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Sarah Rabin,1 Natalia Kika,1 Danielle Lamb,2 Dominic Murphy,1,3 Sharon AM Stevelink,1 Victoria Williamson,1,4 Simon Wessely,1 Neil Greenberg1 1Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; 2Department of Applied Health Research, University College London, London, UK; 3Research Department, Combat Stress, Leatherhead, UK; 4Department of Experimental Psychology, University of Oxford, Oxford, UKCorrespondence: Sarah Rabin, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Weston Education Centre, London, SE5 9RJ, UK, Tel +44 02078485351, Email sarah.p.rabin@kcl.ac.ukAbstract: Moral injury (MI) refers to the persisting distress which may occur following exposure to potentially morally injurious events (PMIEs). The COVID-19 pandemic has drawn attention to MI in healthcare workers, who have been found to experience more frequent PMIEs in their day-to-day work than those in other occupational groups such as the military. These events may occur on an individual, team, organizational or system level and have been associated with increased clinician burnout and distress, and poor psychological wellbeing. This paper focuses on healthcare workers’ experiences of MI, including potential causes and ways to reduce them. There are myriad challenges that influence the development of MI, such as chronic understaffing and the pressure to treat high numbers of patients with limited resources. There are also multiple impacts of MI: at the individual-level, MI can lead to increased staff absences and understaffing, and prolonged patient contact with limited decision-making power. COVID-19 exacerbated such impacts, with a lack of organizational support during a time of increased patient mortality, and uncertainty and heightened pressure on the clinical frontline associated with scarce resources and understaffing. Potential methods for reduction of MI in healthcare workers include pre-exposure mitigation, such as fostering work environments which treat PMIEs in the same way as other occupational hazards and post-exposure mitigation, such as facilitating healthcare workers to process their experiences of PMIEs in peer support groups or with spiritual advisors and, if MI is associated with mental ill-health, talking therapies using trauma-focused and compassion-oriented frameworks.Keywords: moral injury, healthcare workers, causes, effects, mitigation, pandemic, prevention, treatment

ICMA, a software framework to create 3D finite element models of the left ventricle from cardiac ultrasound or magnetic resonance imaging (MRI) data, has been made available as an open-source code. The framework is hardware vendor independent and uses spec

Background Climate change can negatively affect mental health, and poor mental health can negatively affect work. However, less is known about the relationship between mental health and workplace behaviours within the climate change context. Aims To explore existing literature relating to climate-induced mental ill-health as a potential predictor of workplace behaviours. Methods Scoping review, searching five databases for relevant literature using two separate search strategies. Results Only five studies with any relevant data were found. Results could not be easily synthesized because each of the five considered different work-related outcomes. However, the available data suggest that the psychological impact of extreme events could lead to increased job tension, higher turnover intentions and workplace hostility. Stress about extreme weather could also impede the ability to make essential work-related decisions and, for those who work in the environmental sector, concerns about climate could lead to overcommitment to work. There was some evidence that social support might lessen the effects of climate-induced stress on work outcomes. Conclusions Very little literature considers the impacts of climate change on employees' mental health and associated workplace function. The available evidence suggests there are potential negative impacts which may be mitigated by social support. It is important for future research to explore ways of supporting staff and fostering resilience. [ABSTRACT FROM AUTHOR]

Background Research has shown that of the myriad services available to veterans in the UK, very few have been independently evaluated. This report presents the results of a randomized controlled trial assessing the impact of Time Line Therapy™ delivered by the Warrior Programme (a third-sector organization). Aims This study was aimed to determine if the intervention is effective in reducing emotional and functional difficulties in ex-service personnel. Methods A mixed-design analysis of variance model was used to investigate whether the Warrior Programme had a statistically significant impact on self-reported scores. The intervention and control group provided data on measures prior to and immediately after the intervention, and at 3-month follow-up. Results Those in the intervention group (n = 23) reported statistically significant improvements in self-reported scores immediately following intervention: the Clinical Outcomes in Routine Evaluation (CORE) scores (CORE global distress mean difference [MD] = 45.0, 95% confidence interval [CI] 31–60) (CORE subjective well-being MD = 5.9, 95% CI 3.5–8.3) (CORE functioning MD = 16.7, 95% CI 11.4–21.9) (CORE problems/symptoms MD = 19.4, 95% CI 13.1–25.7), general self-efficacy (MD = −9.8, 95% CI −13.6 to –6.8), anxiety (MD = 8.6, 95% CI 5.2–12.1), depression (MD = 10, 95% CI 6.6–13.5), post-traumatic stress disorder (MD = 26.3, 95% CI 17–25) and functional impairment (MD = 11.1, 95% CI 5.3–16.8) over time, compared to the control group (n = 29). However, score improvement was not sustained over time or statistically significant at follow-up. Conclusions The Warrior Programme was effective in reducing emotional and functional difficulties in ex-service personnel immediately after the intervention, but the effect was not sustained at 3-month follow-up. [ABSTRACT FROM AUTHOR]