Sources of moral injury among war veterans: A qualitative evaluation

Schorr, Yonit; Stein, Nathan R.; Maguen, Shira; Barnes, J. Ben; Bosch, Jeane; Litz, Brett T.

doi:10.1002/jclp.22660

Cited by 61 publications

(66 citation statements)

References 25 publications

(57 reference statements)

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“…Our preliminary findings suggest that social isolation may be a form of self‐punishment for self‐based PMIEs whereas isolation may be a form of self‐protection for other‐based PMIEs. In a recent qualitative study of war veterans, Schorr and colleagues () also found similar fine‐grained distinctions between the impact of self‐ and other‐based PMIEs, which may be validated upon completion of Phase I data collection.…”

Section: Discussionmentioning

confidence: 75%

Defining and Measuring Moral Injury: Rationale, Design, and Preliminary Findings From the Moral Injury Outcome Scale Consortium

Yeterian

Berke

Carney

et al. 2019

Journal of Traumatic Stress

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109

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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.

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Section: Discussionmentioning

confidence: 75%

Defining and Measuring Moral Injury: Rationale, Design, and Preliminary Findings From the Moral Injury Outcome Scale Consortium

Yeterian

Berke

Carney

et al. 2019

Journal of Traumatic Stress

Self Cite

109

View full text Add to dashboard Cite

show abstract

“…Notwithstanding this, MI is often theorized as resulting in shame, guilt, distrust, anger, grief, turmoil with God or a higher power, self‐condemnation, and disgust (Bryan et al ; Currier et al ; Jinkerson ; Litz et al ; Shay ). MI can be self‐directed (individual perpetrated an act that led to a transgression of moral boundaries) or other directed (witnessing or hearing about a transgression; Schorr et al ) and is linked with suicidality (suicidal ideation, plans, behaviour, and/or attempt) in veterans (Bryan et al ; ). MI represents an existential set of issues spanning psychological behavioural, spiritual, and interpersonal from an actual or perceived violation of one's moral beliefs (Jinkerson ) resulting in a profound ‘moral disorientation’ (Molendijk , p. 6) in other words ‘the loss of one's moral frame of reference and one's moral self‐perception’ (Molendijk , p. 6).…”

Section: About Moral Injurymentioning

confidence: 99%

Invisible wounds and suicide: Moral injury and veteran mental health

Jamieson

Usher

Maple

et al. 2020

Int J Mental Health Nurs

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“…Leadership betrayal reflects a breach of trust in systems of authority and responsibility over and above interpersonal violations (Schorr et al . 2018; Smith & Freyd 2017). Shay’s (1994) seminal literature on moral injury also identified leadership failings that amounted to betrayal within the structure of command as a core construct.…”

Section: Antecedentsmentioning

confidence: 99%

Military moral injury: A concept analysis

Jamieson

Maple²,

Ratnarajah³

et al. 2020

Int J Mental Health Nurs

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Moral injury is the current term describing the breaching or violation of one’s moral code and has gained international research attention due to suicide linkages in military populations (Jamieson et al., Invisible wounds and suicide: Moral injury and veteran mental health. International Journal of Mental Health Nursing, 29, 105–109, 2020). Moral injury’s core features are spiritual/existential conflict, shame, guilt and self‐condemnation. To date, research focuses on the core features of moral injury and or the nature of events that exposed individuals to moral injury. Walker and Avant (Strategies for Theory Construction in Nursing, Prentice Hall New York, 2011) concept analysis model was used to examine the literature. The aim of this study is to enhance understanding of the defining attributes, antecedents, consequences and empirical referents of moral injury and systematically analyse the concept of moral injury in the context of military members. A literature search was undertaken using specific websites and journals, electronic databases, library catalogues and hand‐searches. Concept analysis was used to explicate moral injury, focusing exclusively on use of the concept in the included literature, comparing the terms used over time and across disciplines, and measurement tools for the concept. This concept analysis provides a renewed definition of moral injury in relation to the experience of veterans – ‘moral trauma’ and defined as: ‘the existential, psychological, emotional and or spiritual trauma arising from a conflict, violation or betrayal, either by omission or commission, of or within one’s moral beliefs or code(s)’. The analysis will facilitate understanding and operationalization of the concept applied to teaching, learning, practice and research.

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Sources of moral injury among war veterans: A qualitative evaluation

Abstract: Implications for the further development of the moral injury construct and treatment are discussed.

Cited by 61 publications

References 25 publications

Defining and Measuring Moral Injury: Rationale, Design, and Preliminary Findings From the Moral Injury Outcome Scale Consortium

Defining and Measuring Moral Injury: Rationale, Design, and Preliminary Findings From the Moral Injury Outcome Scale Consortium

Invisible wounds and suicide: Moral injury and veteran mental health

Military moral injury: A concept analysis

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