Moral Injury
Conditions
Keywords
Moral Injury, Burnout, Healthcare Professionals, Psychiatry
Brief summary
Healthcare professionals working in psychiatric settings face demanding working conditions characterized by high rates of burnout and specific constraints, such as the deprivation of patients' liberty. \*Moral Injury\* (MI), a relatively recent concept, extends beyond burnout by focusing on the distress arising from ethical conflicts and the dissonance between professional values and the realities of clinical practice. Although the concept has begun to emerge from a theoretical perspective, particularly in the United States, it remains largely unknown in France and has yet to be investigated in psychiatric settings at the international level. The hypothesis is that MI plays a central role in healthcare professionals' psychological distress and contributes to the major recruitment and retention crisis affecting public psychiatric institutions. This crisis is reflected, for example, in a 40% vacancy rate for hospital physician positions in public facilities, with particularly acute shortages in child and adolescent psychiatry. The demographic crisis in child and adolescent psychiatry is unprecedented, marked by a 30% decline in the workforce over the past decade and projections suggesting a further 50% reduction within the next ten years. At the same time, mental health disorders among adolescents-particularly suicide attempts among girls-have increased substantially since the COVID-19 pandemic. This study aims to explore the organizational, individual, and systemic factors associated with Moral Injury in order to better understand and prevent this form of professional suffering.
Detailed description
This study is a regional cross-sectional observational survey conducted electronically through online questionnaires administered via the LimeSurvey platform of Aix-Marseille University, which is certified for Health Data Hosting (HDS). The coordinating center will distribute the survey to institutions affiliated with the Psynovia Psychiatry Federation. Participation in the study is voluntary, and data collection is pseudonymized. Participants may withdraw from the study at any time without consequence. Completion of the questionnaires is expected to take approximately 20 minutes. No intervention involving the study population is planned as part of this research. Upon completion of the survey, participants who feel the need to discuss their psychological well-being (e.g., stress, anxiety, sleep disturbances, depressive symptoms, or burnout) will be encouraged to seek support from a healthcare professional, such as their occupational health service and/or primary care physician.
Interventions
Health workers will be invited to complete an online self-questionnaire
Sponsors
Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
Direction Générale de l'Offre de Soins
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Healthcare Professionals working on Psychiatric Facilities in the PACA Region
Exclusion criteria
* Absence of consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Moral Injury Inventory for Healthcare Professionals | One point : Baseline | An overall score out of 100 will be created for the inventory, where a high score indicates a high level of "Moral Injury" |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Moral Injury Events Scale | One point : Baseline | Minimum score = 11, Maximum score = 66 Higher average scores indicate greater intensity of experience |
| Maslach Burnout Inventory | One point : Baseline | 3 scores calculated in this inventory Burnout : minimum score = 0, maximum score = 63, Higher average scores indicate greater intensity of burnout Depersonalization : minimum score = 0, maximum score = 35, Higher average scores indicate greater intensity of depersonalization Personal fulfillment : minimum score = 0, maximum score = 56, Higher average scores indicate greater intensity of personal fulfillment |
| Copenhagen Psychosocial Questionnaire | One point : Baseline | Assesses psychosocial working conditions across domains such as job demands, work organization, social relations, leadership, and well-being. Scores are typically scaled from 0 to 100, with higher scores indicating either more favorable conditions (e.g., social support, job satisfaction) or greater psychosocial risk (e.g., stress, emotional demands), depending on the domain assessed. |
| Team Psychological Safety on 7 points | One point : Baseline | Scale measures the extent to which team members feel safe to speak up, ask questions, admit mistakes, and express concerns without fear of negative consequences. Items are rated on a 7-point Likert scale, with higher scores indicating greater perceived psychological safety within the team. |
| Turnover Intention Scale-6 | One point : Baseline | Scale assesses an employee's intention to leave their current job or organization. Items are rated on a Likert scale, with higher scores indicating a stronger intention to quit and a greater risk of staff turnover. |
| Patient Health Questionnaire-4 | One point : Baseline | This is a brief screening tool combining two items for anxiety and two for depression, used to assess overall psychological distress. Higher total scores indicate greater levels of anxiety and depressive symptoms, with established cut-offs used to categorize severity from minimal to severe distress. |
| World Health Organization Well-Being Index - 5 | One point : Baseline | Assesses short self-reported measure of current psychological well-being, assessing positive mood, vitality, and general interest in life over the past two weeks. Scores range from 0 to 25 (or 0 to 100 when transformed), with higher scores indicating better well-being and lower scores suggesting reduced well-being or possible depression. |
Countries
France
Contacts
CONTACTSophie LAFOND
CONTACTNadège BOURVIS, MD
STUDY_DIRECTORNadège BOURVIS, MD
Centre Hospitalier Intercommunal Toulon La Seyne sur Mer
STUDY_CHAIRLaurent BOYER, MD
Aix Marseille Université
Outcome results
None listed