Abstract
Moral injury has attracted attention widely in various occupations, particularly health professionals. Personality traits involve the professional values in clinical decision-making associated with mental outcomes. The current study examines the relationship between “light personality” style and moral injury. Scores on three subscales of the Light Triad Scale were negatively correlated with the Moral Injury Symptoms Scale-Health Professional. Health professionals more likely to have light personality styles may be less likely to suffer from moral injury under high-stake situations. The findings provide evidence to better understand the inner core of the moral injury, suggesting a potential pathway to improve the moral well-being of health professionals by strengthening key elements of light personality.
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Data Availability
The datasets generated and/or analyzed during the current study are not publicly available due to institutional restrictions but are available from the corresponding author upon reasonable request (wzhzh_lion@126.com).
References
Abbasi-Asl, R., & Hashemi, S. (2019). Personality and morality: Role of the big five personality traits in predicting the four components of moral decision making. International Journal of Behavioral Sciences, 13(3), 123–128.
Akram, F. (2021). Moral injury and the COVID-19 pandemic: A philosophical viewpoint. Ethics, Medicine, and Public Health, 18, 100661. https://doi.org/10.1016/j.jemep.2021.100661
Benedek, D. M., Fullerton, C., & Ursano, R. J. (2007). First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annual Review of Public Health, 28, 55–68. https://doi.org/10.1146/annurev.publhealth.28.021406.144037
Bennett, J. (2008). Groundwork for the metaphysic of morals. Immanuel Kant.
Borges, L. M., Barnes, S. M., Farnsworth, J. K., Bahraini, N. H., & Brenner, L. A. (2020). A commentary on moral injury among health care providers during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S138–S140. https://doi.org/10.1037/tra0000698
Borges, L. M., Holliday, R., Barnes, S. M., Bahraini, N. H., Kinney, A., Forster, J. E., & Brenner, L. A. (2021). A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers. PLoS ONE, 16(11), e0260033. https://doi.org/10.1371/journal.pone.0260033
Čartolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (2021). Moral injury in healthcare professionals: A scoping review and discussion. Nursing Ethics, 28(5), 590–602. https://doi.org/10.1177/0969733020966776
Daniel, P. (2019). Moral injury and moral foundations among recent US veterans. Clinical Psychology. https://doi.org/10.13140/RG.2.2.32685.95206
Erkus, G., & Dinc, L. (2018). Turkish nurses’ perceptions of professional values. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 34(3), 226–232. https://doi.org/10.1016/j.profnurs.2017.07.011
Eysenbach, G. (2004). Improving the quality of Web surveys: The checklist for reporting results of internet E-surveys (CHERRIES). Journal of Medical Internet Research, 6(3), e34. https://doi.org/10.2196/jmir.6.3.e34
Fani, N., Currier, J. M., Turner, M. D., Guelfo, A., Kloess, M., Jain, J., Mekawi, Y., Kuzyk, E., Hinrichs, R., Bradley, B., Powers, A., Stevens, J. S., Michopoulos, V., & Turner, J. A. (2021). Moral injury in civilians: Associations with trauma exposure, PTSD, and suicide behavior. European Journal of Psychotraumatology, 12(1), 1965464. https://doi.org/10.1080/20008198.2021.1965464
Farah Bijari, A., Hefazi Torghabeh, L., & Dehshiri, G. (2022). Evaluation of psychometric characteristics of light triad personality questionnaire in nurses. Brain and Behavior, 12(4), e2514. https://doi.org/10.1002/brb3.2514
Feinstein, A., Pavisian, B., & Storm, H. (2018). Journalists covering the refugee and migration crisis are affected by moral injury not PTSD. JRSM Open, 9(3), 205427041875901. https://doi.org/10.1177/2054270418759010
Fernández-Feito, A., Basurto-Hoyuelos, S., Palmeiro-Longo, M. R., & García-Díaz, V. (2019). Differences in professional values between nurses and nursing students: A gender perspective. International Nursing Review, 66(4), 577–589. https://doi.org/10.1111/inr.12543
