Moral injury and ICD-11 complex PTSD (CPTSD) symptoms among treatment-seeking veterans in the United Kingdom.

Currier, Joseph M.; Foster, Joshua D.; Karatzias, Thanos; Murphy, Dominic

doi:10.1037/tra0000921

Cited by 22 publications

(22 citation statements)

References 8 publications

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“…Moreover, profound changes in cognitions and world assumptions (e.g., "I am a rotten person"), and dysfunctional strategies such as self-destruction, aimed to relieve moral pain, may possibly follow. Importantly, if left unresolved, these PMIEs might result in deep psychiatric and functionally aversive consequences, such as posttraumatic stress disorder (PTSD; Koenig et al, 2019) and complex PTSD (CPTSD; Currier et al, 2021).…”

Section: Moral Injurymentioning

confidence: 99%

Moral injury, PTSD, and complex PTSD among Israeli health and social care workers during the COVID-19 pandemic: The moderating role of self-criticism.

Zerach¹,

Levi‐Belz²

2022

Psychological Trauma: Theory, Research, Practice, and Policy

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Background: During the COVID-19 pandemic, health and social care workers (HSCWs) are facing morally challenging situations and life-threatening decisions. Following exposure to potentially morally injurious events (PMIEs) that undermine deeply held moral beliefs and expectations, HSCWs might experience moral injury (MI) and other deleterious psychiatric consequences. The present study examined associations between exposure to PMIEs, MI symptoms, posttraumatic stress disorder (PTSD), complex PTSD (CPTSD), and self-criticism among HSCWs. Method: A sample of 296 Israeli HSCWs responded to online validated self-report questionnaires in a cross-sectional designed survey in February and March 2021. Results: Participants' self-reported PTSD (8.9%) and CPTSD (4.8%) rates match the rates of Israel's general population. A moderated-mediation model shows that high self-criticism intensified the relations between exposure to PMIEs and MI symptoms, and between MI symptoms and CPTSD symptoms. Importantly, the indirect effect of exposure to PMIEs on both PTSD and CPTSD symptoms via MI symptoms existed only among those with high levels of self-criticism. Conclusions: The study's findings offer a novel overview of the associations between patterns of exposure to PMIEs, MI, PTSD, and CPTSD. Clinicians treating HSCWs coping with COVID-19-related moral injury should be aware of the importance of high self-criticism in the possible posttraumatic sequelae of exposure to PMIEs. Clinical Impact StatementThe empirical exploration of moral injury (MI) among health and social care workers (HSCWs) is scarce, and particularly during the unprecedented COVID-19 pandemic it is timely and important. We examined MI among Israeli HSCWs during the COVID-19 pandemic. We found that high selfcriticism-a known personality risk factor for depression-intensified the relations between exposure to PMIEs and MI symptoms and between MI symptoms and CPTSD symptoms. Importantly, the indirect effect of PMIEs on PTSD and CPTSD via MI existed only among those with high levels of self-criticism.

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Section: Moral Injurymentioning

confidence: 99%

Moral injury, PTSD, and complex PTSD among Israeli health and social care workers during the COVID-19 pandemic: The moderating role of self-criticism.

Zerach¹,

Levi‐Belz²

2022

Psychological Trauma: Theory, Research, Practice, and Policy

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“…PTSD is known to be comorbid with common psychopathologies (Currier, Foster, Karatzias, & Murphy, 2021 ) and the emerging body of literature suggests that CPTSD shares this characteristic, potentially to a greater degree (Armour, 2015 ). Individuals with CPTSD are more likely to report experiencing higher levels of anxiety and depression (Karatzias et al, 2019 ; Mur-Crepulja et al, 2020 ; Murphy, Karatzias, Busuttil, Greenberg, & Shevlin, 2021 ), suicidality (Hyland, Shevlin, Fyvie, & Karatzias, 2018 ; Karatzias et al, 2019 ), moral injury (Mur-Crepulja et al, 2020 ; Murphy et al, 2021 ), substance misuse and psychosis (Facer-Irwin, Karatzias, Bird, Blackwood, & MacManus, 2021 ), and alcohol misuse (Hitch, Toner, & Armour, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans

Spikol

Robinson

McGlinchey

et al. 2022

European Journal of Psychotraumatology

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Background Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies. Objectives A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland ( N = 638, NI) to determine the prevalence of CPTSD and comorbid associations. Methods Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership. Results Three distinct classes emerged: a low endorsement ‘baseline’ class (36%), a ‘Moderate Symptomatic’ class (27%), and a high endorsement ‘Probable CPTSD’ class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid ( OR = .06 in CPTSD), as was anxiety ( OR = .05 in CPTSD) and suicidal ideation ( OR = .32 in CPTSD), with suicidal attempt associated with the CPTSD class ( OR = .51). Conclusions Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI.

