Psychological Trauma: Understanding Risk, Building resilience

Abstract

This PhD aimed to ascertain the protective and vulnerability factors of psychological trauma and moral injury in front-line workers and their families during public health crises. Furthermore, to determine how resilience is developed and how this can mitigate the impact of psychological trauma and moral injury. This PhD further aimed to propose a conceptual model aimed at elucidating the psychological impact, and promotive factors of resilience in front-line workers and their families during public health crises. At present, the psychological impacts of working on the front-line during a public health crisis are not fully understood. As such, a systematic review of the literature was conducted.
The systematic review aimed to explore the existing literature on psychological trauma, moral injury and resilience in front-line workers during public health crises. In total, thirty-two papers met the inclusion criteria, which were subjected to a narrative analysis (Popay et al., 2006). The findings highlighted that front-line workers face a plethora of challenges during public health crises. This included, fear of contagion and transmission, changes to working conditions, increased stress, exposure to trauma and moral injury. However protective factors, such as social support in the workplace and self-compassion, promoted the development of resilience. As such, Study one investigated the lived experiences of front-line workers and their families during the COVID-19 pandemic.
Study one is comprised of two qualitative semi-structured interview studies. Part A had a sample of twenty-one family members of front-line workers, and part B a sample of front-line workers. Identical procedures were utilised in both studies and both parts were analysed using Grounded Theory (Glaser & Strauss, 1967; Glaser, 1978) and a thematic analysis (Braun & Clarke, 2006). The results highlighted several promotive and protective factors of psychological trauma, moral injury and resilience in front-line workers and their families. Seven themes emerged in part A these were: 1.) Elevated stress, including aggravation of pre-existing challenges, 2.) Enhancing wellbeing by using time productively, 3). Unhelpful coping emerging due to restrictions, 4). Connecting with nature to improve wellbeing, 5). Fear of transmission of the virus, 6.) Psychological cost of caring, 7.) Benefits and negatives of online communication. Ten themes emerged in part B and were: 1.) Elevated stress in the workplace, 2.) Organisational support, 3). Fear of transmission, 4.) Feeling betrayed and unsupported by leadership, 5.) Experiencing moral distress in the workplace, 6.) Promoting wellbeing through adopting internal and external coping strategies, 7.) Connecting with nature, 8.) Supporting families, 9.) Feeling resilient and/or able to take control of future actions, and 10.) Maladaptive coping adopted. Overall, the findings indicated front-line workers and their families were psychologically impacted as a result of the COVID-19 pandemic.
Study two aimed to further explore the impact of the COVID-19 pandemic. It sought to ascertain the severity of psychological trauma and moral injury experienced in front-line workers and their families. Furthermore, it aimed to ascertain the factors that underpin resilience during public health crises. Lastly, it aimed to investigate if moral injury and psychological trauma were mediated by resilience. Using a cross-sectional quantitative design, a sample of 203 participants were recruited (Front-line workers N = 98, Families N =105). The results indicated that front-line workers and their families experienced moderate levels of moral injury and psychological trauma during the COVID-19 pandemic. Moderate levels of resilience emerged that were positively predicted by subjective wellbeing. Furthermore, moral injury was found to have a causal effect on psychological trauma via resilience.
This research resulted in the development of a conceptual model called the Health Crisis Impact Model (HCIM). This model proposed a two-way inter-connected pathway that identifies the impact of stressors specific to public health crises on front-line workers and their families. In addition, it presents the protective factors of resilience and highlights how these can promote the development of resilience in individuals and families. The HCIM is preliminary, requires testing and future validation to explore its utility in understanding the impact of future public health crises.