LAY SUMMARY Moral injury (MI) can be defined as a diverse set of outcomes associated with actions that transgress one’s moral beliefs or values. MI can be distressing for an individual at the interpersonal level (e.g., shifting relationships, feelings of betrayal) and the intrapersonal level (e.g., internalized guilt and shame). Indeed, these transgressions of moral beliefs and values have been associated with a high prevalence of mental illnesses, such as posttraumatic stress disorder (PTSD) and depression. Although various forms of assessment exist to identify MI in the individual, treatments for MI are often interlinked or embedded in evidence-based treatments for PTSD and depression. As such, unique contributions of MI as a target of treatment remain largely unclear. In this article, the authors explore existing treatments that may be used to treat MI as a distinct mental health construct and examine their utility in reducing symptoms of MI in military and Veteran populations.
{"title":"Clinical utility of moral injury in a treatment-seeking military-Veteran mental health population","authors":"J. Richardson, Maya Roth, J. Liu","doi":"10.3138/jmvfh-2022-0053","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0053","url":null,"abstract":"LAY SUMMARY Moral injury (MI) can be defined as a diverse set of outcomes associated with actions that transgress one’s moral beliefs or values. MI can be distressing for an individual at the interpersonal level (e.g., shifting relationships, feelings of betrayal) and the intrapersonal level (e.g., internalized guilt and shame). Indeed, these transgressions of moral beliefs and values have been associated with a high prevalence of mental illnesses, such as posttraumatic stress disorder (PTSD) and depression. Although various forms of assessment exist to identify MI in the individual, treatments for MI are often interlinked or embedded in evidence-based treatments for PTSD and depression. As such, unique contributions of MI as a target of treatment remain largely unclear. In this article, the authors explore existing treatments that may be used to treat MI as a distinct mental health construct and examine their utility in reducing symptoms of MI in military and Veteran populations.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87555104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefanie T LoSavio, W. Hale, C. Straud, J. S. Wachen, J. Mintz, S. Young-McCaughan, Sarah Vacek, Jeffrey S. Yarvis, D. Sloan, Donald D. McGeary, Daniel J Taylor, T. Keane, A. Peterson, P. Resick
LAY SUMMARY Military personnel frequently report actions taken by themselves or others that violate deeply held moral beliefs, which can be experienced as a kind of moral injury. Some have questioned whether existing treatments for posttraumatic stress disorder (PTSD), such as cognitive processing therapy, are effective for those who have been exposed to a morally injurious traumatic event. These analyses demonstrate that active duty service members and Veterans seeking treatment for PTSD who reported potentially morally injurious trauma had PTSD and depression outcomes that were as good as those whose traumas were not primarily seen as morally injurious, suggesting that cognitive processing therapy is an efficacious treatment for PTSD in the context of morally injurious trauma.
{"title":"Impact of morally injurious traumatic event exposure on cognitive processing therapy outcomes among Veterans and service members","authors":"Stefanie T LoSavio, W. Hale, C. Straud, J. S. Wachen, J. Mintz, S. Young-McCaughan, Sarah Vacek, Jeffrey S. Yarvis, D. Sloan, Donald D. McGeary, Daniel J Taylor, T. Keane, A. Peterson, P. Resick","doi":"10.3138/jmvfh-2022-0048","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0048","url":null,"abstract":"LAY SUMMARY Military personnel frequently report actions taken by themselves or others that violate deeply held moral beliefs, which can be experienced as a kind of moral injury. Some have questioned whether existing treatments for posttraumatic stress disorder (PTSD), such as cognitive processing therapy, are effective for those who have been exposed to a morally injurious traumatic event. These analyses demonstrate that active duty service members and Veterans seeking treatment for PTSD who reported potentially morally injurious trauma had PTSD and depression outcomes that were as good as those whose traumas were not primarily seen as morally injurious, suggesting that cognitive processing therapy is an efficacious treatment for PTSD in the context of morally injurious trauma.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73878355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Ein, Stephanie A Houle, J. Liu, B. Easterbrook, Clara Baker, Marianela Fuertes, Richard Benjamin Turner, Caleb MacDonald, Kathryn Reeves, E. Deda, Ken Hoffer, Catherine Baillie Abidi, A. Nazarov, J. Richardson
LAY SUMMARY Armed forces personnel are a population at risk for exposure to potentially traumatic and morally injurious events because of the high-risk nature of military operations. The impacts of deployment-related potentially morally injurious events (PMIEs) are increasingly being documented, with outcomes such as mental health and interpersonal problems showing consistent associations with exposure to events that deeply transgress an individual’s deeply held moral beliefs. To date, the literature on deployment-related PMIEs has focused on events such as killing and exposure to atrocities. The impacts of situations in which military personnel encounter children, including children recruited and used as soldiers by local armies and militia, have not yet been examined systematically. This article highlights the scarcity of existing research on this topic and provides recommendations for future study regarding the impact of military encounters with children through the lens of moral injury.