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“…We identified four classes of patients: a MI class ( n = 192; 11.27%), a MI-PTSD class ( n = 565; 33.18%), a PTSD class ( n = 644; 37.82%), and a Neither MI-nor PTSD class ( n = 302; 17.73%). The identification of classes characterized by high MI reflects findings of three latent profile analyses (LPA) of MI in military veterans ( 43 – 45 ). These previous studies identified two groups that were, respectively, high and low in MI plus complex PTSD ( 43 ), two MI groups characterized by psychological distress and spiritual distress, respectively, as well as a non-distressed group ( 44 ), and a high symptoms group, lower symptoms group, and potential MI group ( 45 ).…”

Section: Discussionmentioning

confidence: 59%

“…The identification of classes characterized by high MI reflects findings of three latent profile analyses (LPA) of MI in military veterans (43)(44)(45). These previous studies identified two groups that were, respectively, high and low in MI plus complex PTSD (43), two MI groups characterized by psychological distress and spiritual distress, respectively, as well as a non-distressed group (44), and a high symptoms group, lower symptoms group, and potential MI group (45). Altogether these results confirm that MI is a prominent form of symptomatology amongst police officers and veterans exposed to profession-related trauma.…”

Section: Discussionmentioning

confidence: 65%

“…Research of the prevalence of MI has focused primarily on exposure to PMIEs rather than on MI symptomatology. In the previously mentioned LPA's of MI in military veterans, the high MI distress group was 80.3% (43), the psychological MI group around 74% (44), and the potential MI group 22.2% (45). Most likely the definition of MI and the consequent selection of items influenced the prevalence of MI in different groups.…”

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Moral Injury in Trauma-Exposed, Treatment-Seeking Police Officers and Military Veterans: Latent Class Analysis

Mensink¹,

Schagen²,

Aa³

et al. 2022

Front. Psychiatry

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Exposure to morally injurious events may have a severe, prolonged negative impact on psychosocial functioning, known as moral injury (MI). Research into the prevalence of MI has mostly focused on event exposure rather than on psychosocial impact. Also, the relationship between MI and post-traumatic stress disorder (PTSD) remains a matter of interest. The aim of this study was to identify MI and PTSD symptom profiles among trauma-exposed, treatment-seeking police officers and military veterans, and to explore demographic and clinical differences between symptom profiles. Latent class and multinomial regression analyses were conducted in a sample of 1,703 participants, using the Clinician-Administered PTSD Scale for DSM-5 and the Brief Symptom Inventory. Four classes of participants were identified, labeled as a MI class (n = 192; 11.27%), a MI-PTSD class (n = 565; 33.18%), a PTSD class (n = 644; 37.82%), and a Neither MI-nor PTSD class (n = 302; 17.73%), resulting in 44.45% (n = 757) of participants who met an MI symptom profile with or without PTSD. There were significant differences between the classes in terms of gender as well as PTSD and comorbid psychopathology symptom severity, the latter of which was highest in the MI-PTSD class. In conclusion, a substantial subgroup of trauma-exposed, treatment-seeking police officers and military veterans could be classified as suffering from MI. Routinely screening for MI in treatment-seeking police officers and military veterans is recommended, and interventions aimed at relieving MI in these populations may be indicated.

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Moral injury and ICD-11 complex PTSD (CPTSD) symptoms among treatment-seeking veterans in the United Kingdom.

Cited by 22 publications

References 8 publications

Moral injury, PTSD, and complex PTSD among Israeli health and social care workers during the COVID-19 pandemic: The moderating role of self-criticism.

Moral injury, PTSD, and complex PTSD among Israeli health and social care workers during the COVID-19 pandemic: The moderating role of self-criticism.

Exploring complex-PTSD comorbidity in trauma-exposed Northern Ireland veterans

Moral Injury in Trauma-Exposed, Treatment-Seeking Police Officers and Military Veterans: Latent Class Analysis

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