Abstract Background: Moral injury occurs when negative distressing emotions appear and are suppressed. This could lead to several mental health problems such as depression and post-traumatic stress disorder, and result in long-lasting emotional, behavioral, and social problems. Moral injury, a term more commonly used in war contexts, has come into the spotlight during COVID-19 pandemic. We aimed to evaluate the rate of moral injury and its association with psychological injuries during this healthcare crisis. Methods: We assessed the rates of depression, anxiety, stress, and their association with moral injury among 333 nurses, medical interns, and residents between December 2020 and January 2021. This study was done using validated versions of Depression Anxiety Stress Scales (DASS-21) and Moral Injury Symptom Scale-Healthcare Professionals (MISS-HP) scores. Results: Totally 333 healthcare professionals participated in this study, mostly aged between 26 to 30 years old. Nearly half of the participants had a clinically significant moral injury. The average scores of anxiety and stress were significantly higher in women. The participants who were single showed higher rates of depression and moral injury than married ones. Moreover, anxiety, stress, depression, and moral injury were higher in nurses than other healthcare professionals. The scarcity of personal protective equipment at the workplace and giving care to patients with end-stage COVID-19 diagnosis were among the factors associated with a higher risk of developing mental health problems. Conclusion: The results of this study showed that anxiety, stress, depression, and moral injury were prevalent among healthcare professionals during COVID-19 pandemic. Also, the rates of anxiety, stress, and depression were associated with moral injuries.

The authors have declared no competing interest.

The authors received no financial support for the investigation and authorship.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study protocol was approved by the Medical Ethics Committee of Shiraz University of Medical Sciences (Reg. no. 21417). The participants were asked to fill out an informed consent that was provided at the beginning of the questionnaire. The anonymity and secrecy of the participants were guaranteed.

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All data produced in the present study are available upon reasonable request to the corresponding author.