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

Background: Moral injury (MI) describes emotional, spiritual, and social suffering that can arise following psychological trauma. Prior research in military populations indicates the relevance of MI to adverse psychological outcomes, such as post-traumatic stress disorder (PTSD) and suicidal behavio...

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Published in:	European journal of psychotraumatology Vol. 12; no. 1; p. 1965464
Main Authors:	Fani, Negar, Currier, Joseph M., Turner, Matthew D., Guelfo, Alfonsina, Kloess, Madeleine, Jain, Jahnvi, Mekawi, Yara, Kuzyk, Eva, Hinrichs, Rebecca, Bradley, Bekh, Powers, Abigail, Stevens, Jennifer S., Michopoulos, Vasiliki, Turner, Jessica A.
Format:	Journal Article
Language:	English
Published:	United States Taylor & Francis 01-01-2021 Taylor & Francis Ltd Taylor & Francis Group
Subjects:	Adult Anxiety - psychology centro de la ciudad Child Child Abuse civiles civilians Clinical Daño moral Female Humans inner-city Interviews as Topic Male Moral injury Post traumatic stress disorder Psychopathology Stress Disorders, Post-Traumatic - complications Suicidal Ideation suicide Suicides & suicide attempts suicidio Surveys and Questionnaires Trastorno de estrés postraumático Trauma Wounds and Injuries - psychology 创伤后应激障碍市中心道德伤害 trauma post-traumatic stress disorder centro de la ciudad 创伤 civiles 自杀 suicide inner-city suicidio Moral injury civilians Trastorno de estrés postraumático 市中心平民 Daño moral 创伤后应激障碍道德伤害
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Summary:	Background: Moral injury (MI) describes emotional, spiritual, and social suffering that can arise following psychological trauma. Prior research in military populations 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. Moral injury (MI) describes emotional, spiritual, and social suffering emerging after psychological trauma. Despite conceptual relevance to civilian trauma, it has been largely assessed in military populations. We assessed MI in a sample of high trauma-exposed civilians, finding associations with interpersonal trauma, PTSD, and depression, as well as past suicide attempt.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2000-8066 2000-8198 2000-8066
DOI:	10.1080/20008198.2021.1965464