{"title":"The potentially morally injurious nature of encountering children during military deployments: A call for research","authors":"N. Ein, Stephanie A Houle, J. Liu, B. Easterbrook, Clara Baker, Marianela Fuertes, Richard Benjamin Turner, Caleb MacDonald, Kathryn Reeves, E. Deda, Ken Hoffer, Catherine Baillie Abidi, A. Nazarov, J. Richardson","doi":"10.3138/jmvfh-2022-0044","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0044","url":null,"abstract":"LAY SUMMARY Armed forces personnel are a population at risk for exposure to potentially traumatic and morally injurious events because of the high-risk nature of military operations. The impacts of deployment-related potentially morally injurious events (PMIEs) are increasingly being documented, with outcomes such as mental health and interpersonal problems showing consistent associations with exposure to events that deeply transgress an individual’s deeply held moral beliefs. To date, the literature on deployment-related PMIEs has focused on events such as killing and exposure to atrocities. The impacts of situations in which military personnel encounter children, including children recruited and used as soldiers by local armies and militia, have not yet been examined systematically. This article highlights the scarcity of existing research on this topic and provides recommendations for future study regarding the impact of military encounters with children through the lens of moral injury.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85337080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
LAY SUMMARY With the concept of moral injury being adopted as a way of understanding psychological distress experienced by Veterans, there is a growing interest in what role religion or spirituality might play as a factor in the risk of, or resilience against, experiencing this form of trauma. There is also interest in how religion and spirituality might be used to help treat moral injuries. However, most of the research to date has been conducted with American Christian Veterans and military service members. What is in question is whether these ideas work in the context of Veterans and service members of the Canadian Armed Forces. This article presents a critical warning about how the use of religion and spirituality might possibly cause harm instead of helping as intended.
{"title":"Critical intercession for non-religious Canadian Veterans on the intersections of moral injury, religion, and spirituality","authors":"W. Callaghan","doi":"10.3138/jmvfh-2022-0046","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0046","url":null,"abstract":"LAY SUMMARY With the concept of moral injury being adopted as a way of understanding psychological distress experienced by Veterans, there is a growing interest in what role religion or spirituality might play as a factor in the risk of, or resilience against, experiencing this form of trauma. There is also interest in how religion and spirituality might be used to help treat moral injuries. However, most of the research to date has been conducted with American Christian Veterans and military service members. What is in question is whether these ideas work in the context of Veterans and service members of the Canadian Armed Forces. This article presents a critical warning about how the use of religion and spirituality might possibly cause harm instead of helping as intended.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83817599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bernardette C.E.M. Blom, F. J. June ter Heide, Bart Nauta, T. Mooren, M. Olff
LAY SUMMARY Research has shown time and time again that war has an impact on the mental well-being of Veterans and their families. But what does that impact look like when a mission is characterized by severe violations of norms and values (in other words, moral injury)? In this study, family members of Dutch Veterans talked about the impact on their lives of a mission gone bad in the former Yugoslavia, 25 years after it happened. Although most of the families were doing well, all of the families felt left alone in taking care of their Veterans after they returned and in dealing with negative press coverage. For the well-being of all, they expressed the need for more appreciation for and acknowledgement of Veterans and their families.
