Abstract
Background: Caregiving for people living with serious illnesses often leads to deep, emotional, societal and ethical obstacles, which may negatively impact a caregiver's mental health. Many studies have looked at the mental strain on caregivers (caregiver burden), anxiety and depression; however, there has been little research addressing the importance of moral injury and resiliency in relation to psychological distress; especially with respect to the delivery of care in under-resourced, publicly funded health systems.
Objective: The purpose of this study was to determine the levels of moral injury, resiliency and psychological distress of caregivers of chronic illness patients in public sector hospitals located in Swat, Pakistan and to assess the interrelationship of these three variables.
Methods: A cross-sectional quantitative research methodology was used for this design. This study used convenience sampling to select a total of 384 primary caregivers at selected public hospitals in the region of Swat to obtain the primary data for the study from caregivers with at least 5 years of experience providing care to terminally ill patients. The primary instrument used to collect primary caregiver data was a standardized questionnaire that measured three distinct constructs: the Moral Injury Events Scale (MIES), the Connor–Davidson Resilience Scale (CD-RISC), and the Depression Anxiety Stress Scale (DASS-21). The data collected was analyzed by using SPSS version 27, employing descriptive statistics, chi-square tests, and Pearson correlation analysis to investigate the relationship between the three main constructs of the study.
Results: The results of this study indicated that 43.8% of primary caregivers reported experiencing moderate moral injury, while 31.2% of primary caregivers reported experiencing high moral injury. With respect to the resilience construct, 40.6% of primary caregivers demonstrated experiencing moderate resilience, while 28.6% had low resilience. More than half of primary caregivers surveyed experienced at least mild-to-moderate psychological distress, while 18.2% of primary caregivers surveyed reported experiencing severe psychological distress. A significant negative correlation was identified between moral injury and resilience (r = −0.46), while moral injury had a significant positive correlation with psychological distress (r = 0.52), and resilience had a significant negative correlation with psychological distress (r = −0.49). The chi-square analysis demonstrated statistically significant associations between moral injury and resilience (χ² = 16.84, p < 0.001) and between moral injury and psychological distress (χ² = 29.72, p < 0.001).
Conclusion: The conclusion reached was that there is a high level of moral injury and psychological distress being suffered by the caregivers of patients suffering from chronic disease in public hospitals located in the Swat region of Pakistan. Resilience has been shown to provide a protective function in reducing psychological distress and mitigating the adverse effects of moral injury. It is recommended that systems of care provide organized psychosocial interventions, develop programs that build resilience, and provide policy-level support systems designed to promote the well-being of caregivers and to improve outcomes associated with caregiving.