Moral injury associated with increased odds of past-year mental health disorders : a Canadian Armed Forces examination

Background: Potentially morally injurious experiences (PMIEs) are common during military service. However, it is unclear to what extent PMIEs are related to well-established adverse mental health outcomes.


Objective: The objective of this study was to use a population-based survey to determine the associations between moral injury endorsement and the presence of past-year mental health disorders in Canadian Armed Forces (CAF) personnel and Veterans.


Methods: Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS). With a sample of 2,941 respondents, the weighted survey sample represented 18,120 active duty and 34,380 released CAF personnel. Multiple logistic regressions were used to assess the associations between sociodemographic characteristics (e.g. sex), military factors (e.g. rank), moral injury (using the Moral Injury Events Scale [MIES]) and the presence of specific mental health disorders (major depressive episode, generalized anxiety disorder, panic disorder, social anxiety disorder, PTSD, and suicidality).


Results: While adjusting for selected sociodemographic and military factors, the odds of experiencing any past-year mental health disorder were 1.97 times greater (95% CI = 1.94–2.01) for each one-unit increase in total MIES score. Specifically, PTSD had 1.91 times greater odds (95% CI = 1.87–1.96) of being endorsed for every unit increase in MIES total score, while odds of past-year panic disorder or social anxiety were each 1.86 times greater (95% CI = 1.82–1.90) for every unit increase in total MIES score. All findings reported were statistically significant (p < .001).


Conclusion: These findings emphasize that PMIEs are robustly associated with the presence of adverse mental health outcomes among Canadian military personnel. The results of this project further underscore the necessity of addressing moral injury alongside other mental health concerns within the CAF.



  • Potentially morally injurious experiences are common during military service, but it is poorly understood how these experiences are related to other mental health disorders in Canadian Armed Forces members and Veterans.
  • Following a series of multiple logistic regressions, the odds of experiencing a past-year mental health disorder were 1.97 (95% CI: = 1.94–2.01) times greater per unit increase in total Moral Injury Events Scale score.
  • This emphasizes the association between morally injurious events and deleterious mental health outcomes in Canadian military personnel, and further highlights the importance of addressing moral injury in this population.
Bethany Easterbrook, Rachel A. Plouffe, Stephanie A. Houle, Aihua Liu, Margaret C. McKinnon, Andrea R. Ashbaugh, Natalie Mota, Tracie O. Afifii, Murray W. Enns, J. Don Richardson and Anthony Nazarov | 2023
In: European Journal of Psychotraumatology ; ISSN: 2000-8066 | 14 | 1 | 2192622
Canadians, Diagnosis, Epidemiology, Guilt, Mental health, Military Personnel, Moral Injury (eng), Posttraumatic Stress Disorder, Psychotrauma, PTSD (en), Quality of Life, Shame, Statistical Analysis, Stressors, Veterans