Severity and associated factors of moral injury in healthcare workers during the coronavirus pandemic: a comprehensive meta-analysis

BackgroundThe COVID-19 pandemic has placed significant emotional and ethical burdens on healthcare workers (HCWs), leading to the emergence of moral injury (MI). Understanding the pooled mean and factors associated with MI is crucial for developing interventions and support systems for HCWs. This meta-analysis aims to examine the extent of MI among HCWs during the COVID-19 pandemic and identify potential contributing factors.MethodsA systematic literature search was conducted, and relevant studies reporting on MI in HCWs during the COVID-19 pandemic were included. Pooled means were calculated using random-effects or fixed effect models. Subgroup analyses were conducted based on demographic variables, such as gender, profession, and geographical region. Further, Sensitivity analysis was run to assess the individual study effect.ResultsA total of 36 studies met the inclusion criteria and were included in the meta-analysis. The pooled mean of MI among HCWs during the COVID-19 pandemic was ranged from 3.06 (CI95%: 2.35-3.77) to 119.17 (CI95%: 103.04-135.30), based on the instrument types. Further analyses revealed that females (P = 0.21), younger HCWs (P = 0.13), nurses (P = 0.55), and those in developing countries (P = 0.02) experienced higher levels of MI.ConclusionThis meta-analysis highlights the substantial MI experienced by healthcare workers (HCWs) during the COVID-19 pandemic, with nurses, younger HCWs, and those in developing countries being particularly affected. Although statistical significance was not observed in subgroup differences, trends suggest a heightened vulnerability among specific groups. These findings underscore the urgent need for targeted interventions and policies to support HCWs, particularly in high-risk demographics, and emphasize the importance of standardized MI assessment tools for future research.