Moral injury has been found to be prevalent among healthcare professionals during the COVID-19 public health crisis.

The present study examines the relationship between spirituality, moral injury, and mental health among physicians and nurses in mainland China during the COVID-19 pandemic.

An online cross-sectional study was conducted involving 3006 physicians and nurses in mainland China, where the COVID-19 pandemic has caused high rates of hospital admission and death. The Moral Injury Symptoms Scale-Health Professional was administered, along with measures of mental health and spirituality. Hierarchical linear regression modelling was used to examine the mediating and moderating role of moral injury in the relationship between spirituality and mental health.

Spirituality was positively correlated with moral injury (β = 2.41, P < 0.01), depressive symptoms (β = 0.74, P < 0.01) and anxiety symptoms (β = 0.65, P < 0.01) after controlling sociodemographic variables. Moral injury significantly mediated the relationship between spirituality and both depression and anxiety, explaining 60% (0.46/0.76) of the total association between spirituality and depression and 58% (0.38/0.65) of the association with anxiety. No moderating effect of moral injury was found on the spirituality–mental health relationship.

Although they were the findings of a cross-sectional study, these results suggest that concern over transgressing moral values during the pandemic may have been a driving factor for negative mental health symptoms among Chinese health professionals for whom spirituality was somewhat important. Future longitudinal studies are needed to determine the causal nature of these relationships.

Although mental distress and quality of life (QoL) impairments because of the pandemic have increased worldwide, the way that each community has been affected has varied.

This study evaluated the impact of social distancing imposed by coronavirus disease-2019 (COVID-19) on Brazilians’ mental health and QoL.

In this cross-sectional community-based online survey, data from 1156 community-dwelling adults were gathered between 11 May and 3 June 2020. We examined independent correlates of depression, anxiety and QoL, including sociodemographic and clinical characteristics, optimism/pessimism and spiritual/religious coping. Dependent variables were assessed using the 9-item Patient Health Questionnaire for depressive symptoms, the 7-item Generalized Anxiety Disorder Scale for anxiety symptoms, and the World Health Organization Quality of Life-BREF for QoL. Correlates of depressive and anxiety disorder were estimated using logistic regression.

There were high levels of depressive symptoms (41.9%) and anxiety symptoms (29.0%) in participants. Negative spiritual/religious coping was positively correlated with depressive disorder (odds ratio (OR) = 2.14 95% CI 1.63–2.80; P < 0.001) and with anxiety disorder (OR = 2.46 95% CI 1.90–3.18; P < 0.001), and associated with worse social and environmental QoL (P < 0.001). Healthcare professionals were less likely to have depressive symptoms (OR = 0.71, 95% CI 0.55–0.93; P < 0.001). Participants with friend/family with COVID-19 scored lower on psychological and environmental QoL (P < 0.05). Participants with a longer duration of social isolation were less likely to experience anxiety disorder (OR = 0.99, 95% CI 0.98–0.99; P = 0.004).

We found high levels of depressive and anxiety symptoms and low levels of QoL in Brazil, which has become a pandemic epicentre. Several characteristics were associated with negative mental health symptoms in this study. This information may contribute to local health policies in dealing with the mental health consequences of COVID-19.

Cancer is a leading cause of death worldwide. Religiosity is a factor that may help cancer patients to cope with their disease. The aim of the current study was to validate a Persian translation of the Muslim Religiosity Scale (MRS) in a population of Iranian patients with cancer.

Two thousand patients were invited to participate in this multisite study, of whom 1,879 participated. Patients completed a demographic questionnaire, the MRS, and several scales, including the Patient Health Questionnaire–9, the Hospital Anxiety and Depression Scale, the Perceived Social Support Scale, and the SF–12 quality of life measure. Backward–forward translation was employed to develop a Persian-language version of the MRS. Cronbach's alpha and two-week test–retest reliability were also assessed. Convergent and discriminative validity as well as the factor structure of the scale were also examined.

The internal reliability (α) of the religious practices and beliefs subscales was 0.88 and 0.92, respectively. The intraclass correlation coefficient (ICC) was 0.92 (range = 0.75–1.0). The scale demonstrated solid convergent and discriminative validity. Factor analysis indicated two main factors, as predicted, with an appropriate goodness of fit (χ2 = 76.23, RMSEA = 0.065). Such factors as marital status, quality of life, social support, and self-efficacy were positively associated with MRS total score, while anxiety, depression, and suicide ideation had negative associations.

The MRS is a useful tool for assessing religiosity in Iranian patients with cancer and is associated with a number of important health outcomes.