Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?

Held, Philip; Klassen, Brian J.; Steigerwald, Victoria L.; Smith, Dale L.; Bravo, Karyna; Rozek, David C.; Horn, Rebecca; Zalta, Alyson K.

doi:10.1080/20008198.2021.1877026

Cited by 30 publications

(21 citation statements)

References 42 publications

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“…Additionally, if the provider reported an affirmative response of "Moderately Agree" to "Strongly Agree" on items 1-6 (i.e., perceived transgressions by self or others; e.g., "I saw things that were morally wrong," "I acted in ways that violated my own moral code or values," "I violated my morals by failing to do something I felt I should have done,") and items 7-9 (i.e., perceived betrayal by others; e.g., "I feel betrayed by leaders who I once trusted," "I feel betrayed by fellow medical providers who I once trusted,") then these specific PMIEs were coded as having occurred. This dichotomous scoring approach has been used in several prior investigations [17,18]. Additionally, the MIES has been found to have strong internal validity, temporal stability, and concurrent validity [2].…”

Section: Methodsmentioning

confidence: 99%

A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers

et al. 2021

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Medical leaders have warned of the potential public health burden of a “parallel pandemic” faced by healthcare workers during the COVID-19 pandemic. These individuals may have experienced scenarios in which their moral code was violated resulting in potentially morally injurious events (PMIEs). In the present study, hierarchical linear modeling was utilized to examine the role of PMIEs on COVID-19 pandemic-related difficulties in psychosocial functioning among 211 healthcare providers (83% female, 89% White, and an average of 11.30 years in their healthcare profession [9.31]) over a 10-month span (May 2020 –March 2021). Reported exposure to PMIEs was associated with statistically significant poorer self-reported psychosocial functioning at baseline and over the course of 10-months of data collection. Within exploratory examinations of PMIE type, perceptions of transgressions by self or others (e.g., “I acted in ways that violated my own moral code or values”), but not perceived betrayal (e.g., “I feel betrayed by leaders who I once trusted”), was associated with poorer COVID-19 related psychosocial functioning (e.g., feeling connected to others, relationship with spouse or partner). Findings from this study speak to the importance of investing in intervention and prevention efforts to mitigate the consequences of exposure to PMIEs among healthcare providers. Interventions for healthcare providers targeting psychosocial functioning in the context of moral injury is an important area for future research.

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Section: Methodsmentioning

confidence: 99%

A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers

et al. 2021

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“…Two case studies found reductions in PTSD and depression symptoms for US veterans with MI-related injurious index traumas following standard PE and CPT (Held et al, 2018 ; Paul et al, 2014 ). One study assessed the effectiveness of an intensive outpatient PTSD program (massed-CPT), consisting of group CPT and individual CPT (in conjunction with mindfulness and yoga sessions) and found similar trajectories for PTSD and depression symptoms in veterans endorsing MI-related PTSD (e.g., history of MI; index trauma involved a PMIE) compared to those with PTSD without a PMIE exposure (Held et al, 2021 ). Another case study found reductions in PTSD but no change in depression symptoms, following massed-PE in US active-duty personnel with MI-related index traumas (Evans et al, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review

et al. 2022

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The aim of this research was to describe the evidence examining the approaches taken by mental health providers (MHPs) and chaplains to address symptoms related to moral injury (MI) or exposure to potentially morally injurious events (PMIEs). This research also considers the implications for a holistic approach to address symptoms related to MI that combines mental health and chaplaincy work. A scoping review of literature was conducted using Medline, PsycINFO, Embase, Central Register of Controlled Trials, Proquest, Philosphers Index, CINAHL, SocINDEX, Academic Search Complete, Web of Science and Scopus databases using search terms related to MI and chaplaincy approaches or psychological approaches to MI. The search identified 35 eligible studies: 26 quantitative studies and nine qualitative studies. Most quantitative studies (n = 33) were conducted in military samples. The studies examined interventions delivered by chaplains (n = 5), MHPs (n = 23) and combined approaches (n = 7). Most studies used symptoms of post-traumatic stress disorder (PTSD) and/or depression as primary outcomes. Various approaches to addressing MI have been reported in the literature, including MHP, chaplaincy and combined approaches, however, there is currently limited evidence to support the effectiveness of any approach. There is a need for high quality empirical studies assessing the effectiveness of interventions designed to address MI-related symptoms. Outcome measures should include the breadth of psychosocial and spiritual impacts of MI if we are to establish the benefits of MHP and chaplaincy approaches and the potential incremental value of combining both approaches into a holistic model of care.

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“…The instructions for the MIES were modified for the present study, and participants were instructed to answer the questionnaire and indicate how much they agreed/disagreed with items regarding their work as a VP. Previous studies have found the MIES to have good psychometric properties, with good internal consistency (Bryan et al, 2016 ; Held et al, 2021 ).…”

Section: Methodsmentioning

confidence: 94%

Experiences and impact of moral injury in U.K. veterinary professional wellbeing

Williamson

Murphy

Greenberg

2022

European Journal of Psychotraumatology

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Background Veterinary professionals (VPs) are often exposed to distressing and ethically challenging events in their line of work, yet little is known about whether they may experience moral injury and the impact potentially morally injurious events (PMIEs) may have on their wellbeing. This cross-sectional study aimed to examine the association between PMIEs and the mental health outcomes of U.K. VPs. Method Assessments of PMIE exposure and self-report measures of common mental disorders were administered using an anonymous online questionnaire to 90 U.K. VPs between December 2020 and May 2021. Results Exposure to PMIEs was reported by almost all VPs (89.0%), with acts of omission most frequently reported. Experiences of PMIEs were significantly associated with symptoms of PTSD ( p < 0.01) and experiencing a betrayal event was significantly associated with PTSD symptoms (p<0.05). However, there was no significant association found between PMIE exposure and alcohol misuse or CMD ( p > 0.05). Conclusions This study provides some of the first evidence that experiences of moral injury are significantly associated with adverse mental health outcomes in U.K. VPs. Future work is needed to design effective pathways for prevention and intervention for VPs exposed to highly challenging events. HIGHLIGHTS U.K. veterinary professionals were found to experience moral injury. Experiences of moral injury were significantly associated with symptoms of PTSD.

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Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?

Abstract: Zalta (2021) Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?,

Cited by 30 publications

References 42 publications

A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers

A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers

Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review

Experiences and impact of moral injury in U.K. veterinary professional wellbeing

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