(PS4-A17) Examining Anger as a Moderator in the Association Between Institutional Betrayal and PTSD in Nurses During the COVID-19 Pandemic

Psychological functioning among nurses has garnered increasing interest among researchers, particularly in the wake of the COVID-19 pandemic. Previous research highlighted PTSD as an immediate concern for nurses due to repeated exposure to traumatic events through patient care. The pandemic has strengthened this concern, with studies showing high rates of PTSD among nurses across the globe. Recent work has highlighted the role of institutional betrayal (failure by an institution to uphold trust and protect its members from harmful acts) in association with PTSD among healthcare workers during COVID, suggesting that greater examination of perceptions of perceived betrayal is important. In this study, we examine whether anger moderates the association between institutional betrayal and PTSD; theoretical work holds that when high levels of betrayal trauma are accompanied by anger, there is an increased likelihood of PTSD symptoms. To control for work-related exposure, the percentage of time working with COVID+ patients was treated as a covariate.    

 Participants included 317 nurses (M_age = 43.23; SD_age = 12.70) practicing in Massachusetts during the COVID pandemic. The sample was predominately white (94.3%) and used she/her pronouns (93.2%). Perception of institutional betrayal was measured using a modified version of the Institutional Betrayal Questionnaire; PTSD symptoms were measured using the PTSD Checklist for DSM-5; and anger was measured using the State Anger Scale. A question assessing nurses’ percentage of work involving COVID+ patients was included as well.  

 Moderation analysis was conducted using SPSS version 28.0. The overall model was significant (F (3,312) = 106.23; p < .001; R² = .57). A significant interaction was noted (B = -.02; p = .03), such that anger moderated the association between institutional betrayal and PTSD symptoms, holding percent of work with COVID+ patients constant. Specifically, for every unstandardized unit increase in anger, the unstandardized direct effect of institutional betrayal on PTSD decreased by .02 units.  

 Results suggest that for nurses who report low levels of anger, level of institutional betrayal yielded a dose-response relationship, such that higher levels of institutional betrayal corresponded with higher levels of PTSD symptoms. However, for those with high levels of anger, PTSD symptoms appear more elevated overall, irrespective of level of betrayal. This suggests individual differences may be influential in the relationship between institutional betrayal and PTSD symptoms. Theoretical reasons for these obtained differences will be discussed and clinical implications will be explored.