Fleming, W. H. (2021). Moral Injury and the Absurd: The suffering of moral paradox. Journal of Religion and Health, 60(5), 3012–3033. https://doi.org/10.1007/s10943-021-01227-4
Gorbalenya, A. E., Baker, S. C., Baric, R. S., de Groot, R. J., Drosten, C., Gulyaeva, A. A., Haagmans, B. L., Lauber, C., Leontovich, A. M., Neuman, B. W., Penzar, D., Perlman, S., Poon, L. L. M., Samborskiy, D., Sidorov, I. A., Sola, I., & Ziebuhr, J. (2020). Severe acute respiratory syndrome-related coronavirus: The species and its viruses – a statement of the Coronavirus Study Group [Preprint]. Microbiology. https://doi.org/10.1101/2020.02.07.937862
Graham, J., Meindl, P., Beall, E., Johnson, K. M., & Zhang, L. (2016). Cultural differences in moral judgment and behavior, across and within societies. Current Opinion in Psychology, 8, 125–130. https://doi.org/10.1016/j.copsyc.2015.09.007
Greene, T., Bloomfield, M. A. P., & Billings, J. (2020). Psychological trauma and moral injury in religious leaders during COVID-19. Psychological Trauma: Theory, Research, Practice and Policy, 12(S1), S143–S145. https://doi.org/10.1037/tra0000641
Grežo, M., & Adamus, M. (2022). Light and Dark core of personality and the adherence to COVID-19 containment measures: The roles of motivation and trust in government. Acta Psychologica, 223, 103483. https://doi.org/10.1016/j.actpsy.2021.103483
Griffin, B. J., Purcell, N., Burkman, K., Litz, B. T., Bryan, C. J., Schmitz, M., Villierme, C., Walsh, J., & Maguen, S. (2019). Moral injury: An integrative review. Journal of Traumatic Stress, 32(3), 350–362. https://doi.org/10.1002/jts.22362
Guo, Z. (1995). Chinese confucian culture and the medical ethical tradition. Journal of Medical Ethics, 21(4), 239–246. https://doi.org/10.1136/jme.21.4.239
Hasanovic, A. (2021). Fraternity in humanity and global mental helath—Islamic perspective. Psychiatria Danubina, 33(Suppl 4), 867–869.
Hoffman, J., Liddell, B., Bryant, R. A., & Nickerson, A. (2019). A latent profile analysis of moral injury appraisals in refugees. European Journal of Psychotraumatology, 10(1), 1686805. https://doi.org/10.1080/20008198.2019.1686805
Kant, I. (2012). The Critique of Practical Reason.
Kaufman, S. B., Yaden, D. B., Hyde, E., & Tsukayama, E. (2019). The light vs dark triad of personality: Contrasting two very different profiles of human nature. Frontiers in Psychology, 10, 467. https://doi.org/10.3389/fpsyg.2019.00467
Kaya, H., Işik, B., Şenyuva, E., & Kaya, N. (2017). Personal and professional values held by baccalaureate nursing students. Nursing Ethics, 24(6), 716–731. https://doi.org/10.1177/0969733015624488
King, E. L., & Hawkins, L. E. (2022). Identifying and mitigating moral injury risks in military behavioral health providers. Military Psychology. https://doi.org/10.1080/08995605.2022.2093599
Koenig, H. G., & Al Zaben, F. (2021). Moral injury: An increasingly recognized and widespread syndrome. Journal of Religion and Health, 60(5), 2989–3011. https://doi.org/10.1007/s10943-021-01328-0
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Levi-Belz, Y., Greene, T., & Zerach, G. (2020). Associations between moral injury, PTSD clusters, and depression among Israeli veterans: A network approach. European Journal of Psychotraumatology, 11(1), 1736411. https://doi.org/10.1080/20008198.2020.1736411
Li, J., Zhang, W., Chen, W., Yuan, H., Zhang, S., Tian, M., & Qu, Z. (2019). Applications of the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for children. Journal of Affective Disorders, 254, 109–114. https://doi.org/10.1016/j.jad.2019.05.021
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
Lukić, P., & Živanović, M. (2021). Shedding light on the light triad: Further evidence on structural, construct, and predictive validity of the Light Triad. Personality and Individual Differences, 178, 110876. https://doi.org/10.1016/j.paid.2021.110876
Mauger, P. A., Perry, J. E., Freeman, T., & Grove, D. C. (1992). The measurement of forgiveness: Preliminary research. Journal of Psychology and Christianity., 11, 170–180.
