Moral injury in civilians: associations with trauma exposure, PTSD, and suicide behavior

Negar Fani · Joseph M. Currier · Matthew D. Turner · Alfonsina Guelfo · Madeleine Kloess · Jahnvi Jain +8 more

61 citations0/0 files storedEuropean Journal of Psychotraumatology

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Posttraumatic Stress Disorder Research Suicide and Self-Harm Studies Child Abuse and Trauma

Abstract

Background Moral injury (MI) describes emotional, spiritual, and social suffering that can arise following psychological trauma. Prior research in military pop ulations indicates the relevance of MI to adverse psychological outcomes, such as post-traumatic stress disorder (PTSD) and suicidal behaviours, and shows evidence for MI as a unique construct. Minimal studies of MI have been implemented in civilians, usually restricted to small samples with a specific set of traumatic experiences, despite the conceptual relevance of MI to non-military trauma reactions more broadly (e.g. feelings of betrayal towards a perpetrator of sexual abuse).Objective To address this problem, we assessed MI in trauma-exposed civilians to examine ways in which this construct was related to and distinct from trauma and traumatic stress-related problems, including PTSD and depression. Method We adapted an existing MI scale, Moral Injury Events Scale (MIES) and administered this measure to 81 men and women along with measures of trauma exposure, PTSD and depression, and also asked participants about past suicide attempts.Results We observed that both greater exposure and distress related to potentially morally injurious events were associated with higher trauma exposure, particularly childhood maltreatment, as well as post-traumatic and depressive psychopathology. However, even after accounting for current PTSD and depression symptoms, MI exposure (F = 6.05, p = .017) was significantly higher among participants who had previously attempted suicide.Conclusions These pilot data reveal the ways in which MI is associated with trauma exposure, PTSD and depression and highlight the salience of MI in civilians. Similarly, these data demonstrate the unique relevance of MI to suicide behaviours, independent of post-traumatic psychopathology, indicating that this construct may be an understudied contributor to suicide risk in civilians.

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References

2015The Posttraumatic Stress Disorder Checklist for DSM‐5 (PCL‐5): Development and Initial Psychometric Evaluation 2009Moral injury and moral repair in war veterans: A preliminary model and intervention strategy 1993Reliability and validity of a brief instrument for assessing post-traumatic stress disorder 2019Moral Injury: An Integrative Review 2013Psychometric Evaluation of the Moral Injury Events Scale 2017Achilles in Vietnam: Combat Trauma and the Undoing of Character 2009Trauma exposure and stress-related disorders in inner city primary care patients 2015Measuring Moral Injury

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