Exposure to combat incidents within military and civilian populations as possible correlates of potentially morally injurious events and moral injury outcomes among Israeli combat veterans

Abstract

Objectives: Exposure to potentially morally injurious events (PMIEs) is considered a necessary but insufficient determinant of moral injury (MI) outcomes. However, a question remains regarding possible acts and the necessary features of PMIEs that should be considered transgressive and might lead to MI psychopathological outcomes. We aim to examine the links between exposure to combat incidents within civilian Palestinian populations (CPPs), PMIEs and MI-related outcomes of posttraumatic stress disorder (PTSD) symptoms (PTSS), trauma-related guilt and shame. We also aim to explore the mediating roles of subjective perceptions of PMIEs in the relationship between exposure to combat incidents within CPP and MI-related outcomes among combat veterans. Method: A volunteer sample of 716 Israeli combat veterans responded to self-report questionnaires in a cross-sectional design study. Results: Exposure to combat incidents within CPP has been primarily associated with perpetration based PMIEs and MI-related guilt outcomes. Importantly, betrayal-based PMIEs mediated the association between reports of being the victim of verbal violence by militants and/or civilians and MI outcomes. Moreover, perpetration-based PMIEs mediated associations between reports of personal acts, or witnessing acts, of physical and verbal violence and degradation by militants and/or civilians, and MI outcomes. Conclusions: Military incidents within civilian populations are related to subjective perceptions of PMIEs and MI-related psychopathological outcomes. While betrayalbased experiences might serve as a mechanism to being a victim of verbal violence and MI outcomes, perpetration-based experiences might serve as mechanisms to physical, verbal and degradation incidents and MI outcomes.

Moral injury, depression, and anxiety symptoms among health and social care workers during the COVID-19 pandemic: The moderating role of belongingness

“…Studies focusing on this population are of particular value during the COVID-19 period. Indeed, several studies have shown that the COVID-19 pandemic crisis heightened PMIE exposure among HSCWs worldwide (Hines et al, 2020;Zerach & Levi-Belz, 2021). Moreover, PMIE exposure and MI symptoms among HSCW during the COVID-19 crisis has been linked to several mental health indicators, including secondary traumatic stress (Litam & Balkin, 2021), PTSD (Maftei & Holman, 2021), CPTSD (Zerach & Levi-Belz, 2021), depression, anxiety, and impaired well-being (Amsalem et al, 2021).…”

“…Indeed, several studies have shown that the COVID-19 pandemic crisis heightened PMIE exposure among HSCWs worldwide (Hines et al, 2020;Zerach & Levi-Belz, 2021). Moreover, PMIE exposure and MI symptoms among HSCW during the COVID-19 crisis has been linked to several mental health indicators, including secondary traumatic stress (Litam & Balkin, 2021), PTSD (Maftei & Holman, 2021), CPTSD (Zerach & Levi-Belz, 2021), depression, anxiety, and impaired well-being (Amsalem et al, 2021). Following these findings, it is essential to extend our theoretical understanding and clinical practices as well as explore potential risk conditions and protective factors.…”

Associations between distress tolerance and posttraumatic stress symptoms among combat veterans and their parents: The mediating role of parents’ accommodation

“…The prevalence of combat-related PTSD is estimated at 6–25% and is dependent on the intensity of combat exposure and differences in war theaters and eras (e.g., Fulton et al, 2015). Specifically, recent studies have reported about 21% of Israeli Defense Forces (IDF) combat veterans—the target population of this study—cope with self-reported probable PTSD following military combat service (Zerach & Levi-Belz, 2021,Zerach & Levi-Belz, 2021). Many veterans may also experience a symptom intensity range below the threshold required to establish a diagnosis, although still experiencing PTSS.…”

Experiences of Potentially Morally Injurious Events among New Zealand Defence Force Personnel

“…Moral injury occurs as a result of a potentially morally injurious event (PMIE) (Phoenix Australia, 2020). Examples of a PMIE include; not being able to intervene to protect civilians because of the rules of engagement, having to make decisions that affect the survival of others, or the harming or killing others in the context of war Zerach & Levi-Belz, 2021). In these instances, the thoughts and feelings associated with the PMIE event can mediate the relationship between being exposed to a violent situation and guilt and shame (Zerach & Levi-Belz, 2021).…”

“…Examples of a PMIE include; not being able to intervene to protect civilians because of the rules of engagement, having to make decisions that affect the survival of others, or the harming or killing others in the context of war Zerach & Levi-Belz, 2021). In these instances, the thoughts and feelings associated with the PMIE event can mediate the relationship between being exposed to a violent situation and guilt and shame (Zerach & Levi-Belz, 2021). This means that the way that the individual interprets the morally injurious event can influence whether they experience adverse outcomes, such as feelings of guilt and shame.…”