{"title":"‘Where am I in all of this?’ Impact of a morally injurious mission on the home front of Dutchbat III military Veterans","authors":"Bernardette C.E.M. Blom, F. J. June ter Heide, Bart Nauta, T. Mooren, M. Olff","doi":"10.3138/jmvfh-2022-0065","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0065","url":null,"abstract":"LAY SUMMARY Research has shown time and time again that war has an impact on the mental well-being of Veterans and their families. But what does that impact look like when a mission is characterized by severe violations of norms and values (in other words, moral injury)? In this study, family members of Dutch Veterans talked about the impact on their lives of a mission gone bad in the former Yugoslavia, 25 years after it happened. Although most of the families were doing well, all of the families felt left alone in taking care of their Veterans after they returned and in dealing with negative press coverage. For the well-being of all, they expressed the need for more appreciation for and acknowledgement of Veterans and their families.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73719349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amanda Bonson, Dominic Murphy, V. Aldridge, N. Greenberg, V. Williamson
LAY SUMMARY This article looks at how moral injury (MI) may develop by considering what event features may be especially salient and cause MI and what experiences an individual may have after an event that might lead to the occurrence of a MI. It proposes that the beliefs someone has about themselves, others, and the world can be shaped by experiences in childhood and early life. Once an individual has experienced a potentially morally injurious event (PMIE) — for example, witnessing something that violates deeply held moral or ethical codes but being unable to stop it, doing something that violates these ethical codes, or experiencing a significant betrayal — they may try to make sense of it by changing the way they see the world, themselves, and others. This can lead to problems in the individual’s relationship with themselves and others, leading to feelings of shame and guilt and withdrawal from other people. More important, for an event to be a PMIE, it must significantly challenge strongly held moral beliefs and a sense of right and wrong.
{"title":"Conceptualization of moral injury: A socio-cognitive perspective","authors":"Amanda Bonson, Dominic Murphy, V. Aldridge, N. Greenberg, V. Williamson","doi":"10.3138/jmvfh-2022-0034","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0034","url":null,"abstract":"LAY SUMMARY This article looks at how moral injury (MI) may develop by considering what event features may be especially salient and cause MI and what experiences an individual may have after an event that might lead to the occurrence of a MI. It proposes that the beliefs someone has about themselves, others, and the world can be shaped by experiences in childhood and early life. Once an individual has experienced a potentially morally injurious event (PMIE) — for example, witnessing something that violates deeply held moral or ethical codes but being unable to stop it, doing something that violates these ethical codes, or experiencing a significant betrayal — they may try to make sense of it by changing the way they see the world, themselves, and others. This can lead to problems in the individual’s relationship with themselves and others, leading to feelings of shame and guilt and withdrawal from other people. More important, for an event to be a PMIE, it must significantly challenge strongly held moral beliefs and a sense of right and wrong.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89398558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marie-Louise Sharp, Margaret Jones, H. Burdett, N. Fear
LAY SUMMARY The COVID-19 pandemic influenced ways in which individuals volunteered and created barriers for participation because of differing restrictions. The research assessing how Veterans volunteer is limited, but there may be aspects of military culture that encourage service to others. The authors investigated volunteering among UK Veterans during the COVID-19 pandemic and what factors made Veterans more or less likely to volunteer. The study found that 60% of Veterans had volunteered in the past 12 months, a level similar to that among the UK general population. Overall, Veterans volunteered more often through formal organizations rather than on an informal basis, such as helping individuals such as neighbours. However, in relative terms, levels of formal volunteering decreased and levels of informal volunteering increased during the pandemic. Veterans were more likely to volunteer if they were officers or to increase volunteering if they felt lonely. Veterans who reduced volunteering were more likely to have mental health problems. Understanding volunteering among Veterans may open up more opportunities for participation.
