Moral injury severity profiles and their pathways to negative emotions in medical staff: the differential mediating role of emotion regulation

BACKGROUND: Moral injury (MI) and negative emotions (NE) are core psychological issues that severely impair the mental health and professional competence of medical staff, while emotion regulation serves as a crucial psychological resource for coping with occupational psychological distress. However, the latent severity profiles of MI among medical staff, as well as the differential mediating effects of emotion regulation strategies, i.e., cognitive reappraisal (CR) and expressive suppression (ES), between MI and negative emotion (NE) remain unexplored. OBJECTIVE: This study aimed to identify the latent subtypes of MI among medical staff via latent profile analysis and to explore the mediating role of CR and ES between MI and NE, so as to provide empirical evidence for formulating targeted psychological intervention strategies for medical staff. METHODS: This was a cross-sectional survey. 1001 medical staff were enrolled via a convenience sampling method. Questionnaires were used to assess MI, anxiety, depression and emotion regulation among medical staff, with latent profile analysis applied for subgroup identification. The relationships among variables were analyzed using Pearson correlation analysis and mediation analysis. RESULTS: Three profiles of MI were identified and designated as the low injury profile (62.84%), emotion injury profile (25.27%), and value injury profile (11.89%). MI correlated positively with NE (r = 0.38-0.41) and negatively with CR (r = -0.19). Overall, CR had mediated MI-NE associations, while ES did not. Critically, profile‑specific mediation showed that ES had mediated effects in value injury profile, whereas CR partially mediated effects in emotion injury profile. CONCLUSION: To mitigate negative emotions in medical staff, administrators should account for individual differences in MI profiles. For the emotion injury profile, prioritize CR to restructure self-blame. For value injury profile, focus on reducing ES and fostering healthy emotional expression. Tailoring emotion regulation strategies to specific MI profiles is essential to safeguard staff mental health and care quality.