Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, M_age = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout.

Background: Because there is a relationship between mental health (MH) and medical adversity and autonomic dysregulation, we hypothesized that individuals infected with COVID-19 would report greater current autonomic reactivity and more MH difficulties (emotional distress, mindfulness difficulties, and posttraumatic stress). We also hypothesized that individuals diagnosed with COVID-19 who are experiencing difficulties related to their prior adversity and those providing medical care to COVID-19 patients would be more negatively impacted due to their increased stress and infection rates.Method: US participants (N = 1,638; 61% female; Age M = 46.80) completed online self-report measures of prior adversity, current autonomic reactivity and current MH difficulties, and COVID-19 diagnosis history. Participants diagnosed with COVID-19 (n = 98) were more likely to be younger and providing medical care to COVID-19 patients.Results: Individuals diagnosed with COVID-19 reported increased current autonomic reactivity, being more negatively impacted by their prior MH/medical adversities, and currently experiencing more MH difficulties with an increased likelihood of clinically-significant PTSD and depression (p < 0.01 – p < 0.001). Current autonomic reactivity mediated 58.9% to 85.2% of the relationship between prior adversity and current MH difficulties; and COVID-19 diagnosis moderated and enhanced the effect of prior adversity on current autonomic reactivity (p < 0.01). Being a medical provider was associated with increased current autonomic reactivity (p < 0.01), while moderating and enhancing the relationship between current autonomic reactivity and emotional distress and posttraumatic stress symptoms (p < 0.05). Combining COVID-19 diagnosis with being a medical provider increased likelihood of clinically-significant PTSD and depression (p < 0.01).Conclusion: Individuals diagnosed with COVID-19, particularly medical providers, have increased current autonomic reactivity that is associated with their prior adversities and current MH difficulties.

Childhood maltreatment history may influence autonomic reactivity and recovery to stressors. Hypothetically, the maltreatment history may contribute to a retuned autonomic nervous system that is reflected in a novel metric, vagal efficiency (VE), designed to assess the functional efficiency of vagal cardioinhibitory pathways on heart rate. We explored whether VE mediates the well-documented relationship between maltreatment history and psychiatric symptoms. We also investigated the relationship between measures of autonomic regulation in response to the physical and emotional challenges and psychiatric symptoms. Participants (n = 167) completed self-report measures of psychiatric symptoms and had continuous beat-to-beat heart rate monitored before, during, and after physical and emotional stressors. Participants with maltreatment histories exhibited lower VE, which mediated the association of maltreatment history and the psychiatric symptoms of anxiety and depression. Consistent with prior literature, there were significant associations between maltreatment history and autonomic reactivity (i.e., heart rate and respiratory sinus arrhythmia) during emotional and physical challenges; however, when VE was entered as a covariate these associations were no longer statistically significant. Blunted VE may reflect a neural pathway through which maltreatment retunes autonomic regulation and provides a neurophysiological platform that increases mental health risk.

Mindful education (ME) in schools can address student well-being and stressors, as well as improve the overall school environment. Implementing a whole-school mindfulness curriculum can be challenging, especially when serving students in both general education and emotional behavioral disorder (EBD) settings. We investigated the feasibility, implementation, and benefits of a whole-school mindfulness curriculum (MindUP) in an urban elementary school. This study is unique in that it investigated how to implement mindfulness curriculum within both general education and EBD student populations. Participants included 55 staff and 436 students. This study used a concurrent mixed methods design. The qualitative data included interviews, informal focus groups, and participant feedback, and the quantitative data included participant satisfaction surveys and teacher assessment of student behaviors before/after the curriculum. While implementing MindUP, teacher feedback was incorporated to adapt the program (e.g., decrease lesson length, provide supplemental child-friendly breathing activities). Qualitative data indicated the adapted MindUP program improved school climate and aided teachers with teaching coping skills, especially breathing techniques, to help their students self-regulate when stressed. Data indicated students in regular education improved in their aggression/disruptive behaviors, concentration/attention, and social/emotional competence, whereas students in the EBD program only improved in their aggression/disruptiveness (effect sizes 0.15 to 0.51). An adapted MindUP curriculum was accepted, implemented, effective, and sustainable in both the general education and EBD settings. The program helped students learn mindfulness-based coping strategies with breathing being the most beneficial mindfulness intervention for managing and reducing student stress and for creating a calmer school climate.

Background/Objectives. Medical and social care professionals (MSCPs) are disproportionately affected by chronic occupational stress, placing them at elevated risk for autonomic dysregulation, affective disorders, and burnout. Method. This preliminary study includes data obtained from two samples. The data protocols were approved by University of Florida’s IRB (IRB202200233 approved 24 February 2023 and IRB202401217 approved on 2 October 2024) and registered at ClinicalTrials.gov (NCT05766852 and NCT06580119). With a total sample of 39 female MSCPs, we investigated the effects of the novel Somatic Psychoeducational Intervention (SPI), grounded in Polyvagal Theory, on autonomic reactivity, psychological distress symptoms, and salivary oxytocin levels. Participants engaged in a three- to four-week intervention integrating psychoeducation, interoceptive training, breathwork, and somatic movement. A subset was randomly assigned via a random number generator to allow for comparison of the intervention group (n = 8) to control group (n = 7). Results. Repeated measures ANOVA revealed increases in salivary oxytocin (η_p² = 0.46) and reductions in autonomic reactivity (η_p² = 0.24) and psychological distress symptoms (η_p² ranging from 0.24 to 0.47). Benefits were sustained at one-month follow-up. Subset analyses focused on participants receiving the intervention at the same time found that only the participants in the intervention group improved with regard to autonomic reactivity and symptoms of anxiety and depression. Correlational analyses showed that changes in oxytocin and autonomic reactivity were associated with mindfulness improvements, which in turn predicted symptom reduction. Conclusions. These preliminary findings support SPI as a potentially scalable intervention with neurophysiological and psychological benefits. However, high attrition and small subgroup sizes necessitate cautious interpretation.

Background/Objectives: Given that post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) are separate constructs that can co-occur following adversity, we examined how prior adversity and current functioning difficulties may relate to the likelihood of meeting criteria for PTSD and scoring above the cutoff for PTG among individuals who reported being impacted by their prior adversity. Methods: Participants (n = 2112) in this international sample completed online measures assessing their adversity history, current functioning difficulties (i.e., negative world assumptions and autonomic reactivity), PTSD symptomatology, and PTG. Results: Chi square analyses suggested a trend toward an association between meeting criteria for PTSD and scoring above the cutoff for PTG, although not statistically significant (p = 0.061). Multivariable logistic regression analysis found that individuals most impacted by caregiver abuse and certain specific adversities (i.e., parent with a mental health problem, caregiver and non-caregiver sexual abuse, and being held captive) were more likely to meet the criteria for PTSD. Whereas those most impacted by life-threatening situations and the specific adversities of being impacted by a life-threatening illnesses or injury, were more likely to meet the criteria for PTG. However, the strongest predictor of the likelihood of PTSD was increased autonomic reactivity, and the strongest predictor of the likelihood of PTG was fewer negative world assumptions. Conclusions: Our research suggests the need to assess the perceived impact of adversity history, as well as the potential negative consequences of autonomic reactivity and negative world assumptions, as these may be associated with PTSD symptomatology and PTG.