Proposing the Integrated Pathway Model of Moral Injury (IPM-MI): A moderated mediation analysis of moral injury among secure mental healthcare staff.

Abstract

Background: Moral injury remains a prevalent issue for staff working in secure mental healthcare services, though understanding of the underlying mechanisms driving the development of moral injury and associated well-being outcomes remains limited. This multi-study paper explores several developmental, cognitive and emotional pathways to moral injury, and subsequent psychological and somatic adversities.
Method: Staff working in secure mental healthcare settings were recruited to study one (n=527) and study two (n=325), and completed several self-report questionnaires.
Results: Findings indicated a serial mediating effect of childhood trauma symptoms, early maladaptive schemas, and maladaptive metacognitions in the pathway between exposure to potentially morally injurious events and moral injury, which was moderated by social and organisational support. Additionally, the pathway between moral injury and psychological, somatic and functional outcomes was mediated by negative emotional schema.
Conclusion: The results support a developmental-cognitive model to account for the development of moral injury and associated adverse well-being outcomes in secure mental healthcare staff. Drawing on the findings and wider literature, the Intergrated Pathway Model of Moral Injury (IPM-MI) is proposed and discussed.