Moral injury in animal care workers: prevalence, pathways, and phenomenology in a cross-sector sample.

Introduction: Moral injury, the psychological harm resulting from events that violate one's deeply held moral beliefs, has been extensively studied in military and healthcare populations but remains largely unexamined among animal care workers. Methods: This cross-sectional survey of 291 animal care workers across six sectors (rescue, shelter, animal control, veterinary medicine, volunteer/foster, and other) provides the first empirical prevalence estimate of moral injury in this cross-sector population using a validated syndrome measure. Results: Findings from the Moral Injury Outcome Scale (MIOS) indicate that 83.5% of participants endorsed at least one morally injurious experience pathway; most common was witnessing (63.9%), followed by being affected by others' transgressions (38.5%) and direct participation (29.2%). Applying published caseness thresholds, 18.9% of the potentially morally injurious event (pMIE) endorsers met criteria for moral injury as a clinical syndrome and an additional 21.4% for moral distress (subclinical), with blended shame and trust violation presentations characterizing the majority (53.1%) of clinical cases. Patient Health Questionnaire-9 scores exceeded the clinical threshold for moderate depression (M = 10.96, SD = 6.27). One-way analysis of variance revealed significant sector differences in functional impairment, trust violations, and depression, with shelter workers reporting the highest levels across nearly all measures. The MIOS Shame subscale was more strongly associated with both depression (r = .646) and functional impairment (r = .343) than the Trust Violations subscale, which showed no significant relationship with functional impairment (r = .045, p = .456). Endorsement of the direct participation pathway was the only exposure pathway significantly associated with caseness classification, with 31.8% of direct participation endorsers meeting criteria for moral injury compared to 12.0% of non-endorsers (p < .001). A departure from standard MIOS administration presenting impact items to all participants revealed that a small number of pMIE non-endorsers met caseness thresholds despite actively denying exposure, raising questions about the comprehensiveness of current pathway categories. Discussion: These findings identify moral injury as a prevalent and clinically significant occupational experience among animal care workers, with distinct shame-based and trust violation-based mechanisms in predicting functional decline and clinical severity, respectively. Implications for targeted intervention and organizational reform are discussed.