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The impact of moral injury on depression and suicide in U.S. military veterans: the role of internalizing behaviors
Dissertation   Open access

The impact of moral injury on depression and suicide in U.S. military veterans: the role of internalizing behaviors

Lauren B. Johnson
Doctor of Philosophy (Ph.D.), Drexel University
Apr 2020
DOI:
https://doi.org/10.17918/00000996
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Abstract

Depression, Mental Psychic trauma Post-traumatic stress disorder Veterans--Psychology Veterans
Posttraumatic stress contributes to a significant disease burden among military veterans and has prompted considerable emphasis to be placed on effectively treating trauma-related disorders. While there has been progress in addressing posttraumatic stress through increased utilization of evidence-based interventions, there remains anecdotal evidence from mental health providers and empirical research (i.e., lower than expected remission rates following treatment), that suggests an incomplete understanding of traumatic experiences among military personnel. Recently, there has been increased attention on the construct, moral injury (MI), whereby service members behave or observe others behaving in ways that transgress deeply held moral beliefs. While evidence has started to emerge on the negative impact of these experiences, there are gaps in empirical research on the diverse sequelae of moral injury. The present study aimed to determine the influence of theoretically-relevant variables (i.e., event centrality, experiential avoidance) on the relationship between MI and depressive symptoms as well as current suicide ideation. A sample of 300 military veterans completed an online survey that included a demographics questionnaire and the following validated self-report measures: Expressions of Moral Injury Scale- Military Version, Centrality of Event Scale- short form, Acceptance and Action Questionnaire-II, Beck Scale for Suicide Ideation, Patient Health Questionnaire-9, PTSD Checklist for DSM-5, and Suicide Behaviors Questionnaire-Revised. Results demonstrated that experiential avoidance and event centrality were significant moderators between MI and depressive symptoms and suicide ideation. Currently, there are few evidence-based treatments that have been demonstrated to be effective in targeting the symptoms of moral injury. However, the outcome of this study highlights salient treatment targets and clinical recommendations that can "bridge the gap" as knowledge continues to increase on the etiology, impact, and outcomes of moral injury. The identification of event centrality and experiential avoidance as points of intervention encourage investigation into additional variables that may also be important to consider when treating veterans with elevated moral injury symptoms who are experiencing distress. As more variables are identified, it will be possible to evaluate additional intervention strategies and develop novel treatments that can mitigate the impact of moral injury symptoms. Ideally, this will lead to the more comprehensive care of veterans experiencing trauma-related sequelae and further enhance suicide prevention efforts among military populations.

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