Brennan, CJ 
ORCID: 0000-0002-8284-835X, Roberts, C ORCID: 0000-0003-4275-601X and Cole, JC ORCID: 0000-0003-3515-0183
(2024)
Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis
BMJ Open, 14 (2).
e071776-.
ISSN 2044-6055, 2044-6055
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Prevalence of occupational moral injury and post-traumatic embitterment disorder.pdf - Open Access published version Download (519kB) | Preview |
Abstract
Objectives Occupational moral injury and posttraumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation. Design A systematic review and meta-analysis. Data sources Google Scholar, PubMed, APA PsycINFO, Web of Science Core Collection, Scopus, ScienceDirect and Sage Journals Online were searched in June 2020 and updated in November 2022. Eligibility criteria for selecting studies Observational studies that measured prevalence or average scores of moral injury, or PTED in any occupational group and any geographical location. Data extraction and synthesis Two independent reviewers screened and coded eligible studies. Study design, participant demographics, sampling method, location, measurement tool and prevalence or average scores were extracted. Risk of bias was assessed using the Quality Assessment Checklist for Prevalence Studies tool. Meta-analysis was conducted using random effects models. Results that could not be combined were summarised qualitatively in a narrative synthesis using the Guidance for Systematic Reviews. Results In total, 88 studies across armed forces and veterans, healthcare, first responders, educators, journalists, child protection service employees, the unemployed, public-sector employees and mixed occupations were included. Studies included in each separate meta-analysis based on the measure used ranged from 2 to 30. The pooled prevalence of clinically relevant moral injury in healthcare professionals was 45%, and exposure to any potentially morally injurious event (PMIE) across occupations was 67%. Exposure to transgressions by others and betrayal was significantly lower in the armed forces than civilian occupations. Pooled prevalence of PTED across occupations was 26%. Conclusion Exposure to PMIEs, moral injury symptoms and PTED are prevalent at work and exposure to transgressions by others and betrayal are more likely in civilian occupations than the armed forces.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Occupational Diseases, Prevalence, Stress Disorders, Post-Traumatic, Occupational Exposure, Cost of Illness, Child, World Health Organization, Occupational Injuries |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 22 Feb 2024 08:20 |
| Last Modified: | 24 Jan 2026 04:46 |
| DOI: | 10.1136/bmjopen-2023-071776 |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3178833 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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