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Advances in Mental Health, PTSD and Moral Injury
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Advances in Mental Health, PTSD and Moral Injury

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (10 August 2023) | Viewed by 8083

Special Issue Editors

Prof. Dr. Suzette Brémault-Phillips

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Guest Editor
Department of Occupational Therapy, University of Alberta, Edmonton, AB T6G 2G4, Canada
Interests: mental health; resilience; happiness; aging; spirituality
Prof. Dr. Eric Vermetten

E-Mail Website
Guest Editor
Department of Psychiatry, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
Interests: psychiatry; neuroscience; PTSD; stress; military; war history; dissociation; imaging; memory; hypnosis

Special Issue Information

Dear Colleagues,

Trauma is prevalent in society, affecting individuals of all ages and cutting across a range of populations, including civilians, service members, and refugees. The unstable presentation and debilitating impacts of post-traumatic stress disorder (PTSD) and related comorbidities can be devastating. In recent times, our understanding of the fear-based pathophysiology of PTSD has shifted to include conditions such as moral injury (MI). Current knowledge of the commonalities between, and assessment of, PTSD, MI and related conditions needs further exploration. Timely and tailored approaches to interventions are also needed, including monitoring, education, prevention, and early identification and ranging through to interventions related to sleep, memory processing, cognitive avoidance, and emotional blunting. Advances in prevention and treatment for individuals, groups and institutions affected by trauma requires interdisciplinary efforts from experts in neurosciences, mental health, sociology, anthropology, theology, rehabilitation, public health and law. This issue provides an opportunity to advance our knowledge of psychotrauma and its devastating impact by exploring not only concepts and assessments, but also current and promising practices and policies that target both specific populations and the broader public.

Prof. Dr. Suzette Brémault-Phillips
Prof. Dr. Eric Vermetten
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • psychotrauma
  • PTSD
  • moral injury
  • public health
  • interventions

Published Papers (3 papers)

