Moral injury and chronic pain among military veterans in an integrated behavioral health clinic.

Abstract

Objective: Military service may place veterans at increased risk for perpetrating, witnessing, or failing to prevent events that violate deeply held moral values. In some cases, veterans may develop moral injury (MI) symptoms that transcend and/or overlap with mental health conditions such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Further, PTSD and MDD are 2 established risk factors for chronic pain. However, research has not examined the association between MI symptoms and chronic pain. Method: We tested whether MI would emerge as a salient correlate of concurrent reports of chronic pain in the presence of PTSD and MDD symptom severity among 59 veterans seeking integrated behavioral health care. Results: Findings indicated the severity of MI symptoms was significantly linked with veterans’ concurrent reports of chronic pain. Self-directed MI symptoms emerged as a correlate of worse pain in the presence of PTSD and MDD. Conclusions: Preliminary findings demonstrate possible associations between MI and chronic pain among veterans with a need for holistic health care. Future research should examine mechanisms for an apparent MI-chronic pain link.

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis

“…The PRISMA flowchart delineates the review process (see figure 1). Of the 81 full texts included in the review,6 12–21 43–112 some reported multiple studies in the same paper, so there were 88 separate studies included in the review. Of these, six reported prevalence estimates or average scores that could not be pooled, so they were included in the narrative synthesis only.…”