Relationships between moral injury syndrome model variables in combat veterans.

Moral injury is a unique type of trauma characterized by guilt and shame that may develop after acting inconsistently with one’s moral values or observing moral violations by trusted individuals. According to the moral injury syndrome model, exposure to potentially morally injurious events (pMIEs–e.g., killing combatants or civilians) statistically predicts the development of proposed moral injury symptoms. Moral injury’s core symptoms (e.g., guilt and loss of meaning) are further hypothesized to mediate relationships between pMIEs and secondary symptoms (e.g., depression, anxiety, and posttraumatic stress disorder symptoms). To empirically evaluate these propositions, the relationships between exposure to pMIEs, core symptoms, and secondary symptoms were examined in a community sample of combat veterans (N = 72). pMIE exposure was statistically associated with all proposed moral injury symptoms. Furthermore, the relationships between pMIE exposure and secondary symptoms were all mediated by core symptoms. Results highlight guilt’s centrality in moral injury. (PsycINFO Database Record (c) 2019 APA, all rights reserved)