New research from Canada has identified links between moral injury (MI) and the risk of developing post-traumatic stress disorder (PTSD). Public safety personnel, such as police officers, firefighters, paramedics, health care workers, correctional workers, routinely workplace psychosocial stressors that increase their risk of developing PTSD.
Moral injury is the psychological, social, spiritual, and behavioural distress and impairment an individual experiences after their moral values are violated by themselves or others. Public safety personnel report a range of potential moral injury events including having to make life-and-death decisions (which can engender reactions such as shame, guilt, anger etc.), witnessing human suffering, betrayal from leaders and working within impaired social systems.
Surveying of Canadian public safety personnel between June 2022 and June 2023 found that MI was the strongest predictor of PTSD compared to all other covariates (above and beyond the impacts of age, gender, depression, anxiety, stress and childhood adversity) and is significantly associated with PTSD symptoms. Anxiety and stress were also found to be independently associated with PTSD.
The findings of the research highlighted the importance of considering MI when addressing PTSD and attempting to control the conditions that may lead to it impacting public safety personnel. The impact of poor or mis-guided leadership actions and broken systems as exacerbators of existing hazards must be a consideration in the risk assessment of activities with the potential to result in psychosocial hazards such as vicarious trauma.
This information also confirms that existing evidence-based treatments for PTSD such as prolonged exposure and cognitive processing therapy, may not adequately target features consistent with MI due to the life-threat and fear-based focus of such treatments.
Moral injury and paramedic practice | Journal of Paramedic Practice