The relation between adverse childhood experiences and moral injury in the Canadian Armed Forces

Abstract

Background: There is increasing evidence that moral injuries (MIs) may affect the mental health of Canadian Armed Forces (CAF) members and veterans. Despite knowledge suggesting that MIs are related to multiple negative mental health outcomes, including the onset of post-traumatic stress disorder (PTSD), it is unknown whether pre-traumatic variables, including the presence of childhood abuse, are related to MIs. Objective: This study seeks to investigate the potential relationship between adverse childhood experiences and later onset MI in military members. Methods: Thirty-three patients newly admitted to an inpatient unit for treatment of trauma-related disorders received a standardized self-assessment package, including the PTSD Checklist for DSM-5 (PCL-5), the Moral Injury Events Scale (MIES; adapted for the Canadian context), and the Adverse Childhood Experiences Questionnaire (ACE-Q), which is a retrospective measure of childhood abuse. Results: Analyses revealed a significant relation between childhood emotional abuse and the presence of MI in adulthood. Specifically, emotional abuse during childhood was correlated with total score on the MIES (p = 0.006) and with its two subscales, perceived betrayals (p = 0.022) and perceived transgressions (p = 0.016). These correlations remained significant when controlling for age and gender. Conclusions: Among CAF members and veterans, childhood events are related to the presence of MI during adulthood. These preliminary data are provocative in suggesting that emotional abuse during childhood may increase the likelihood of endorsing MI during adult military service. Further work is needed to identify pre-traumatic variables that may serve to increase risk or enhance resilience to the development of MI in military members.

Family Socioeconomic Status and Exposure to Childhood Trauma: Racial Differences

“…This is because the consequences of trauma are intensity-dependent; thus, there is a need to collect data on the number of traumatic events. Multiple traumas (2+) are an indicator of a more stressful situation and have a stronger effect on a wide range of psychosocial outcomes [59][60][61][62][63][64][65][66][67].…”

Defining Moral Injury Among Military Populations: A Systematic Review

“…Additionally, Battaglia et al. (2019) used quantitative analyses with a sample of participants from the Canadian Armed Forces. Mixed‐method approaches were utilized in three of the articles (i.e., Frankfurt, Frazier, & Engdahl, 2017; Stein et al., 2012; Sun et al., 2019), which explored moral injury in 216 U.S. veterans and 122 active duty personnel.…”

“…Bryan et al, 2016;Koenig et al, 2018aKoenig et al, , 2018bLitz et al, 2018), active duty Marines (i.e., , or members of the National Guard/Reserves (i.e., C. Bryan, Bryan, Roberge, Leifker, & Rozek, 2018). Additionally, Battaglia et al (2019) used quantitative analyses with a sample of participants from the Canadian Armed Forces. Mixed-method approaches were utilized in three of the articles (i.e., Frankfurt, Frazier, & Engdahl, 2017;Stein et al, 2012;Sun et al, 2019), which explored moral injury in 216 U.S. veterans and 122 active duty personnel.…”

What Celebrity Case Studies Can Teach about Clinical Formulation of Mental Health Conditions

“…These experiences threatened the belongingness he sought both from his military family and his cultural community. His idealism about military service became established with its accompanying sense of fulfillment through duty and responsibility for others but this nobility of purpose also served to heighten the triggering trauma experience in that he considered it to be a shameful failure to protect innocent lives, which left him vulnerable to what is being termed moral injury (Battaglia et al, 2019). Further, the precipitants were not just the tragic circumstances of witnessing atrocities but also his now disturbingly conflicted loyalty to the military system he had so admired when those higher than him in the chain of command failed to measure up to noble standards.…”