Moral injury, depression, and anxiety symptoms among health and social care workers during the COVID-19 pandemic: The moderating role of belongingness

Background: The COVID-19 pandemic can affect health and social care workers’ (HSCWs’) mental health in their role as frontline workers in this crisis. The pandemic poses unique challenges to HSCWs as they face morally daunting decisions while working with limited knowledge and resources. This study primary objective was to examine the moderating role of thwarted belongingness in the relationships between HSCWs’ exposure to potentially morally injurious events (PMIEs) and moral injury symptoms, depression, and anxiety. Method: A sample of 296 Israeli HSCWs completed validated self-report questionnaires that include measures of depression, anxiety, PMIE exposure, moral injury symptoms, and a sense of thwarted belongingness. Results: About one-third (33.6%) of the sample met the criteria for major depression and 21.5% for generalized anxiety. Beyond demographic and work-related characteristics, PMIEs contributed to depression and anxiety levels. The indirect effect of PMIE exposure on anxiety/depression symptoms through MI symptoms was significant only at high levels of thwarted belongingness among HSCWs. Thus, greater PMIE exposure contributes to more MI symptoms, which, in turn, is linked to higher levels of anxiety/depression symptoms among HSCWs with high levels of thwarted belongingness. Limitations: Cross-sectional design, self-report questionnaires, sample limited to Israeli HSCWs. Conclusions: The study’s findings highlight the mental burden of HSCWs during the COVID-19 pandemic and the critical contribution of PMIE exposure and thwarted belongingness to this burden. Clinicians treating HSCWs coping with depression and anxiety following the COVID-19 should also attend to moral injury symptoms as well to the belongingness experience.