Occupational Stress and Moral Injury in US Healthcare Workers (HCW) with Caregiving Duties During the COVID-19 Pandemic

Abstract

Rationale: The advent of the global pandemic due to SARS-CoV-2 infections resulting in COVID-19 disease resulted in increased demands on HCWs for professional services. In concert, many pre-school, primary, and secondary schools closed physical facilities and initiated virtual curricula, requiring the presence of caregivers at home for younger children during typical working hours. The tension of increased job responsibilities and home caregiving responsibilities with limited remedies in HCWs during the COVID-19 pandemic may result in increased stress and possible moral injury. Methods: We surveyed HCWs at a single large tertiary academic hospital in June 2020. Participants were part of a larger study examining occupational distress, resilience, and moral injury. Status as a caregiver to children <18 years old, partnership status, changes in caregiving responsibilities, work patterns, and difficulties in work due to caregiving were evaluated using a subset of items from the University of Washington Caregiver Stress Scale. Symptoms of occupational stress were evaluated with the Impact of Event Scale - Revised (IES-R), and signs of potential moral injury were evaluated with the Moral Injury Event Scale (MIES). Results: Out of 96 respondents, 38 HCW self-identified as caregivers to children. The majority of caregiving HCW (73%) spent >50% of their professional time in clinical work. Caregivers were principally married (82%) or partnered (2.6%). Approximately 60% of caregivers reported increased caregiving responsibility for themselves as well as their spouse or partner. Few HCWs reported missing work due to childcare responsibilities. Mean IES-R scores were similar in caregivers and non-caregivers (14.8 ± 10.7 v. 14.2 ± 10.6, p=0.78) demonstrating moderate occupational stress. Mean MIES scores were similar in caregivers and noncaregivers (13.3 ± 9.1 v. 15.0 ± 7.6, p=0.33) and demonstrated low levels of potentially morally injurious events. Conclusions: While HCWs experienced an increase in childcare responsibilities during the COVID-19 pandemic, levels of occupational stress and possible moral injury were low to moderate when assessed in June 2020. Few HCWs reported work absence due to childcare needs, suggesting that these HCWs accessed alternative means of childcare to allow them to continue clinical work. Presence of a partnered marital status and concomitant increase in the partner's childcare responsibilities, in addition to high socioeconomic status, might have facilitated these arrangements. Other unmeasured resilience factors may also have contributed to low levels of occupational stress and moral injury, such as employer expectations on work tasks or expanded resources for childcare.