Understanding moral injury and its predictors among Chinese physicians

Moral injury - the betrayal of one's moral and professional values - is a negative factor affecting physicians' wellbeing. However, few studies have examined moral injury and its predictors in healthcare professionals. Therefore, this study aimed to explore the prevalence, associated factors, and predictors of moral injury in Chinese physicians.

This study was a cross-sectional survey conducted from September 14 to October 27, 2023, in mainland China. A total of 549 physicians completed the online self-administered questionnaire through the WeChat app. The 10-item Moral Injury Symptom Scale-Health Professional (MISS-HP) was used to assess the severity of moral injury symptoms, and the Moral Injury Events Scale (MIES) was used to measure exposure to potentially morally injurious events (PMIEs).

The results of the study showed a mean score of 42.07 (SD = 13.67) for the MISS - HP, and the prevalence of moral injury among the physicians was 31.6%. The multiple linear regression identified five main predictors of moral injury: exposure to PMIEs, job satisfaction, lack of organizational support, witnessing patient suffering or death, and mental health needs.

Chinese physicians reported experiencing different types of PMIEs and suffering from moral injury-related symptoms in their clinical practice. It helped to understand modifiable risk factors for moral injury, highlighting the need for systemic interventions. Healthcare institutions can mitigate moral injury and safeguard the wellbeing of healthcare workers by building peer-support networks, improving communication to address workload issues, and implementing recognition systems for ethics.