Impact of moral injury on the lives of UK military veterans: a pilot study

Abstract

IntroductionResearch suggests that moral injury (MI) in US veterans is associated with poor psychological outcomes and disruption in functioning. However, little is known about how MI may impact UK Armed Forces (AF) veterans. This study aimed to explore the impact of MI on veteran psychological well-being and functioning.MethodsSix veterans identified as having had exposure to MI and four clinicians who treated veterans with MI were recruited from a UK charitable organisation which provides psychological care for veterans. Data were analysed using thematic analysis.ResultsMI was perceived to cause substantial psychological distress in this sample. Our data suggest that some veterans held extremely negative self-appraisals which appeared to contribute towards and maintain their distress. Issues relating to spirituality following MI were thought to be infrequent; however, a loss of faith was perceived by clinicians to be more common in morally injured veterans than heightened spiritual/religious views. Several difficulties relating to employment were described, including increased trouble coping with occupational stress and authority figures. Interpersonal difficulties were frequently reported, with withdrawal from others often leading to relationship breakdown with spouses and children.ConclusionThis study provides some of the first evidence of the impact of MI on UK AF veterans’ psychological, spiritual, social and day-to-day functioning all of which would pose challenges to clinicians aiming to manage such difficulties. These findings highlight several gaps in existing care provision for morally injured veterans, including addressing issues related to spirituality, employment and family functioning, which could ultimately improve veteran well-being.

Healthcare Workers and COVID-19-Related Moral Injury: An Interpersonally-Focused Approach Informed by PTSD

“…At the individual level, it is important to consider risk and resilience factors that may affect one's likelihood of developing moral injury after exposure to a PMIE. Williamson et al ( 114 ) highlighted risk factors for moral injury in the military, which may be pertinent to healthcare workers during the pandemic, including loss of life to a vulnerable person (e.g., elderly, children), perception of leaders not taking responsibility for events or being unsupportive, staff feeling unprepared for the emotional or psychological impacts of decisions, concurrent exposure to other traumatic events and a lack of social support after exposure to a PMIE. Furthermore, our research group has shown that emotional abuse during childhood ( 115 , 116 ) and emotional regulation ( 116 ) are critical factors related to moral injury.…”

ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in treatment seeking veterans: risk factors and comorbidity

“…A recent meta-analysis has demonstrated that reporting moral injuries is more strongly associated with PTSD than a range of other mental health difficulties [50]. The reason behind the association between CPTSD and moral injury is unclear, however, it has been suggested that moral injury is associated with potentially more complex emotional responses (such as shame and guilt) [51][52][53] which are also closely related to CPTSD.…”

Effects of Resilience Strength Training on Constructs Associated with Moral Injury among Veterans

“…Nash (2016) suggested the facets of moral injury include a damaged self-concept, social alienation, a loss of self-regulation, and a damaged concept of the world. Recent investigations and reviews of moral injury support these being common attributes of moral injury (Held et al, 2019;Kelley et al, 2019;Koenig et al, 2019;Williamson et al, 2019). The principle components analysis of the psychometric measures used in the present study indicated the impact of RST was focused on two factors, orientation towards one's social environment and orientation towards oneself.…”