Evidence map›Paper›PMID 41117444›Full record

ArticleJournal of clinical psychology2026

Guilt, Not Shame, Mediates the Longitudinal Relationship Between Moral Distress and Suicidal Ideation Among Frontline Nurses During COVID-19.

David P Cenkner, Candace W Burton, Danisha Jenkins, Garrett K Chan, Alyson K Zalta

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Article in Journal of clinical psychology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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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

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

David P CenknerDepartment of Psychology, University of California, Irvine, Irvine, California, USA.ORCID 0000-0002-1318-4043
Candace W BurtonSchool of Nursing, University of Nevada, Las Vegas, Las Vegas, Nevada, USA.
Danisha JenkinsSchool of Nursing, San Diego State University, San Diego, California, USA.
Garrett K ChanHealthImpact, Oakland, California, USA.
Alyson K ZaltaDepartment of Psychology, University of California, Irvine, Irvine, California, USA.

Funding

University of California Health Participation in the National COVID Cohort Collaborative (N3C)UL1TR001414 · NCATS · UNIVERSITY OF CALIFORNIA-IRVINE · PI COOPER, DAN M, VILAIN, ERIC J. · 2015 to 2023
$35.1M
Institute for Clinical and Translational ScienceUM1TR004927 · NCATS · UNIVERSITY OF CALIFORNIA-IRVINE · PI DAN M COOPER, Eric J. Vilain · 2024 to 2026
$12.2M
NCATS NIH HHS UL1 TR001414NCATS NIH HHS UM1 TR004927The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR0001414 and the Regents of the University of California. Any opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of NIH, the Regents of the University of California, or the ICTS.
6 · The paper itself

Abstract

objectiveNurses frequently experienced moral distress during the COVID-19 pandemic. Moral distress can lead to negative mental health outcomes, such as depression and suicidal ideation, but the mechanisms underlying these relationships are not well understood. The current study examined whether guilt and shame resulting from morally distressing events mediate the relationships between moral distress and depression symptoms/suicidal ideation during the COVID-19 pandemic.

methodsRegistered nurses (N = 96) who directly cared for COVID-19 patients completed self-report assessments at two time points over 3 months between May and November 2021.

resultsTime 1 guilt (OR = 1.39, p = 0.03) mediated the relationship between Time 1 moral distress and Time 2 suicidal ideation, controlling for Time 1 suicidal ideation. By contrast, Time 1 shame was not a significant mediator (OR = 0.84, p = 0.40). Neither guilt (B = 0.03, p = 0.75) nor shame (B = -0.05, p = 0.59) at Time 1 mediated the relationship between Time 1 moral distress and Time 2 depression symptoms, controlling for Time 1 depression symptoms. However, there was a significant direct effect of Time 1 moral distress on Time 2 depression symptoms (B = 0.20, p = 0.03) in this model.

conclusionsOur findings suggest the importance of educating the nursing workforce on the psychological consequences of workplace moral distress. Intervening on feelings of guilt may reduce suicidal ideation in nurses endorsing moral distress.

Indexed as

COVID-19DepressionGuiltMoralsNursesNursing Staff, HospitalPsychological DistressShameSuicidal IdeationAdultEthical DilemmasFemaleHumansLongitudinal StudiesMaleMiddle AgedCOVID‐19healthcare workersmoral injurynursing workforceprospectivesuicide

Identifiers

PMID41117444
PMCPMC13098317

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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.