Invisible wounds and suicide: Moral injury and veteran mental health

Jamieson, Nikki; Usher, Kim; Maple, Myfanwy; Ratnarajah, Dorothy

doi:10.1111/inm.12704

Cited by 19 publications

(20 citation statements)

References 30 publications

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“…Unresolved moral frustration, moral suffering, compassion fatigue, and burnout were proffered by participants as potential reasons PSP leave their professions, a pattern also evidenced among healthcare workers [47,48]. Research on suicide and MI has predominantly focused on military personnel [49] and veterans [50][51][52]. Our results provide preliminary evidence of similar associations between MI, resignations, and suicide among PSP.…”

Section: Discussionsupporting

confidence: 60%

“…MI appears to involve fractures to personal identity at the level of "self" [49,50], resulting in a slow disintegration of selfhood, identity, and the ability to engage in the world (i.e., relationality). Other researchers have evidence that PSP report feeling alienated from their past selves as a result of service [51], which may be explained in part by pervasive MI resulting from an inability to live congruently with oneself [52].…”

Section: Discussionmentioning

confidence: 99%

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Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics

Smith-MacDonald

Lentz

Malloy

et al. 2021

IJERPH

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The work of public safety personnel (PSP) is inherently moral; however, the ability of PSP to do what is good and right can be impeded and frustrated, leading to moral suffering. Left unresolved, moral suffering may develop into moral injury (MI) and potential psychological harm. The current study was designed to examine if MI is relevant to frontline public safety communicators, firefighters, and paramedics. Semi-structured interviews (n = 3) and focus groups (n = 3) were conducted with 19 participants (public safety communicators (n = 2); paramedics (n = 7); and firefighters (n = 10)). Interviews and focus groups were audio-recorded, transcribed, coded, and constantly compared in accordance with the grounded theory method. A conceptual theory of “frustrating moral expectations” emerged, with participants identifying three interrelated properties as being potentially morally injurious: chronic societal problems, impaired systems, and organizational quagmires. Participants navigated their moral frustrations through both integrative and disintegrative pathways, resulting in either needing to escape their moral suffering or transforming ontologically. The current study results support MI as a relevant concept for frontline PSP. Given the seriousness of PSP leaving their profession or committing suicide to escape moral suffering, the importance of the impact of MI on PSP and public safety organizations cannot be ignored or underestimated. Understanding the similarities and differences of morally injurious exposures of frontline PSP may be critical for determining mental health and resilience strategies that effectively protect PSP.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics

Smith-MacDonald

Lentz

Malloy

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…Without operationalizing a new and agreed definition for moral trauma, future research, proper assessment and the development of effective approaches may be hindered (Jamieson et al . 2020). When definitional consensus occurs, to the degree consensus is possible, it will greatly reduce future methodological problems and enhance research and practice.…”

Section: Resultsmentioning

confidence: 99%

“…2011; Hodgson & Carey 2017; Jamieson et al . 2020; Jinkerson 2016; Jordan et al . 2017; Kelley et al .…”

Section: Consequencesmentioning

confidence: 99%

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Military moral injury: A concept analysis

Jamieson

Maple²,

Ratnarajah³

et al. 2020

Int J Mental Health Nurs

Self Cite

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Moral injury is the current term describing the breaching or violation of one’s moral code and has gained international research attention due to suicide linkages in military populations (Jamieson et al., Invisible wounds and suicide: Moral injury and veteran mental health. International Journal of Mental Health Nursing, 29, 105–109, 2020). Moral injury’s core features are spiritual/existential conflict, shame, guilt and self‐condemnation. To date, research focuses on the core features of moral injury and or the nature of events that exposed individuals to moral injury. Walker and Avant (Strategies for Theory Construction in Nursing, Prentice Hall New York, 2011) concept analysis model was used to examine the literature. The aim of this study is to enhance understanding of the defining attributes, antecedents, consequences and empirical referents of moral injury and systematically analyse the concept of moral injury in the context of military members. A literature search was undertaken using specific websites and journals, electronic databases, library catalogues and hand‐searches. Concept analysis was used to explicate moral injury, focusing exclusively on use of the concept in the included literature, comparing the terms used over time and across disciplines, and measurement tools for the concept. This concept analysis provides a renewed definition of moral injury in relation to the experience of veterans – ‘moral trauma’ and defined as: ‘the existential, psychological, emotional and or spiritual trauma arising from a conflict, violation or betrayal, either by omission or commission, of or within one’s moral beliefs or code(s)’. The analysis will facilitate understanding and operationalization of the concept applied to teaching, learning, practice and research.

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The Ethics of Ethics: A Help or Hindrance When Conducting Sensitive Research with Australian Veterans?

Jamieson

2021

Researchers at Risk

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Invisible wounds and suicide: Moral injury and veteran mental health

Cited by 19 publications

References 30 publications

Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics

Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics

Military moral injury: A concept analysis

The Ethics of Ethics: A Help or Hindrance When Conducting Sensitive Research with Australian Veterans?

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