ORCID

https://orcid.org/0000-0002-1530-3931

Date of Award

2026

Document Type

Dissertation

Degree Name

Philosophy (Ph.D)

Department

Psychology

First Advisor

Elizabeth Brondolo

Second Advisor

Melissa Peckins

Third Advisor

Wilson McDermut

Abstract

Potentially morally injurious events (PMIEs) are specific traumatic stress exposures characterized by violation of one’s moral beliefs by omission or commission, by witnessing others violating a shared moral code, or by perceived betrayals by trusted leaders or systems in their support of shared values. Researchers have proposed subtypes of PMIEs including moral transgressions by the self (by commission or omission), witnessing moral transgressions by others, and betrayals by trusted leaders and systems. A growing body of literature has documented negative mental health effects of PMIEs in healthcare providers (HCPs). However, important gaps in knowledge remain regarding the measurement and mental health effects of PMIEs in HCPs. This study aimed to examine the measurement of PMIEs, their relations with mental health, and potential mechanisms of these effects in a sample of HCPs working during the early waves of COVID-19 in Italy. Results of factor analyses showed superior fit for a three-factor model of PMIEs, supporting the multidimensionality of the construct. Moral transgressions by the self were associated with greater symptoms of PTSD and depression, whereas witnessed transgressions and betrayals were associated with symptoms of PTSD, depression, and burnout. PMIEs subdimensions varied in their indirect effects through schemas related to alienation and dehumanization. Alienation emerged as a significant mediator of relations of PMIEs-Betrayals with all three mental health outcomes. Dehumanization of colleagues mediated relations of PMIEs-Self and PMIEs-Others with symptoms of PTSD and depression, but all other specific indirect effects were not statistically significant. No statistically significant mediation by dehumanization of patients was found. Our findings support the theoretical conceptualization of PMIEs as a construct, highlighting the importance of betrayals and as a distinct subdimension with unique clinical impacts. Tests of mediation supported the notion of differential effects of PMIE types through alienation and dehumanization, and combined models showed direct and indirect effects of betrayals above and beyond other subdimensions. These findings also have implications for cognitive and affective treatment approaches, as greater understanding of subdimensions of PMIEs can inform appropriate frameworks of psychotherapeutic intervention for moral injury and other PMIE associated distress.

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