Psychometric properties of a Modified Moral Injury Questionnaire in a military population.

Abstract

Moral injury (MI) results from perpetration of or exposure to distressing events, known as morally injurious events (MIEs), that challenge moral beliefs and values. Due to the type of involvement in recent military conflicts, many veterans report MIEs that may cause dissonance and, in turn, MI. Although two existing measures assess MIEs, neither currently assesses the defining characteristics of MI (i.e., guilt, shame, difficulty forgiving self and others, and withdrawal). The present study reports the initial psychometric test of a modified version (Robbins, Kelley, Hamrick, Bravo, & White, 2017) of the Moral Injury Questionnaire – Military version (MIQ-M; Currier, Holland, Drescher, & Foy, 2015) in a sample of 328 military personnel (e.g., veterans, National Guard/reservists, active duty members). The MIQ-M was modified to assess both MIEs and the defining characteristics of MI. Exploratory factor analyses suggested a three-factor model of MIEs consisting of Atrocities of war, Psychological consequences of war, and Leadership failure or betrayal. The modified MIQ-M factors were correlated with defining characteristics of MI. In addition, each MIE factor and associated defining characteristics of MI were positively correlated with symptoms of posttraumatic stress disorder, depression, and anxiety, as well as substance use. The modified MIQ-M is a reliable measure of MI that is comprised of three subscales that are associated with, but distinct from, mental health outcomes. Although findings are promising, further research evaluating the applicability of the modified MIQ-M in clinical settings is required to establish construct validity of the defining characteristics and secondary manifestations of MI.

Moral Injury, Substance Use, and Posttraumatic Stress Disorder Symptoms Among Military Personnel: An Examination of Trait Mindfulness as a Moderator

“…Moral injury was assessed with a modified version (Braitman et al., ) of the Moral Injury Questionnaire–Military Version (MIQ‐M; Currier et al., ). The original MIQ‐M is a 20‐item self‐report measure that assesses PMIEs during combat or other types of deployment.…”

“…Due to high collinearity, we summed the PMIE follow‐up questions such that there was a single total moral injury score, with higher scores indicating greater endorsement of moral injury. Braitman and colleagues () found strong reliability among the PMIEs using Cronbach's alpha values, with values ranging from .67 to .95. The items moderately correlated with, yet were distinct from, symptoms of anxiety, depression, and PTSD (Braitman et al., ).…”

“…Braitman and colleagues () found strong reliability among the PMIEs using Cronbach's alpha values, with values ranging from .67 to .95. The items moderately correlated with, yet were distinct from, symptoms of anxiety, depression, and PTSD (Braitman et al., ). In our analytic sample, Cronbach's alpha was .95.…”

“…In our analytic sample, Cronbach's alpha was .95. It is important to note that any PMIEs a participant indicated he or she did not experience (i.e., a rating of never ) were excluded from this calculation (see Braitman et al., for psychometric information on the revised version of the MIQ‐M). On average, participants reported having experienced 18 distinct PMIEs ( M = 18.24; SD = 8.10), with 98% of participants reporting having experienced at least two PMIEs.…”

Morally Injurious Experiences of Combat Exposed Veterans of Iraq and Afghanistan: Moderating Effects of Self-Forgiveness on Feelings of Shame and Guilt

“…Cronbach's alpha coefficients were calculated to measure the internal consistency reliability of each instrument. Internal consistency results for the MIQ-M in this study (α = 0.87) were consistent with Braitman et al (2018) results of a Cronbach's alpha (α = 0.92) for the MIQ-M. The HFS-SF internal consistency for this study (α = 0.73) was lower than the initial reported internal consistency by Thompson and colleagues (2005) (α = 0.86), but the HFS-SF internal consistency for this study is in the acceptable range (Cohen, 1988).…”