Exposure to Potentially Morally Injurious Events in U.K. Health and Social Care Workers During COVID-19: Associations With PTSD and Complex PTSD

Talya Greene, Jasmine Harju-Seppänen, Jo Billings, Chris R. Brewin, Dominic Murphy, Michael A.P. Bloomfield

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Health and social care workers (HSCWs) have been shown to be at risk of exposure to potentially morally injurious events (PMIEs) and mental health problems during the COVID-19 pandemic. This study aimed to examine associations between exposure to PMIEs and meeting threshold criteria for probable posttraumatic stress disorder (PTSD) and probable complex PTSD (CPTSD) in U.K. HSCWs immediately after the peak of the first COVID-19 wave.

METHOD: Frontline HSCWs from across the United Kingdom working in diverse roles in hospitals, nursing or care homes, and other community settings were recruited to the Frontline-COVID study via social media. Participants ( n = 1,056) completed a cross-sectional online survey (May 27, 2020-July 23, 2020) which assessed exposure to PMIEs (nine-item Moral Injury Events Scale), and meeting symptom thresholds for probable PTSD and probable CPTSD (International Trauma Questionnaire).

RESULTS: PMIEs related to witnessing others' wrongful actions and betrayal events were more commonly endorsed than perceived self-transgressions. The rate of probable International Classification of Diseases, 11th Revision (ICD-11) PTSD was 8.3%, and of probable ICD-11 CPTSD was 14.2%. Betrayal-related PMIEs were a significant predictor of probable PTSD or probable CPTSD, together with having been redeployed during the pandemic. The only variable that differentially predicted probable CPTSD as compared with probable PTSD was not having had reliable access to personal protective equipment; none of the PMIE types were differential predictors for screening positive for probable PTSD versus probable CPTSD.

CONCLUSIONS: Exposure to PIMEs could be important for PTSD and CPTSD development. Interventions for moral injury in HSCWs should be investigated. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Original languageEnglish
JournalPsychological Trauma: Theory, Research, Practice, and Policy
Early online date22 Jun 2023
StateE-pub ahead of print - 22 Jun 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s)


  • frontline workers
  • moral injury
  • occupational trauma
  • pandemics

ASJC Scopus subject areas

  • Clinical Psychology
  • Social Psychology


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