McKay, R., & Whitehouse, H. (2015). Religion and morality. Psychological Bulletin, 141(2), 447–473. https://doi.org/10.1037/a0038455
Murray, H., & Ehlers, A. (2021). Cognitive therapy for moral injury in post-traumatic stress disorder. Cognitive Behaviour Therapist, 14, e8. https://doi.org/10.1017/S1754470X21000040
Perez, D., Larson, P., & Bair, J. (2021). U.S. Veterans experience moral injury differently based on moral foundations preferences. Journal of Community Engagement and Scholarship, 13(4). https://doi.org/10.54656/WMOL9112
Pfeffer, C., Hart, R., Satterthwaite, M., Bryant, R., Knuckey, S., Brown, A. D., & Bonanno, G. A. (2022). Moral injury in human rights advocates. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001404
Rassin, M. (2008). Nurses’ professional and personal values. Nursing Ethics, 15(5), 614–630. https://doi.org/10.1177/0969733008092870
Reynolds, K. A., Pankratz, L., Jain, B., Grocott, B., Bonin, L., King, G., Sommer, J. L., El-Gabalawy, R., Giuliano, R. J., Kredentser, M., Mota, N., & Roos, L. E. (2022). Moral injury among frontline long-term care staff and management during the COVID-19 pandemic. Frontiers in Health Services, 2. https://www.frontiersin.org/articles/https://doi.org/10.3389/frhs.2022.841244
Riedel, P.-L., Kreh, A., Kulcar, V., Lieber, A., & Juen, B. (2022). A scoping review of moral stressors, moral distress and moral injury in healthcare workers during COVID-19. International Journal of Environmental Research and Public Health, 19(3), 1666. https://doi.org/10.3390/ijerph19031666
Rodríguez, E. A., Agüero-Flores, M., Landa-Blanco, M., Agurcia, D., & Santos-Midence, C. (2021). Moral injury and light triad traits: Anxiety and depression in healthcare personnel during the coronavirus-2019 pandemic in honduras. Hispanic Health Care International: THe Official Journal of the National Association of Hispanic Nurses, 19(4), 230–238. https://doi.org/10.1177/15404153211042371
Saba, S. K., Davis, J. P., Lee, D. S., Castro, C. A., & Pedersen, E. R. (2022). Moral injury events and behavioral health outcomes among American veterans. Journal of Anxiety Disorders, 90, 102605. https://doi.org/10.1016/j.janxdis.2022.102605
Shanafelt, T., Ripp, J., & Trockel, M. (2020). Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA, 323(21), 2133–2134. https://doi.org/10.1001/jama.2020.5893
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Wang, Z., Harold, K. G., Tong, Y., Wen, J., Sui, M., Liu, H., Zaben, F. A., & Liu, G. (2022.). Moral injury in Chinese health professionals during the COVID-19 pandemic. American Psychological Association. 250–257. https://doi.org/10.1037/tra0001026.
Williams, R. D., Brundage, J. A., & Williams, E. B. (2020). Moral injury in times of COVID-19. Journal of Health Service Psychology, 46(2), 65–69. https://doi.org/10.1007/s42843-020-00011-4
Zhizhong, W., Koenig, H. G., Yan, T., Jing, W., Mu, S., Hongyu, L., & Guangtian, L. (2020). Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic. BMC Psychiatry, 20(1), 556. https://doi.org/10.1186/s12888-020-02954-w
Zuromski, K. L., Ustun, B., Hwang, I., Keane, T. M., Marx, B. P., Stein, M. B., Ursano, R. J., & Kessler, R. C. (2019). Developing an optimal short-form of the PTSD checklist for DSM-5 (PCL-5). Depression and Anxiety, 36(9), 790–800. https://doi.org/10.1002/da.22942
Acknowledgements
We would like to thank colleagues at the General Hospital of Ningxia Medical University for their assistance in data collection.
Funding
This work was supported by the Funding for Ph.D. researchers of Guangdong Medical University in 2022 under Grant number GDMUB2022049; Funding from the China Medical Board under Grant number CMB16-254.
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All authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by QL and ZH. The first draft of the manuscript was written by QL, ZH, XH, and MX, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The survey was anonymous. The potential risks and benefits of the survey were described on the first page of the survey. Online informed consent was obtained by asking participants to check a box on the device's screen with the response (I agree to participate in the study; I do not agree to participate in the survey). If the answer was “I do not agree”, the survey was immediately terminated automatically. This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the institutional review board of Ningxia Medical University (approval #2020–112).
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Qiuhui Lei and Zhehao He are co-first authors
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Lei, Q., He, Z., Koenig, H.G. et al. Light Personality Style and Moral Injury Among Chinese Health Professionals. J Relig Health 62, 3942–3956 (2023). https://doi.org/10.1007/s10943-023-01921-5
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DOI: https://doi.org/10.1007/s10943-023-01921-5