(PS1-A5) Coping Styles Moderate the Relationship Between Institutional Betrayal and Symptoms of PTSD in Nurses During the COVID-19 Pandemic

Institutional betrayal (IB) occurs when an institution relied upon by a person harms them (Smith et al, 2014). IB has been associated with symptoms of trauma as well as other negative sequelae (Lind et al, 2020). This study sought to (1) determine if IB uniquely predicts symptoms of Post-Traumatic Stress Disorder (PTSD) among nurses during the COVID-19 pandemic; and (2) identify coping style moderators within this predictive model. Study data are drawn from a survey of 429 nurses (m(age)=43.6, SD(age) = 12.68, 94% White, 94% using she/her pronouns) administered with the Massachusetts Nurses Association between June-September 2020. IB was measured by the Institutional Betrayal Questionnaire (IBQ) (Smith et al, 2013) and symptoms of PTSD were measured by the PTSD Checklist for DSM-5 (PCL-5) (Weathers et al, 2013). Coping styles were assessed by the Brief-COPE (Carver, 1997) and analyzed using a 4-factor model: problem focused, emotion focused, avoidant, and socially supported coping (Fluharty et al, 2021). We hypothesized that IB would uniquely predict symptoms of PTSD in this sample (Adams-Clark et al, 2021). Further, we expected emotion focused coping to buffer against PTSD symptoms (Fluharty et al, 2021) and avoidant coping styles to be associated with increased PTSD symptoms (Dehon et al, 2021). Analyses of socially supported and problem focused coping were exploratory.

We first conducted a hierarchical multiple regression to determine if the addition of IB improved the prediction of PTSD symptoms beyond level of workplace COVID-19 exposure. The full model of level of exposure and IB to predict symptoms of PTSD was statistically significant: R² = 0.131, F(1,316) = 47.712, p= <.001. The addition of IB to the prediction of symptoms of PTSD led to a statistically significant increase in R² of .102, F(1,315) = 41.70, p=< .001. A one unstandardized unit increase in IB led to a 0.73 unstandardized unit increase in PTSD symptoms, holding workplace exposure to COVID-19 constant.  

Next, interaction terms between each coping style and IB were individually added to the regression model using PROCESS. All variables were positively scaled. Emotion focused coping and problem focused coping did not significantly moderate the relationship between IB and symptoms of PTSD. However, there were statistically significant moderator effects of avoidant coping (ΔR² = .017, F(1,322) = 8.90, p= .0031, b=-0.087, t(322)= -2.98, p=.003) and socially supported coping (ΔR² = .0167, F(1,324) = 6.52, p= 0.011, b= -0.072, t(324) = -2.55, p=.01), indicating that a significant proportion of the variance in PTSD symptoms was accounted for by these interaction terms. Conditional effects analysis revealed that at low and average avoidant or socially supported coping, PTSD symptoms significantly decreased.

These results indicate that that IB predicts symptoms of PTSD in this sample, holding workplace exposure to COVID-19 constant. This relationship is weakened by avoidant and socially supported coping styles; therefore, these styles may be more effective when dealing with IB. Implications for understanding the role of institutions in influencing trauma symptoms are discussed. Study results may inform efforts to identify helpful coping strategies in the context of IB.