{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:34Z","timestamp":1788502354808,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic has increased attention to moral injury (MI) among healthcare professionals (HCPs). MI refers to the psychological distress that may arise following exposure to events that violate individuals\u2019 deeply held moral beliefs. The Moral Injury Symptoms Scale\u2013Health Professional (MISS-HP) is an instrument designed to assess MI symptoms among HCPs. Although the MISS-HP has been evaluated in several countries, divergent psychometric solutions have been reported, and the instrument has not yet been evaluated in Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the psychometric properties of the Swedish version of the MISS-HP among hospital-based HCPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>HCPs were recruited using an online survey distributed across Swedish hospitals. Exploratory factor analysis (EFA) was performed to investigate the factorial structure of the MISS-HP. Internal consistency was assessed using McDonald\u2019s Omega and construct validity through measures of psychological distress. Recevier operating characteristic (ROC) analysis was used to estimate a candidate cut-off score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The sample included 585 HCPs (mean age = 45.95\u202fyears, 72.2% women, 51.4% nurses). EFA supported a two-factor solution (Guilt\/Shame, Trust\/Meaning) comprising six of the original MISS-HP ten items and showed good fit [\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      (4) = 9.07,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.059; RMSEA = 0.046; TLI = 0.975; RMSR = 0.018], accounting for 43.6% of the total variance. McDonald\u2019s Omega indicated good internal consistency (\n                      <jats:italic>\u03c9<\/jats:italic>\n                      = 0.80). Measures of psychological distress were moderately associated with MISS-HP scores and ROC analysis identified a candidate cut-off score of \u2265 20.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The resulting six-item Swedish MISS-HP demonstrated satisfactory psychometric performance for measuring MI symptoms in the sample.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1923213","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:29:26Z","timestamp":1788499766000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Swedish moral injury symptoms scale\u2013health professional: psychometric evaluation in a sample of hospital-based healthcare professionals across Sweden"],"prefix":"10.3389","volume":"17","author":[{"given":"Anna","family":"Hjalmarsson","sequence":"first","affiliation":[{"name":"Department of Sociology, Ume\u00e5 University","place":["Ume\u00e5, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Grimell","sequence":"additional","affiliation":[{"name":"Department of Sociology, Ume\u00e5 University","place":["Ume\u00e5, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelle","family":"van Gurp","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Radboud Institute for Health Sciences (IQ Health)","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milou","family":"Looijmans","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Radboud Institute for Health Sciences (IQ Health)","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tine","family":"Molendijk","sequence":"additional","affiliation":[{"name":"Department of Military Management Studies, Faculty of Military Sciences, Netherlands Defense Academy","place":["Breda, Netherlands"]},{"name":"Department of Political Science, Radboud University Nijmegen","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Gomes","family":"Almeida","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Universidade Federal de S\u00e3o Paulo (UNIFESP)","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niek","family":"Kok","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center, Radboud Institute for Health Sciences (IQ Health)","place":["Nijmegen, Netherlands"]},{"name":"Department of Ethics and Law, Leiden University Medical Center","place":["Leiden, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Feijo","family":"Mello","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Universidade Federal de S\u00e3o Paulo (UNIFESP)","place":["S\u00e3o Paulo, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno Messina","family":"Coimbra","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Universidade Federal de S\u00e3o Paulo (UNIFESP)","place":["S\u00e3o Paulo, Brazil"]},{"name":"Amsterdam UMC, Department of Psychiatry, Amsterdam Public Health and Global Health Research Institute, University of Amsterdam","place":["Amsterdam, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1002\/jts.22404","article-title":"Associations among exposure to potentially morally injurious experiences, spiritual injury, and alcohol use among combat veterans","volume":"32","author":"Battles","year":"2019","journal-title":"J. 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