), and higher perceived organizational support (respondent belief that their health organization valued them) was most strongly associated with lower moral distress (β = -0.22, p < .001). Controlling for other factors, high levels of moral distress, but not low levels, were strongly associated (adjusted odds ratios 3.0 to 11.5) with screening positive for anxiety, depression, posttraumatic stress disorder, burnout, and intention to leave patient care.
conclusionsThe intensity of moral distress among U.S. internists was low overall. However, the 13% with high levels of moral distress had very high odds of adverse mental health outcomes. Organizational support may lower moral distress and thereby prevent adverse mental health outcomes.
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