Personality Perspective on Moral Injury Among Chinese Healthcare Workers: A Network Analysis

Existing research has established a high prevalence of moral injury (MI) among healthcare workers and its association with severe negative outcomes, underscoring the need to elucidate its underlying mechanisms. Although personality traits are theorized to predispose individuals to MI, direct empirical evidence for this relationship remains scarce. This study recruited 439 physicians (240 female) and 562 nurses (527 female) from three hospitals in southern China. Participants were assessed for MI symptoms, Big Five (BF) personality traits, Light Triad (LT) traits, and Dark Triad (DT) traits. Using network analysis, we constructed the BF-LT-DT-MI network to identify the trait-to-symptom connections. Bridge expected influence (BEI) was computed to quantify the bridging role of these traits toward the MI symptoms cluster. In the BF-LT-DT-MI network, trait-to-symptom connections were distinct (e.g., Agreeableness-Loss of trust; Neuroticism-Loss of meaning; Conscientiousness-Loss of faith; Faith in Humanity-Loss of trust; Humanism-Loss of faith; Kantianism-Loss of faith; Machiavellianism-Self-condemnation; Psychopathy-Feeling betrayed; Psychopathy-Self-condemnation). Neuroticism, Machiavellianism and Psychopathy had the highest positive BEIs, whereas Conscientiousness, Agreeableness, Extraversion, and Faith in Humanity had the highest negative BEIs. Our findings provide novel insights into MI through the lens of personality and may offer empirical targets for early screening, prevention, and intervention among healthcare workers. The clinical implications are discussed.