The Invisible Wound: Moral Injury and Its Impact on the Health of Operation Enduring Freedom/Operation Iraqi Freedom Veterans

Abstract

Many veterans are now returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) deployments with physical and mental health problems. However, there are few studies that examine the impact of moral injury on both physical and mental well-being. This study examines the impact of moral injury on self-reported general physical health, general mental health, post-traumatic stress disorder symptoms, and depression symptoms. Cross-sectional data were collected at as part of a pilot study at the New Jersey Veteran Affairs. 100 OEF/OIF veterans recruited at the New Jersey Veteran Affairs completed the paper questionnaire. We found that moral injury and combat experiences positively predicted post-traumatic stress disorder scores. Seeing the aftermath of battle and moral injury were negatively associated with mental well-being and positively associated with depression. Physical health status was negatively associated with depression. Spirituality and moral injury were negatively associated with physical health, whereas age was positively associated with physical health. Moral injury plays an important role in both physical and mental health outcomes for OEF/OIF veterans, but it is often not addressed in health care. These results underline the need for an approach to veterans' health care that includes discussion of existential and moral issues since they may impact health outcomes for many service members.

A Critical Outlook on Combat-Related PTSD: Review and Case Reports of Guilt and Shame as Drivers for Moral Injury

“…In conclusion, we feel it is important to further explore the concept of moral injury, as well as the relation between guilt and shame in military populations, and its implications for the onset, maintenance, and treatment of combat-related PTSD and other mental conditions (see also Currier et al, 2015;Yan, 2016). We reviewed and illustrated how guilt and shame can be drivers to chronicity in PTSD.…”

Spiritual Dimensions of Moral Injury: Contributions of Mental Health Chaplains in the Canadian Armed Forces

“…S/R has been found to be positively related to an individual's ability to integrate stressful life events into their personal framework and experiences ( 23 ). Factors that are independently linked to post-traumatic growth (PTG) and increased well-being among veterans include intrinsic religiosity, spirituality, and purpose in life ( 24 , 25 ).…”

Einsatzerlebnisse, moralische Verletzungen, Werte und psychische Erkrankungen bei Einsatzsoldaten der Bundeswehr

“…So stehen die Ergebnisse zu Depressivität und PTBS zum Teil auch im Einklang mit jüngs-ten US-amerikanischen Studien, in denen moralische Verletzungen eine hohe Erklärungskraft bezüglich der Häufigkeit von Depressionen und PTBS bei Veteranen aus den Irak-und Afghanistankriegen aufwiesen [Yang, 2016]. Dabei stand PTBS zudem in Verbindung mit Kampfhandlungen, Depression dagegen mit nur indirekt kriegsbezogenen Erfahrungen, wie dem Umgang mit Flüchtlingen, was dem in dieser Studie ermittelten Faktor «Konfrontation mit Not, Leid, Gewalt in der Bevölkerung» ähnelt.…”

“…Dabei stand PTBS zudem in Verbindung mit Kampfhandlungen, Depression dagegen mit nur indirekt kriegsbezogenen Erfahrungen, wie dem Umgang mit Flüchtlingen, was dem in dieser Studie ermittelten Faktor «Konfrontation mit Not, Leid, Gewalt in der Bevölkerung» ähnelt. Ein Unterschied zwischen dieser und der Untersuchung von Yang [2016] liegt somit offenbar in der herausgehobenen Bedeutung des Kontakts zur Zivilbevölkerung und der demgegenüber vergleichsweise begrenzten Auswirkung von Kampfhandlungen auf die psychische Symptomatik bei deutschen Einsatzsoldaten. Die eher geringe Intensität von Kampfhandlungen im deutschen Einsatzgebiet könnte diese Abweichungen erklären, gegebenenfalls aber auch kulturelle Unterschiede, die mit Sozialisations-oder militärischen Ausbildungserfahrungen zusammenhängen könnten.…”