Moral Injury as a Mediator of the Associations Between Sexual Harassment and Mental Health Symptoms and Substance Use Among Women Veterans

Abstract

Moral injury is an array of symptoms theorized to develop in response to morally injurious events, defined as events that challenge one’s core moral beliefs and expectations about the self, others, and world. Recent measures of moral injury have distinguished self-directed moral injury (e.g., moral injury symptoms that emerge following the perpetration of morally injurious events) from other-directed moral injury, the symptoms of which are believed to stem from one’s response to actions that others have committed (e.g., within-rank violence, failures of leadership, and acts of betrayal committed by trusted others or institutions). Using a convenience sample of 154 primarily former military women, the present study examined if other-directed moral injury symptoms (e.g., anger, betrayal, and mistrust) associated with military experience would mediate the association between military sexual harassment and mental health and substance abuse symptoms. Results demonstrated that 85.8% ( n = 127) of the of this sample of women veterans reported experiencing sexual harassment during their military service. Using a single mediation model, we further demonstrated that other-directed moral injury mediated the association between sexual harassment experience and mental health symptoms. Given the percentage of women veterans who reported sexual harassment, these results suggest that additional training for military members, and particularly, military leaders, is necessary to begin to reduce sexual harassment. In addition, mental health providers who work with current and former military members should consider how other-directed moral injury may be associated with mental health symptoms among women veterans who have experienced sexual harassment while in the military.

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.…”

Exposure to potentially morally injurious events, disruption in assumptive world, moral injury symptoms, and psychological distress among Israeli female veterans

“…In that regard, Hamrick, et al. (2022) found that PMIEs of others mediated the association between sexual harassment experience and mental health symptoms among female veterans, This result highlights the importance of PMIEs in understanding psychological difficulties among female veterans in the aftermath of traumatic experiences. Moreover, female veterans seem to be exposed to similar rates of PMIEs and also exhibit similar rates of PTSD, but higher rates of depression and non‐PTSD anxiety disorders compared with male veterans (Freedy et al., 2010).…”

“…For example, female combat veterans are more likely to be exposed to traumas of an interpersonal nature, such as child abuse or sexual assault (for review, see Zinzow et al, 2007), and that female veterans report greater life stressors and work stress compared to males (Lehavot et al, 2018;Vogt et al, 2011). In that regard, Hamrick, et al (2022) found that PMIEs of others mediated the association between sexual harassment experience and mental health symptoms among female veterans, This result highlights the importance of PMIEs in understanding psychological difficulties among female veterans in the aftermath of traumatic experiences. Moreover, female veterans seem to be exposed to similar rates of PMIEs and also exhibit similar rates of PTSD, but higher rates of depression and non-PTSD anxiety disorders compared with male veterans (Freedy et al, 2010).…”

“How can they treat it if they can't identify it?”: Mental health professionals' knowledge and perspectives of moral injury.

“…Research data support the possibility that exposure to transgressive acts may be related to higher rates of depressive disorders. This exposure may also facilitate destructive behaviors, such as substance and alcohol abuse (Hamrick et al, 2021), self-handicapping behaviors and demoralization (e.g., Zerach & Levi-Belz, 2019), and even suicidal ideation and behavior (Levi-Belz, Dichter, et al, 2020; Williamson et al, 2020). Moreover, to date, most studies have explored the link between exposure to PMIEs and PTSD (e.g., Barnes et al, 2019; Levi-Belz, Greene, et al, 2020).…”