Moral Injury and Spiritual Struggles in Military Veterans: A Latent Profile Analysis

Abstract

War‐related traumas can lead to emotional, relational, and spiritual suffering. Drawing on two community samples of war zone veterans from diverse military eras (Study 1, N = 616 and Study 2, N = 300), the purpose of this study was to examine patterns of constellations between outcomes related to moral injury (MI) and common ways in which veterans may struggle with religion or spirituality, defined as divine, morality, meaning, interpersonal, and doubt. Results from latent profile analyses revealed three distinct classes across the samples, based on psychometrically validated instruments: (a) no MI‐related outcomes or spiritual struggles (nondistressed group; Study 1 = 72.7%, Study 2 = 75.0%); (b) MI‐related outcomes and equivalent or lower degrees of spiritual struggles relative to MI‐related outcomes (psychological MI group; Study 1 = 19.2%, Study 2 = 17.0%); and (c) MI‐related outcomes and salient struggles with religious faith or spirituality, both within their own profiles and compared to other groups (spiritual MI group; 8.1% and 8.0% in the two samples). When we compared severity of spiritual struggles within MI groups, turmoil with God or a higher power emerged as a defining feature of the spiritual MI group in both samples. In addition, secondary analyses revealed membership in this third group was linked with greater importance of religion or spirituality before military service, χ2(1, N = 616 and 300) = 4.468–8.273. Overall, although more research is needed, these findings highlight the possible utility of differentiating between psychological and spiritual subtypes of MI according to war zone veterans’ religious or spiritual backgrounds.

Invisible wounds and suicide: Moral injury and veteran mental health

“…The core characteristics of MI have not yet reached universal consensus (Kelley et al 2019). Notwithstanding this, MI is often theorized as resulting in shame, guilt, distrust, anger, grief, turmoil with God or a higher power, self-condemnation, and disgust (Bryan et al 2014;Currier et al 2019;Jinkerson 2016;Litz et al 2009;Shay 2014). MI can be self-directed (individual perpetrated an act that led to a transgression of moral boundaries) or other directed (witnessing or hearing about a transgression; Schorr et al 2018) and is linked with suicidality (suicidal ideation, plans, behaviour, and/or attempt) in veterans (Bryan et al 2014;2018).…”

Commentary on the Special Issue on Moral Injury: Advances, Gaps in Literature, and Future Directions

“…Research to date has generally confirmed the initial constructs while providing more knowledge on the associations between certain types of PMIEs and their MI outcomes. For example, self‐directed PMIEs have been associated with shame and guilt; self‐blame; feelings of being unlovable, unforgivable, or incapable of moral decision‐making; and self‐handicapping behaviors (Currier, Foster, & Isaak, [this issue]). Betrayal, on the other hand, has been associated with anger, moral disgust, beliefs and attitudes related to mistrust of others, and revenge fantasies for the responsible person or persons (Currier, Foster et al., ).…”

Religious and Spiritual Struggles among Military Veterans in a Residential Gambling Treatment Program

“…Clinicians should attend to the role that gambling plays in the lives of veterans and address the religious and spiritual struggles that arise from problem gambling. Currier, Foster, and Isaak (2019) are provided for comparison to a non-clinical sample. The demonic struggles subscale was not administered in the Currier, Foster, and Isaak (2019) study.…”

“…for meaning-related struggles, the decrease was medium, t(156) = 6.37, p ≤ .001, d = .54; and for moral struggles, the decrease was small, t(156) = 4.09, p ≤ .001, d = .37. Table 1 also presents findings from an administration of the RSS (excluding demonic struggles) to veterans (N = 616) conducted by Currier, Foster, and Isaak (2019). These figures provide an appropriate benchmark for comparing spiritual struggles among a non-clinical sample of veterans to those who participated in our study.…”