Certain events, termed potentially morally injurious events, can transgress an individual's existing moral framework and elicit morally injurious outcomes, which, in turn, can be associated with negative mental health outcomes. This systematic review and meta-analysis (Prospero ID-CRD42018104621) aimed to examine the relationship between moral injury outcomes and mental health. Fifty-nine articles, representing 50 independent samples, were reviewed, including for methodological quality. We found statistically significant relationships between all moral injury outcomes and mental health, with predominately moderate-large effect sizes observed. Relationships were typically stronger if studies measured moral injury outcomes only, compared with studies that included measurement of both exposure and outcomes. The Moral Injury subscales (Self, Others, and Betrayal) were also significantly related to poorer mental health. Overall, the meta-analytic results support reliable associations between moral injury outcomes and poorer mental health. Future research needs to diversify into nonmilitary populations, consider measurement tool selection, and strive for greater consensus regarding theoretical frameworks to direct this emerging research area.

Objective This study investigated whether moral injury appraisals moderated the relationships between trauma, postmigration living difficulties, resilience, and mental health outcomes in adolescent refugees. Method Eighty‐five adolescent refugees from a community sample completed an online survey. Results A significant interaction was found between moral injury and discrimination for externalizing and posttraumatic stress disorder (PTSD) symptoms; adolescents whom had experienced high levels of discrimination combined with high levels of moral injury had poorer mental health. A significant interaction was found between moral injury and resilience for internalizing symptoms: high levels of resilience appeared to buffer the association between moral injury and internalizing symptoms. Contrary to predictions, stressful life experiences and postmigration living difficulties did not interact significantly with moral injury to predict mental health. Conclusions Discrimination may contribute to perpetuating poor mental health in adolescent refugees with high levels of moral injury. Resilience may buffer some of the negative effects of moral injury.

Objective: While moral injury can influence psychological outcomes experienced by adult refugees, no research to date has examined moral injury among young refugees. This study aimed to investigate the associations between moral injury and mental health in young people with refugee backgrounds. Method: Participants were 85 young refugees (58.80% female), aged on average 20.78 years (SD = 2.29, range = 16-25 years), living in Melbourne Australia. This community sample completed measures of moral injury appraisals, traumatic stress, resilience, and mental health using an online survey. Results: Moral injury appraisals significantly correlated with poorer mental health. Regression analyses demonstrated that moral injury predicted differences on externalizing symptoms but not internalizing or PTSD symptoms. Further, the relationship between traumatic stress and externalizing symptoms was mediated by moral injury appraisals. Similarly, the relationship between postmigration living difficulties and internalizing symptoms was mediated by moral injury appraisals. Conclusions: Findings indicated young people with refugee backgrounds also experience moral injury appraisals and these are associated with poor mental health. Further research is needed to understand the factors associated with psychological outcomes experienced by young refugees and to guide clinical assessments and novel interventions for this population. Clinical Impact StatementThis study was the first to explore whether young people with refugee backgrounds exhibit reactions to traumatic events that violate important moral values (termed "moral injury"). We surveyed young refugees aged 16 to 25 years from diverse backgrounds living in Australia. Our findings showed that like adults, young refugees also experience moral injury, and these are associated with poor mental health. These findings are important for therapists conducting clinical assessments and providing mental health support.

ObjectivesThis study aimed to identify predictors of positive and negative post‐traumatic psychological outcomes within a sample of Iranian cancer survivors.MethodsIn this cross‐sectional research, 300 (167 females; age M = 53.00, SD = 27.57) cancer survivors (breast cancer, leukaemia, colorectal cancer) were recruited from oncology outpatient clinics in Iran. Participants completed measures of post‐traumatic stress disorder (PTSD), post‐traumatic growth (PTG), cognitive processing, attentional biases, and autobiographical memory specificity.ResultsUsing partial least square structural equation modelling, it was found that the proposed model was capable of predicting PTSD and PTG. Negative attentional biases were significantly associated with PTSD symptoms, but were not significantly associated with PTG. In contrast, memory specificity and positive attentional biases tended to be associated with PTG, but were not significantly associated with PTSD symptoms. Second, negative cognitive processing was significantly associated with PTSD symptoms, while positive cognitive processing was significantly associated with PTG. Finally, there was support for indirect pathways between positive cognitive tendencies and PTG through positive cognitive processing, while there were indirect pathways between negative habitual cognitive tendencies and PTSD symptoms through negative cognitive processing.ConclusionsOur findings support growing evidence for differential trajectories to PTG and PTSD symptoms in cancer. Such cognitive factors may be important therapeutic targets in psycho‐oncology interventions. Statement of contribution What is already known on this subject? The diagnosis of cancer and its subsequent treatment can result in symptoms of post‐traumatic stress disorder (PTSD). Positive changes and psychosocial growth (post‐traumatic growth; PTG) are also common as a result of patients’ experience of cancer. What does this study add? This study identified predictors of positive (PTG) and negative trauma (PTSD) outcomes within a sample of Iranian cancer survivors (N = 300). General habitual cognitive tendencies (memory specificity, attentional biases) were associated with cognitive processing, which in turn contributed to psycho‐traumatic adaption. There was support for indirect pathways between positive cognitive tendencies and PTG through positive cognitive processing, while there were indirect pathways between negative habitual cognitive tendencies and PTSD symptoms through negative cognitive processing.

Typically, individuals have an attentional bias towards the left visual field. This is often absent in individuals with attention-deficit/hyperactivity (ADH) disorder (ADHD). We used a motion-induced blindness task with targets in four quadrants in order to assess left/right as well as upper/lower spatial biases in perceptual disappearances, and also measured changes in the disappearances with time-on-task. Fifty-eight university students (41 female) completed the Conners Adult ADHD self-report short-form to assess the number of ADH traits, and 48 trials of a one-minute motion-induced blindness (MIB) task. Through a hybrid hypothesisdriven and data-driven analysis approach, we found that the MIB illusion increased with more ADH traits, decreased with time-on-task, and was stronger for left and lower quadrants. The time-on-task likely contributed to the strength of the illusion through changes in arousal, as pupil size decreased with time-on-trial in a subset of participant (n=11) for who we measure eye-movements. Additionally, whilst participants were biased towards the lower left visual field, this was, unexpectedly, most prominent with those with higher ADH traits. This novel result suggests an additive effect of left/right and upper/lower spatial biases. Taken together, this study supports an association between spatial attention, arousal and ADH traits in MIB.