{"title":"Volunteering behaviours among UK military Veterans during the COVID-19 pandemic and associations with health and well-being","authors":"Marie-Louise Sharp, Margaret Jones, H. Burdett, N. Fear","doi":"10.3138/jmvfh-2022-0056","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0056","url":null,"abstract":"LAY SUMMARY The COVID-19 pandemic influenced ways in which individuals volunteered and created barriers for participation because of differing restrictions. The research assessing how Veterans volunteer is limited, but there may be aspects of military culture that encourage service to others. The authors investigated volunteering among UK Veterans during the COVID-19 pandemic and what factors made Veterans more or less likely to volunteer. The study found that 60% of Veterans had volunteered in the past 12 months, a level similar to that among the UK general population. Overall, Veterans volunteered more often through formal organizations rather than on an informal basis, such as helping individuals such as neighbours. However, in relative terms, levels of formal volunteering decreased and levels of informal volunteering increased during the pandemic. Veterans were more likely to volunteer if they were officers or to increase volunteering if they felt lonely. Veterans who reduced volunteering were more likely to have mental health problems. Understanding volunteering among Veterans may open up more opportunities for participation.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73882398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie A Houle, Joseph Inhaber, R. Jetly, Andrea R. Ashbaugh
LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of events that deeply transgress a person’s core moral beliefs and values. Such events are reportedly common in the military context, and strong associations have been demonstrated between exposure to potentially morally injurious events (PMIEs) and suicidality. This study explored differences in negative cognitions between treatment-seeking Canadian Armed Forces members and Veterans with and without current suicidal thoughts and behaviours (STBs), all of whom reported current distress in response to a PMIE. Those exhibiting STBs reported stronger negative beliefs about the self. Scores for event-related guilt cognitions and self-blame were similar across individuals with and without STBs. Individuals reporting STBs also displayed higher depression and symptoms of posttraumatic stress disorder. The results suggest that severity of mental health symptoms and negative self-evaluations may be most pertinent in their association with suicidality in the MI context. Results remain preliminary, however, and additional research is needed to properly examine how event and self-related evaluations affect suicidality after PMIEs.
{"title":"Negative cognition in the context of suicidality after exposure to military-related potentially morally injurious events","authors":"Stephanie A Houle, Joseph Inhaber, R. Jetly, Andrea R. Ashbaugh","doi":"10.3138/jmvfh-2022-0057","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0057","url":null,"abstract":"LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of events that deeply transgress a person’s core moral beliefs and values. Such events are reportedly common in the military context, and strong associations have been demonstrated between exposure to potentially morally injurious events (PMIEs) and suicidality. This study explored differences in negative cognitions between treatment-seeking Canadian Armed Forces members and Veterans with and without current suicidal thoughts and behaviours (STBs), all of whom reported current distress in response to a PMIE. Those exhibiting STBs reported stronger negative beliefs about the self. Scores for event-related guilt cognitions and self-blame were similar across individuals with and without STBs. Individuals reporting STBs also displayed higher depression and symptoms of posttraumatic stress disorder. The results suggest that severity of mental health symptoms and negative self-evaluations may be most pertinent in their association with suicidality in the MI context. Results remain preliminary, however, and additional research is needed to properly examine how event and self-related evaluations affect suicidality after PMIEs.","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86007614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comments on Tien and Beckett’s ‘Medical support for future large-scale combat operations’","authors":"A. Kirkpatrick, Jessica L. Mckee, K. Breeck","doi":"10.3138/jmvfh-2022-0066","DOIUrl":"https://doi.org/10.3138/jmvfh-2022-0066","url":null,"abstract":"","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81170415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Census data a step forward in understanding well-being of military members, Veterans","authors":"S. Bélanger, D. Pedlar, Dianne Groll","doi":"10.3138/jmvfh.9.1.ed","DOIUrl":"https://doi.org/10.3138/jmvfh.9.1.ed","url":null,"abstract":"","PeriodicalId":36411,"journal":{"name":"Journal of Military, Veteran and Family Health","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88246523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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