Page 68 - JSOM Summer 2023

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TABLE 5 Partial Regression Coefficients and Squared Semi-Partial Correlations (sr ) for Each Predictor on Each Block of an HLM Predicting
PMBS Total Score (n = 811)
Std. Error
Predictor B B β sr 2 p-value
Block 1
Female 1.35 0.97 0.05 — .163
Caucasian –1.93 1.76 –0.04 — .272
Age –0.06 0.05 –0.58 — .238
Latinx –0.84 2.47 –0.1 — .734
Block 2
Years of Field Experience (>5) 0.00 0.06 0.00 — .985
Employed Full-time 1.89 1.13 0.06 — .096
Primary Employer (EMS) 0.88 1.45 0.03 — .541
Primary Employer (Fire) –1.04 1.76 –0.03 — .556
ALS Provider 0.33 1.13 0.00 — .977
Block 3
Primary Information Source (employer, PCP, or continuing education class) –2.13 1.04 –0.07 0.004 .040
Member of household diagnosed with COVID-19 3.13 1.03 0.10 0.010 .003
Friend(s) diagnosed with COVID-19 –2.80 1.22 –0.08 0.006 .021
Feels HCWs are at higher risk of infection –1.41 1.25 –0.04 — .260
Can make an informed decision about COVID-19 vaccination 2.41 1.44 0.06 — .093
Would not be comfortable with a family member being treated by an 3.23 2.05 0.07 — .115
unvaccinated EMS professional
Would not be comfortable with a family member being treated by an 2.03 2.00 0.12 — .312
unvaccinated HCW
Reported to work with flu- or COVID-like symptoms 3.99 1.00 0.13 0.016 <.001
Believes information sources are reliable and accurate 3.57 0.75 0.17 0.024 <.001
Block 4
Higher workplace stress 0.86 1.05 0.03 — .414
Less workplace satisfaction 1.77 1.02 0.06 — .082
Higher general level of anxiety 4.62 1.03 0.18 0.021 <.001
ALS, Advanced Life Support; COVID-19, Coronavirus Disease 2019; EMS, Emergency Medical Services; HCW, Healthcare Worker; HLM, Hi-
erarchical Linear Model; PCP, Primary Care Physician; PMBS, Posttraumatic Maladaptive Belief Scale

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half of confirmed COVID-19 cases in those aged <18 years. 28,30 demonstrated a strong correlation to PTSI. The TH subscale
Demographic variables overall were predictive of maladaptive describes an individual’s thoughts about his or her safety from
cognitions, explaining a significant 1.8% of the model. Addi- other people within the world at large. TH scores have shown
tionally, age, sex, and race were all significant in the univariate a strong linear relationship with PTSI as well as an association
analysis, following trends proffered by the CDC. 28 with decreased feelings of dependence and closeness with oth-
ers. 34,35 In this context, dependence is defined as the extent that
A civilian study of maladaptive coping conducted by Cheng et a person believes other people to be reliable, while closeness
al. identified higher levels of anxiety and sleep disturbances in is defined as an individual’s comfort with closeness and inti-

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respondents who felt they lacked information about the pan- macy. In our sample, TH scores were 13.85 ± 5.65, which is
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demic compared with those who did not. In our univariate higher than civilian averages. 33
analysis, respondents who felt they lacked quality information
about the pandemic scored an average of 5 points higher on The SWJ subscale was inversely correlated with positive
the PMBS than did their informed counterparts. Despite this growth post-event, and increased scores were indicative of
particular variable not showing as predictive in our regression decreased self-worth and increased self-judgment. Those with
analysis, we were able to show predictive utility in those who moral injury and PTSI may internalize maladaptive cognitions
felt their sources of information were accurate and reliable, and believe they are “unforgivable.” Both SWJ and RTO sub-
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which is consistent with Cheng’s results. A total of 45% of scales have shown an association with moral injury. Because
respondents in Cheng’s study showed clinically relevant anxi- the impetus of moral injury is a threat to morality, forgiveness
ety; in our sample, 44.8% of EMS professionals self- reported of self is a key tenet in these subscales as well as the treatment
higher general levels of anxiety than prior to the start of the of moral injury. A 2015 study by Bryan, et al. showed that
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pandemic. a lack of self-forgiveness differentiated suicidal ideators from
attempters. Ergo, forgiveness of others and of self may play an
Given that roughly 10% of those exposed to traumatic events important role in the treatment of moral injury.
will go on to develop PTSI, our results are concerning. 19,23,24,31–33
Recent studies have identified direct links between trauma- or Further research should examine how EMS professionals are
stress-related disorders and suicidality in EMS profession- processing events and coping during the COVID-19 pandemic,
als. 24–26 Overall scores on the PMBS and all subscales have particularly those in minority communities.

66 | JSOM Volume 23, Edition 2 / Summer 2023