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Research

17 pages, 399 KiB  
Article
Coping, Supports and Moral Injury: Spiritual Well-Being and Organizational Support Are Associated with Reduced Moral Injury in Canadian Healthcare Providers during the COVID-19 Pandemic
by Andrea M. D’Alessandro-Lowe, Mauda Karram, Kim Ritchie, Andrea Brown, Heather Millman, Emily Sullo, Yuanxin Xue, Mina Pichtikova, Hugo Schielke, Ann Malain, Charlene O’Connor, Ruth Lanius, Randi E. McCabe and Margaret C. McKinnon
Int. J. Environ. Res. Public Health 2023, 20(19), 6812; https://doi.org/10.3390/ijerph20196812 - 23 Sep 2023
Viewed by 1698
Abstract
Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace [...] Read more.
Healthcare providers (HCPs) have described the onset of shame- and trust-violation-related moral injuries (MI) throughout the COVID-19 pandemic. Previous research suggests that HCPs may turn to various coping methods and supports, such as spirituality/religiosity, substance use, friends/family or organizational support, to manage workplace stress. It remains unknown, however, if similar coping methods and supports are associated with MI among this population. We explored associations between MI (including the shame and trust-violation presentations individually) and coping methods and supports. Canadian HCPs completed an online survey about their mental health and experiences during the COVID-19 pandemic, including demographic indices (e.g., sex, age, mental health history) and measures of MI, organizational support, social support, spiritual well-being, self-compassion, alcohol use, cannabis use and childhood adversity. Three hierarchical multiple linear regressions were conducted to assess the associations between coping methods/supports and (i) MI, (ii) shame-related MI and (iii) trust-violation-related MI, when controlling for age, mental health history and childhood adversity. One hundred and seventy-six (N = 176) HCPs were included in the data analysis. Spiritual well-being and organizational support were each significantly associated with reduced total MI (p’s < 0.001), shame-related MI (p = 0.03 and p = 0.02, respectively) and trust-violation-related MI (p’s < 0.001). Notably, comparison of the standardized beta coefficients suggests that the association between trust-violation-related MI and both spiritual well-being and organizational support was more than twice as great as the associations between these variables and shame-related MI, emphasizing the importance of these supports and the trust-violation outcomes particularly. Mental health history (p = 0.02) and self-compassion (p = 0.01) were additionally related to shame-related MI only. Our findings indicate that heightened levels of spiritual well-being and organizational support were associated with reduced MI among HCPs during the COVID-19 pandemic. Rather than placing sole responsibility for mental health outcomes on HCPs individually, organizations can instead play a significant role in mitigating MI among staff by implementing evidence-informed organizational policies and interventions and by considering how supports for spiritual well-being may be implemented into existing models of care where relevant for employees. Full article
(This article belongs to the Special Issue Advances in Mental Health, PTSD and Moral Injury)
18 pages, 947 KiB  
Article
Moving Forward from Moral Injury: A Mixed Methods Study Investigating the Use of 3MDR for Treatment-Resistant PTSD
by Lorraine Smith-MacDonald, Chelsea Jones, Matthew R. G. Brown, Rachel S. Dunleavy, Annelies VanderLaan, Zornitsa Kaneva, Tristin Hamilton, Lisa Burback, Eric Vermetten and Suzette Brémault-Phillips
Int. J. Environ. Res. Public Health 2023, 20(7), 5415; https://doi.org/10.3390/ijerph20075415 - 06 Apr 2023
Viewed by 2386
Abstract
Background: Exposure to trauma and potentially morally injurious events may lead to moral injury (MI). The link between MI and posttraumatic stress disorder (PTSD) may have particularly relevant implications for treatment-resistant PTSD (TR-PTSD). Multi-modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR), a technology-assisted exposure-based [...] Read more.
Background: Exposure to trauma and potentially morally injurious events may lead to moral injury (MI). The link between MI and posttraumatic stress disorder (PTSD) may have particularly relevant implications for treatment-resistant PTSD (TR-PTSD). Multi-modal Motion-Assisted Memory Desensitization and Reconsolidation (3MDR), a technology-assisted exposure-based trauma therapy that has been used in the treatment of PTSD, may also be an acceptable modality for patients in the treatment of TR-PTSD and MI. This proof-of-concept study aimed to investigate (1) whether MI co-occurs in military members (MMs) and veterans with TR-PTSD, and (2) the perspectives of MMs and veterans with TR-PTSD utilizing 3MDR for MI. Methods: This study employed a mixed-methods clinical trial. Military Members and veterans participated in this study (N = 11) through self-reported questionnaires, video recordings of treatment sessions, and semi-structured interviews post-session and post-intervention, with longitudinal follow-up to 6 months. Results: MI scores correlated with self-reported measures of mental health symptoms related to PTSD. The thematic analysis revealed three emergent themes: (1) Realities of War, (2) Wrestling Scruples, and (3) Moral Sensemaking. Conclusion: MI was highly correlated with TR-PTSD and themes regarding MI. This result, while preliminary, allows for the postulation that MI may be contributing to the continuation of PTSD symptoms in TR-PTSD, and that 3MDR may be an acceptable modality for addressing these symptoms in MMs and veterans. Full article
(This article belongs to the Special Issue Advances in Mental Health, PTSD and Moral Injury)
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12 pages, 307 KiB  
Article
The Hidden Crisis: Understanding Potentially Morally Injurious Events Experienced by Healthcare Providers during COVID-19 in Canada
by Kim Ritchie, Andrea M. D’Alessandro-Lowe, Andrea Brown, Heather Millman, Mina Pichtikova, Yuanxin Xue, Maxwell Altman, Isaac Beech, Mauda Karram, Fardous Hosseiny, Sara Rodrigues, Charlene O’Connor, Hugo Schielke, Ann Malain, Randi E. McCabe, Alexandra Heber, Ruth A. Lanius and Margaret C. McKinnon
Int. J. Environ. Res. Public Health 2023, 20(6), 4813; https://doi.org/10.3390/ijerph20064813 - 09 Mar 2023
Cited by 2 | Viewed by 3659
Abstract
Background: Healthcare providers (HCPs) may be at elevated risk for moral injury due to increased exposure to potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic. Identifying PMIEs experienced during the COVID-19 pandemic is a critical first step for understanding moral injury in [...] Read more.
Background: Healthcare providers (HCPs) may be at elevated risk for moral injury due to increased exposure to potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic. Identifying PMIEs experienced during the COVID-19 pandemic is a critical first step for understanding moral injury in HCPs. Accordingly, the purpose of the present study was to gain a deeper understanding of the work-related PMIEs experienced by HCPs in Canada during the pandemic. Methods: Canadian HCPs completed an online survey between February and December 2021 about mental health and functioning, including demographics and the Moral Injury Outcome Scale (MIOS). We conducted a qualitative thematic analysis of PMIEs described extemporaneously by HCPs in the open-text field of the MIOS. Results: One-hundred and twenty-four (N = 124) HCPs were included in analysis. Eight PMIE-related themes were identified, comprising patients dying alone; provision of futile care; professional opinion being ignored; witnessing patient harm; bullying, violence and divided opinions; resources and personal protective equipment; increased workload and decreased staffing; and conflicting values. Conclusions: Understanding broad categories of PMIES experienced by Canadian HCPs during the COVID-19 pandemic provides an opportunity to enhance cultural competency surrounding their experiences which will aid the development of targeted prevention and intervention approaches. Full article
(This article belongs to the Special Issue Advances in Mental Health, PTSD and Moral Injury)
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