In the current paper, we first describe the rationale for and methodology employed by an international research consortium, the Moral Injury Outcome Scale (MIOS) Consortium, the aim of which is to develop and validate a content‐valid measure of moral injury as a multidimensional outcome. The MIOS Consortium comprises researchers and clinicians who work with active duty military service members and veterans in the United States, the United Kingdom, the Netherlands, Australia, and Canada. We describe the multiphase psychometric development process being conducted by the Consortium, which will gather phenomenological data from service members, veterans, and clinicians to operationalize subdomains of impact and to generate content for a new measure of moral injury. Second, to illustrate the methodology being employed by the Consortium in the first phase of measure development, we present a small subset of preliminary results from semistructured interviews and questionnaires conducted with care providers (N = 26) at three of the 10 study sites. The themes derived from these initial preliminary clinician interviews suggest that exposure to potentially morally injurious events is associated with broad psychological/behavioral, social, and spiritual/existential impacts. The early findings also suggest that the outcomes associated with acts of commission or omission and events involving others’ transgressions may overlap. These results will be combined with data derived from other clinicians, service members, and veterans to generate the MIOS.
Sexual assault is a prevalent trauma associated with high rates of posttraumatic stress disorder (PTSD). Social cognitive theories posit that behavioral self-blame (i.e., attributing the cause of the assault to personal peri-event behavior) contributes to the etiology and maintenance of PTSD symptoms. Yet the direction of the association between self-blame and PTSD symptoms in the acute aftermath of sexual assault is unknown. This study evaluated temporal pathways between behavioral self-blame and PTSD symptom severity in an epidemiological sample of sexual assault survivors ( n = 126) assessed at four time points in the months immediately following the assault. Results of cross-lagged panel modeling revealed that reports of behavioral self-blame at the first assessment following sexual assault predicted PTSD symptom severity at Time 2. However, there was no association between behavioral self-blame at Time 2 and PTSD symptom severity at Time 3, nor was there an association between behavioral self-blame at Time 3 and PTSD symptom severity at Time 4. Instead, PTSD symptom severity predicted behavioral self-blame at Times 3 and 4. Findings suggest that behavioral self-blame following sexual assault may be particularly relevant to the onset of PTSD symptoms, while PTSD symptoms themselves appear to intensify subsequent perceptions of behavioral self-blame. Clinical implications and limitations are discussed.
Posttraumatic stress disorder (PTSD) and alcohol misuse are commonly co-occurring problems in active-duty service members (SMs) and veterans. Unfortunately, relatively little is known about the temporal associations between these problems in the acute period following exposure to combat stressors. Discerning the temporal associations between these problems across the deployment cycle could inform prevention and treatment efforts. In this study, we examined the association between PTSD symptom severity and problem alcohol use in a large cohort of United States Marines (n = 758) evaluated prior to deployment and approximately 1, 5, and 8 months postdeployment. Results indicate that problem alcohol use was associated with a subsequent exacerbation of PTSD symptoms between the 1st and 2nd and 2nd and 3rd postdeployment assessments. PTSD symptom severity was associated with increased problem alcohol use between the 1st and 2nd postdeployment assessments. These findings suggest that problem drinking may lead to new onset or worsening of PTSD symptoms over time and that SMs with greater PTSD symptom severity upon returning from deployment may increase alcohol use in the weeks immediately following homecoming.
Objective: We evaluated patterns and predictors of change from three efficacy trials of trauma-focused cognitive–behavioral treatments (TF-CBT) among service members (N = 702; mean age = 32.88; 89.4% male; 79.8% non-Hispanic/Latino). Rates of clinically significant change were also compared with other trials. Method: The trials were conducted in the same setting with identical measures. The primary outcome was symptom severity scores on the PTSD Symptom Scale—Interview Version (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993). Results: Symptom change was best explained by baseline scores and individual slopes. TF-CBT was not associated with better slope change relative to Present-Centered Therapy, a comparison arm in 2 trials. Lower baseline scores (β = .33, p < .01) and higher ratings of treatment credibility (β = −.22, p < .01) and expectancy for change (β = −.16, p < .01) were associated with greater symptom change. Older service members also responded less well to treatment (β = .09, p < .05). Based on the Jacobson and Truax (1991) metric for clinically significant change, 31% of trial participants either recovered or improved. Conclusions: Clinicians should individually tailor treatment for service members with high baseline symptoms, older patients, and those with low levels of credibility and expectancy for change.
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