Moral injury, suicidal ideation, and suicide attempts in a military sample.

Abstract

Moral injury entails emotional distress associated with perceived violations of one's moral code and has been proposed to be a possible contributor to self-injurious thoughts and behaviors (SITB) among military personnel. Three dimensions of moral injury have previously been empirically derived: transgressions committed by others (Transgressions-Others), transgressions committed by oneself (Transgressions-Self), and perceived betrayal by others (Betrayal). The current study examined the relationship of these dimensions of moral injury with SITB in a clinical sample of 151 active duty military personnel. Transgressions-Other and Transgressions-Self were significantly higher among personnel with a history of suicide attempt relative to history of suicidal ideation and no suicidality (Hedge's g's Ͼ .64). Transgressions-Self was associated with significantly more severe suicidal ideation during the past week (p ϭ .018).

Guilt as a Mediator of the Relationship Between Depression and Posttraumatic Stress With Suicide Ideation in Two Samples of Military Personnel and Veterans

“…Furthermore, guilt was significantly associated with suicide ideation in both samples, which aligns with previous research (A. O. Bryan, Bryan, et al, 2014;C. J. Bryan, Ray-Sannerud, et al, 2013;Hendin & Haas, 1991).…”

“…Recent research has supported an association among moral injury, suicide ideation, and suicide attempts, and has also suggested that moral injury (especially distress about one's own moral transgressions) may serve as a mechanism that underlies the relationship of posttraumatic stress with suiciderelated outcomes (A. O. Bryan, Bryan, et al, 2014). Research also suggests that self-forgiveness following perceived inappropriate actions is associated with decreased risk for suicide attempts and moderates the effect of posttraumatic stress on risk for suicide attempts among military personnel and veterans (A. O. Bryan, Theriault, .…”

A model comparison approach to trauma-related guilt as a mediator of the relationship between PTSD symptoms and suicidal ideation among veterans

“…Moral injury is a syndrome characterized by emotional responses of guilt and shame following perceived violation of moral values. Moral injury has been related to myriad social and functional difficulties, including SI (Bryan et al, 2014). Research is needed to better understand the relationship between trauma-related guilt and moral injury.…”

Treating PTSD Within the Context of Heightened Suicide Risk

“…Negative self-concept, in particular, appears to be especially key to understanding the emergence of suicidal thoughts and behaviors within the context of PTSD. Guilt, remorse, self-blame, and self-criticism not only increase risk of suicidal thoughts and behaviors [20][21][22][23][24]; accumulating evidence suggests they explain the relationship of PTSD with suicide-related outcomes [22,25,26]. Guilt has also been found to be a risk factor for the later development of other trauma-related sequelae such as depression and substance use disorders [27][28][29][30][31], each of which serves as a suicide risk factor in its own right.…”