Background: Treatments for posttraumatic stress (PTS) are effective for many but not all people. There is a continued need to further our understanding of psychological mechanisms involved in the development and maintenance of PTS. Research has examined dysregulation of negative affect (NA) in PTS but relatively little attention has been paid to the role of dysregulation of positive affect (PA) in PTS.

Moral injury is the profound psychological distress which can arise following participating in, or witnessing, events which transgress an individual’s morals and include harming, betraying, or failure to help others, or being subjected to such events, e.g. being betrayed by leaders. It has been primarily researched in the military, but it also found in other professionals such as healthcare workers coping with the COVID-19 pandemic and civilians following a wide range of traumas.

Studies of posttraumatic stress disorder (PTSD) report volume abnormalities in multiple regions of the cerebral cortex.

The COVID-19 pandemic forces frontline health-care workers to make difficult medical decisions that may result in moral injury. Understanding the extent to which physicians, nurses, and other health-care workers experience moral injury while working in a pandemic is of critical importance to establish preventative measures and trauma-informed treatment. A national sample of health-care workers (n = 109) participated in the study.