Examining the outcomes and acceptability of a peer-led spiritual intervention for moral injury in a veteran service organization.

Abstract

The purpose of this proof-of-concept study was to examine the outcomes and acceptability of a spiritual intervention for moral injury led by veteran peers in a Veteran Service Organization (VSO), called "Heroes to Heroes." From baseline to 1-year follow-up, 101 veterans who participated in the intervention completed the evaluation surveys at four time points assessing psychological outcomes (moral injury, posttraumatic stress disorder [PTSD] symptoms, and life satisfaction), spiritual outcomes (spiritual struggles and spiritual transcendence), and their perceived helpfulness of the program. In addition, we conducted four focus groups with six to eight alumni to more fully understand veterans' views and experiences of the program. Focusing on the longitudinal surveys, latent growth modeling analyses revealed veterans generally improved across the psychological and spiritual outcomes in the study. Specifically, veterans reported steady decreases in moral injury outcomes, PTSD symptoms, and spiritual struggles along with increased life satisfaction and spiritual transcendence over the 1-year period. An inductive content analysis of veterans' responses to open-ended items in the surveys and focus group interviews revealed four possible mechanisms or facilitators of these outcomes: (a) social connectivity and belonging (e.g., shared vulnerability and camaraderie); (b) behavioral engagement in core aspects of their spirituality (e.g., sacred practices and visiting sacred places); (c) spiritual transformation and growth (e.g., closeness with God and divine forgiveness); and (d) appreciation for diversity (e.g., religious and military). Overall, these findings affirm the potential effectiveness and acceptability of the VSO's peer-led spiritual intervention for promoting the holistic healing among veterans who are contending with emotional and spiritual wounds of war. Impact StatementMilitary veterans who participated in the peer-led spiritual intervention, on average, improved on psychological and spiritual outcomes assessed over the 1-year period. In addition, qualitative findings suggested that these improvements might be attributed to increased social connectivity and belonging, behavioral engagement in core aspects of spirituality, spiritual transformation and growth, and appreciation for cultural diversity.

Towards a Holistic Model of Care for Moral Injury: An Australian and New Zealand Investigation into the Role of Police Chaplains in Supporting Police Members following exposure to Moral Transgression

“…Several previous studies have reported on MI interventions developed and delivered by chaplains (see the scoping review from Jones et al, 2022 and Currier et al, 2023 ) but we believe that this is the first to use a qualitative methodology to explore the support provided by chaplains in routine practice and how this support is received by police members. The initial scope of enquiry was the nature of support sought and provided following the experience of a PMIE but as noted in the results, the types of moral transgressions described by both police members and police chaplains varied on a continuum of severity, which included, but was not limited to, PMIEs.…”

“…While the support currently provided by chaplains aligns closely with what police members say that they need, this should be considered one component of an holistic approach that also involves evidence-based care from mental health practitioners for MI and related mental health injuries such as PTSD (Koenig et al, 2020 ), major depressive disorder (Nazarov et al, 2018 ), generalized anxiety disorder (Lee et al, 2022 ), as well as self-injurious thoughts and behaviours (Zerach & Levi-Belz, 2019 ). It has been previously reported that police chaplains can potentiate beneficial spiritual interventions for directly improving MI outcomes (Currier et al, 2023 ) as well as facilitating access to psychological services as a function of regular, direct engagements with members and outreach opportunities. Both of these were observed in the current study with the majority of chaplains describing their approach as offering flexible spiritual guidance alongside referral or encouragement to access other forms of support, thus demonstrating an appreciation of their role within the holistic model of care.…”