From moral distress to somatic symptoms in social workers: perceived stress as a mediator and workplace social support as a moderator

Although the concept of moral distress has emerged as a useful framework for understanding professional suffering in social work, its connection to physical health outcomes remains largely unknown. This study examined whether moral distress was indirectly associated with somatic symptoms via perceived stress among Spanish social workers, and whether workplace social support moderated the association between moral distress and perceived stress. A cross-sectional, questionnaire-based design was employed with a complete-case analytical sample (N = 454). A moderated mediation model was estimated using path analysis with bootstrap confidence intervals. Moral distress was positively associated with perceived stress, which in turn was positively associated with somatic symptoms. Workplace social support was negatively associated with perceived stress. A significant indirect association was observed between moral distress and somatic symptoms via perceived stress. Contrary to hypothesis 5, however, workplace social support did not buffer this association; rather, the association was stronger at higher levels of support, with a significant index of moderated mediation. These findings suggest that moral distress may operate, at least statistically, through perceived stress. They also emphasise the importance of organisational conditions that facilitate or hinder moral agency in practice.