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COVID-19 related Moral Injury in Health Care Workers


Researcher bios and how their research backgrounds relate to this study

Dr. Margaret McKinnon is Full Professor and Associate Chair, Research in Department of Psychiatry and Behavioural Neurosciences at McMaster University, where she holds the Homewood Chair in Mental Health and Trauma. Work in Dr. McKinnon’s laboratory focuses on identifying the neural and behavioural correlates of PTSD and trauma-related illnesses and on translating this knowledge to the development and testing of novel treatment interventions aimed at reducing the cognitive and affective sequelae of these conditions. A licensed clinical psychologist and clinical neuropsychologist, Dr. McKinnon has a special interest in military, veteran, and public safety populations (including healthcare workers), and has worked with these groups clinically and in her research program. She has published or in press nearly 150 scientific works. Dr. McKinnon is a frequent commentator in the media on matters related to PTSD, moral injury, and the impact of trauma on special populations.

Purpose of this research project

This study seeks to address the knowledge gap in the types of experiences and factors that influence the development of Moral Injury (MI) and psychological distress, as well as the types of supports that can moderate MI. MI is increasingly of interest in Health Care Workers (HCW) across a range of health care occupations, including nursing, medicine, respiratory therapy, allied health (Bagshaw et al., 2016; Brazil, Kassalainen, Ploeg, & Marshall, 2010; Houston et al., 2013), and administration (Craig Mitton & Evelyn, 2010). Witnessing the quality of patient care deteriorate due to lack of continuity, or poor communication has been found to be among the most distressing situations for HCW (Whitehead, Herbertson, Hamric, Epstein, & Fisher, 2015), and is associated with increased psychological distress and difficulties in family, social and occupational functioning (Mantri, Lawson, Wang, & Koenig, 2020). From an occupational perspective, MI has been associated with low job satisfaction, high rates of burnout (Lamiani, Borghi, & Argentero, 2016) and intention to leave their profession (Whitehead et al., 2015). By understanding more about MI, we are hoping to find ways to help moderate it.


How this research will help LGBT2SQ people and communities

A critical consideration of our study that has high implications for HCW and Public Safety Personnel (PSP) risk and resiliency with respect to mental health is experiences of chronic minority stress. Minority stress theory (Meyer, 2003) posits that sexual, racial, ethnic and gender minorities experience distinct, chronic and uncontrollable stressors related to their stigmatized identities, including systemic oppression, victimization, discrimination, microaggressions, violence, and internalized homonegativity. It has been well documented that these experiences disproportionately compromise the mental health of sexual minorities, which include lesbian, gay, bisexual, and pansexual people, and lead to significant adverse changes in cognitions and behaviour (Newcomb & Mustanski, 2010). We will examine the impacts to mental health and the specific factors that give rise to moral injury during the pandemic, and in addition, how the stress of working during the COVID-19 pandemic dynamically interacts with minority stress. We hope to elucidate the unique lived experience of minority identities among HCW, PSP, and funeral workers through an intersectional lens, and understand how risk and resiliency for mental illness during the COVID-19 pandemic is affected by chronic stress associated with stigmatized and marginalized identities.


1) Health Care Workers (direct and indirect), Public Safety Personnel, and funeral workers who worked during the COVID-19 pandemic within Canada. Participants must be able to speak and read English, be at least 18 years of age, and meet the criteria of one of the five groups: a) HCW providing direct patient related care (e.g. physician, nurse, respiratory therapist, occupational therapist, physiotherapist, social worker, chaplain, personnel support worker); b) Indirect/supporting worker in health care facilities (e.g. dietary, environmental services); c) Administrative staff in health care facilities (e.g. supervisor, manager, directors); d) Student or resident in a health care profession who completed a clinical practicum during COVID-19; e) A public safety personnel, including police officer, firefighter, correctional workers, dispatcher, border patrol officer, or paramedic. f) A funeral worker, including funeral directors and/or embalmers employed by funeral homes/organizations.
2) Health Care Workers (direct and indirect) who worked on a designated COVID-19 unit in a healthcare facility within Canada. Participants must be able to speak and read English, be at least 18 years of age, and be either a: a) HCW providing direct patient related care on a designated COVID-19 unit (e.g. physician, nurse, respiratory therapist, occupational therapist, physiotherapist, social worker, chaplain, personnel support worker), b) Indirect/supporting worker in health care facilities (e.g. dietary, environmental services), or c) Administrative staff (e.g. supervisor, manager, directors) who is associated with the COVID-19 unit.
3) Respiratory Therapists (RT), Respiratory Therapist students, or retired Respiratory Therapist who worked in Canada during the COVID-19 pandemic. Participants must be able to speak and read English, be at least 18 years of age, be provincially Registered Respiratory Therapists in Canada and were employed full time or part time during the COVID-19 pandemic.
4) Health Care Workers, Public Safety Personnel, and funeral workers, who self identify with a gender, sexual or racial/ethnic minority group, and are interested in participating in this section of the study.


Participants are provided a $50.00 gift card as a thank-you for their time and contribution to the study.

Mitigation measures

Interviewers have experience and have been trained for mental health interviews.

Promoting the Study

This study is being promoted via word of mouth, social media, advertising with Canadian groups who serve minority populations, and through email mailing lists/networks related to our collaborators.

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