Burnout, moral injury, and suicidal/self-harm ideation among healthcare professionals in Mainland China: Insights from an online survey during the COVID-19 pandemic

Objective This survey explored the relationships between burnout, moral injury, and suicidal/self-harm ideation among Chinese health professionals in mainland China. Methods Health professionals were surveyed online using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, Patient Health Questionnaire-9, and the Moral Injury Symptom Scale-Health Professional version. Results A total of 6,146 health professionals participated in the study. The average age of participants was 34.9 ± 8.5 years, and suicidal/self-harm ideation was present in 2,338 participants (38.0%). The prevalence of suicidal/self-harm ideation was more common among those with severe burnout (vs. mild burnout), particularly in the dimensions of emotional exhaustion, depersonalization, and decreased personal accomplishment. The prevalence of suicidal/self-harm ideation among those with significant moral injury symptoms was higher than in those without moral injury. Unconditional logistic regression analysis demonstrated that those with moderate or severe emotional exhaustion, moderate or severe reduced sense of professional accomplishment, and moderate or severe depersonalization were at increased risk of suicidal/self-harm ideation. Structural equation modelling demonstrated that burnout significantly mediated the relationship between moral injury and suicidal/self-harm ideation. The proportion of mediation (PM) by burnout was 43.0%. Conclusions This study found that burnout and moral injury were significant predictors of suicidal/self-harm ideation among health professionals in China. Both moral injury and burnout had positive and direct effects on suicidal/self-harm ideation, and burnout mediated the relationship between moral injury and suicidal/self-harm ideation. Interventions to address moral injury and subsequent burnout in Chinese healthcare workers may enhance the mental health of these healthcare professionals and increase the quality of care that they provide.