The relationship between moral injury appraisals, trauma exposure, and mental health in refugees

Joel Hoffman · Belinda Jayne Liddell · Richard Allan Bryant · Angela Nickerson

61 citations0/0 files storedDepression and Anxiety

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Migration, Health and Trauma Psychoanalysis and Psychopathology Research Posttraumatic Stress Disorder Research

Abstract

BACKGROUND: Refugees are often exposed to multiple traumatic experiences, leading to elevated rates of psychological disorders. There is emerging evidence that appraisals of traumatic events as violating deeply held moral beliefs and frameworks (i.e., moral injury) impact negatively on refugee mental health. Despite this, no research has systematically investigated moral injury appraisals in refugees. METHOD: Participants were 222 refugees from diverse backgrounds who had recently resettled in Australia. They completed measures of mental health in Arabic, Farsi, Tamil, or English through an online survey. This study first investigated the factor structure of the Moral Injury Appraisals Scale (MIAS), and then examined the relationship between the moral injury factors and key predictor (age, gender, trauma exposure) and outcome (Posttraumatic stress disorder [PTSD] symptom clusters, anger, and depression) variables. RESULTS: Confirmatory factor analyses of the MIAS supported a two-factor model, comprising a Moral Injury-Other (MI-Other) factor (i.e., interpreting the violation as being enacted by others) and a Moral Injury-Self (MI-Self) factor (i.e., interpreting the violation as being enacted by oneself). Structural equation modeling analyses indicated that both factors were predicted by higher trauma exposure, and both predicted more severe anger and depression. Notably, while MI-Other was associated with more severe PTSD, MI-Self was associated with lower levels of intrusions. CONCLUSION: These results suggest that there may be subtypes of moral injury appraisals that are associated with different mental health outcomes. These findings have potential implications for designing treatments that address the psychological impact of the refugee experience.

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