Factors associated with exposure to potentially morally injurious events (PMIEs) and moral injury in a clinical sample of veterans

Introduction: Moral injury is not inevitable following exposure to a potentially morally injurious event (PMIE). Since moral injury is associated with poor mental health outcomes, it is clinically important to understand when moral injury develops following PMIE exposure and when it does not. The current study explores associations between both PMIE exposure and moral injury with a range of mental health and functioning outcomes to explore possible differences in comorbidities between those who do, and those who do not go on to develop moral injury following PMIE exposure.

Methods: A total of 428 treatment-seeking veterans from a national charity (Mage = 50.4, SDage = 10.9) completed an online questionnaire which included the Moral Injury Outcome Scale to assess PMIE exposure and moral injury symptoms, and measures of other mental health outcomes.

Results: Independent t-tests revealed significant differences between mean scores on measures of common mental health difficulties (CMD, anxiety and depression), physical health problems, loneliness and complex PTSD between veterans who had experienced a PMIE and veterans who had not. The presence of caseness for CMD, physical health difficulties, anger difficulties, PTSD and CPTSD were significantly associated with moral injury, and trust and shame subscales of the MIOS.

Discussion: These findings build on previous theory and research indicating a distinction between exposure to PMIEs and moral injury. These distinctions suggest potential risk factors for developing moral injury following a PMIE and highlight the possible relevance of poor psychosocial functioning in the development of moral injury. Longitudinal research is needed to explore the observed associations further.