Experiences and impact of moral injury in human trafficking survivors: a qualitative study.

Background: Research in recent years has increasingly highlighted the relationship between exposure to potentially morally injurious events (PMIEs) and poor mental health outcomes. Human trafficking survivors often report exposure to many traumatic and PMIEs and given the complexities of trafficking exploitation, survivors may be especially vulnerable to moral injury. Despite this, no research has investigated experiences of PMIEs and moral injury in human trafficking survivors. The objective was to explore survivors' experiences of PMIEs, the impact of PMIEs on wellbeing and functioning and the factors that may influence outcomes following PMIEs.

Method: Participants were seven human trafficking survivors from diverse backgrounds who had settled in the UK. In-depth semi-structured interviews were conducted via telephone. Data were analysed using thematic analysis.

Results: Human trafficking survivors were found to experience multiple PMIEs, including transgressive acts committed by others and betrayal by trusted loved ones or those in positions of authority. Experiencing PMIEs contributed towards considerable psychological distress, including intense feelings of shame, anger and worthlessness, and negatively impacted survivors daily functioning. Formal support, especially practical help (e.g. warm clothing) and social support groups, were experienced as particularly beneficial.

Conclusions: This study provides some of the first evidence that human trafficking survivors may be vulnerable to moral injury and indicates the impact that exposure to PMIEs can have on functioning. Future work is needed to ensure that statutory organisations consider the potential for causing moral injury when interacting with human trafficking survivors and clinical care teams are equipped to provide tailored guidance and support.