@article{ref1,
title="Moral injury: the effect on mental health and implications for treatment",
journal="Lancet psychiatry",
year="2021",
author="Williamson, Victoria and Murphy, Dominic and Phelps, Andrea and Forbes, David and Greenberg, Neil",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="Moral injury is understood to be the strong cognitive and emotional response that can occur following events that violate a person's moral or ethical code.1 Potentially morally injurious events include a person's own or other people's acts of omission or commission, or betrayal by a trusted person in a high-stakes situation. For example, health-care staff working during the COVID-19 pandemic might experience moral injury because they perceive that they received inadequate protective equipment, or when their workload is such that they deliver care of a standard that falls well below what they would usually consider to be good enough. Unlike post-traumatic stress disorder, which can occur following threat-based trauma, potentially morally injurious events do not necessarily involve a threat to life. Rather, morally injurious events threaten one's deeply held beliefs and trust. Moral injury is not considered a mental illness. However, an individual's experiences of potentially morally injurious events can cause profound feelings of shame and guilt, and alterations in cognitions and beliefs (eg, "I am a failure", "colleagues don't care about me"), as well as maladaptive coping responses (eg, substance misuse, social withdrawal, or self-destructive acts). It is these challenged beliefs and altered appraisals that are thought to lead to the development of mental health problems, with a 2018 meta-analysis finding that exposure to potentially morally injurious events was significantly associated with post-traumatic stress disorder, depression, and suicidality... Language: en
",
language="en",
issn="2215-0374",
doi="10.1016/S2215-0366(21)00113-9",
url="http://dx.doi.org/10.1016/S2215-0366(21)00113-9"
}