Exposure to potentially morally injurious events and long-term psychological outcomes among Dutch military service members deployed to Afghanistan : A latent class approach

Exposure to potentially morally injurious events (PMIEs) during military deployment is common and may lead to long-lasting negative psychological consequences, referred to as moral injury. Few studies investigated long-term outcomes following exposure to PMIEs. This study investigated patterns of exposure to PMIEs during deployment and associations with long-term psychological outcomes in a cohort (N = 471) of Dutch Afghanistan veterans 10 years post-deployment. Latent class analysis was used to identify classes characterized by patterns of exposure to PMIEs. We investigated differences between classes in posttraumatic stress disorder symptoms, depressive symptoms, anger, interpersonal sensitivity, guilt, and meaning-making. Three groups were identified: high exposure to betrayal, acts of commission, and omission (13.6 %, n = 64), moderate exposure to death involving witnessing deaths, particularly of innocents (44.9 %, n = 212), and minimal exposure to all PMIEs (41.5 %, n = 195). The high exposure class had the most prominent negative psychological outcomes, including posttraumatic stress disorder symptoms, depression, interpersonal sensitivity, guilt, and suppressed anger, as compared to the other classes. Higher levels of expressed anger were present in the moderate and high exposure classes as compared to the minimal exposure class. Meaning in terms of personal growth or added value from deployment experiences was similar for the three classes. Our findings point to long-term negative psychological outcomes among veterans after exposure to deployment-related PMIEs with higher exposure especially being linked to more negative psychological outcomes. This highlights the need for early screening of PMIEs and targeted moral injury interventions to prevent adverse outcomes.

Highlights

• Three classes were identified: high exposure, moderate exposure to death, and minimal exposure
• Moderate exposure to death was characterized by witnessing numerous deaths, particularly involving innocents.
• High exposure included betrayal, extreme violence and guilt over not saving someone.
• Veterans with high exposure to potentially morally injurious events had the most mental health symptoms at the 10-year mark.
• Earlier screening and targeted intervention regarding moral injury is indicated.