Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review
Background: Moral injury (MI) involves distress over having transgressed or violated core moral boundaries, accompanied by feelings of guilt, shame, self-condemnation, loss of trust, loss of meaning, and spiritual struggles. MI is often found in Veterans and Active Duty Military personnel with postt...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-06-01
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| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00443/full |
| _version_ | 1818315672298455040 |
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| author | Harold G. Koenig Harold G. Koenig Harold G. Koenig Nagy A. Youssef Michelle Pearce |
| author_facet | Harold G. Koenig Harold G. Koenig Harold G. Koenig Nagy A. Youssef Michelle Pearce |
| author_sort | Harold G. Koenig |
| collection | DOAJ |
| description | Background: Moral injury (MI) involves distress over having transgressed or violated core moral boundaries, accompanied by feelings of guilt, shame, self-condemnation, loss of trust, loss of meaning, and spiritual struggles. MI is often found in Veterans and Active Duty Military personnel with posttraumatic stress disorder (PTSD). MI is widespread among those with PTSD symptoms, adversely affects mental health, and may increase risk of suicide; however, MI is often ignored and neglected by mental health professionals who focus their attention on PTSD only.Methods: A review of the literature between 1980 and 2018 conducted in 2018 is presented here to identify scales used to assess MI. Databases used in this review were PsychInfo, PubMed (Medline), and Google Scholar. Search terms were “moral injury,” “measuring,” “screening,” “Veterans,” and “Active Duty Military.” Inclusion criteria were quantitative measurement of MI and health outcomes, Veteran or Active Duty Military status, and peer-review publication. Excluded were literature reviews, dissertations, book chapters, case reports, and qualitative studies.Results: Of the 730 studies identified, most did not meet eligibility criteria, leaving 118 full text articles that were reviewed, of which 42 did not meet eligibility criteria. Of the remaining 76 studies, 34 were duplicates leaving 42 studies, most published in 2013 or later. Of 22 studies that assessed MI, five used scales assessing multiple dimensions, and 17 assessed only one or two aspects (e.g., guilt, shame, or forgiveness). The remaining 20 studies used one of the scales reported in the first 22. Of the five scales assessing multiple dimensions of MI, two assess both morally injurious events and symptoms and the remaining three assess symptoms only. All studies were cross-sectional, except three that tested interventions.Conclusions: MI in the military setting is widespread and associated with PTSD symptom severity, anxiety, depression, and risk of suicide in current or former military personnel. Numerous measures exist to assess various dimensions of MI, including five multidimensional scales, although future research is needed to identify cutoff scores and clinically significant change scores. Three multidimensional measures assess MI symptoms alone (not events) and may be useful for determining if treatments directed at MI may both reduce symptoms and impact other mental health outcomes including PTSD. |
| first_indexed | 2024-12-13T09:09:15Z |
| format | Article |
| id | doaj.art-79c491fdbf474a1b9e91221e75f54d68 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-13T09:09:15Z |
| publishDate | 2019-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-79c491fdbf474a1b9e91221e75f54d682022-12-21T23:53:00ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402019-06-011010.3389/fpsyt.2019.00443384381Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A ReviewHarold G. Koenig0Harold G. Koenig1Harold G. Koenig2Nagy A. Youssef3Michelle Pearce4Duke University Medical Center, Durham, NC, United StatesKing Abdulaziz University, Jeddah, Saudi ArabiaNingxia Medical University, Yinchuan, ChinaMedical College of Georgia, Augusta University, Charlie Norwood VA Medical Center, Augusta, GA, United StatesDepartment of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United StatesBackground: Moral injury (MI) involves distress over having transgressed or violated core moral boundaries, accompanied by feelings of guilt, shame, self-condemnation, loss of trust, loss of meaning, and spiritual struggles. MI is often found in Veterans and Active Duty Military personnel with posttraumatic stress disorder (PTSD). MI is widespread among those with PTSD symptoms, adversely affects mental health, and may increase risk of suicide; however, MI is often ignored and neglected by mental health professionals who focus their attention on PTSD only.Methods: A review of the literature between 1980 and 2018 conducted in 2018 is presented here to identify scales used to assess MI. Databases used in this review were PsychInfo, PubMed (Medline), and Google Scholar. Search terms were “moral injury,” “measuring,” “screening,” “Veterans,” and “Active Duty Military.” Inclusion criteria were quantitative measurement of MI and health outcomes, Veteran or Active Duty Military status, and peer-review publication. Excluded were literature reviews, dissertations, book chapters, case reports, and qualitative studies.Results: Of the 730 studies identified, most did not meet eligibility criteria, leaving 118 full text articles that were reviewed, of which 42 did not meet eligibility criteria. Of the remaining 76 studies, 34 were duplicates leaving 42 studies, most published in 2013 or later. Of 22 studies that assessed MI, five used scales assessing multiple dimensions, and 17 assessed only one or two aspects (e.g., guilt, shame, or forgiveness). The remaining 20 studies used one of the scales reported in the first 22. Of the five scales assessing multiple dimensions of MI, two assess both morally injurious events and symptoms and the remaining three assess symptoms only. All studies were cross-sectional, except three that tested interventions.Conclusions: MI in the military setting is widespread and associated with PTSD symptom severity, anxiety, depression, and risk of suicide in current or former military personnel. Numerous measures exist to assess various dimensions of MI, including five multidimensional scales, although future research is needed to identify cutoff scores and clinically significant change scores. Three multidimensional measures assess MI symptoms alone (not events) and may be useful for determining if treatments directed at MI may both reduce symptoms and impact other mental health outcomes including PTSD.https://www.frontiersin.org/article/10.3389/fpsyt.2019.00443/fullmoral injuryinternal conflictposttraumatic stress disorderVeteransActive Duty Militaryscreening |
| spellingShingle | Harold G. Koenig Harold G. Koenig Harold G. Koenig Nagy A. Youssef Michelle Pearce Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review Frontiers in Psychiatry moral injury internal conflict posttraumatic stress disorder Veterans Active Duty Military screening |
| title | Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review |
| title_full | Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review |
| title_fullStr | Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review |
| title_full_unstemmed | Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review |
| title_short | Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review |
| title_sort | assessment of moral injury in veterans and active duty military personnel with ptsd a review |
| topic | moral injury internal conflict posttraumatic stress disorder Veterans Active Duty Military screening |
| url | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00443/full |
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