Journal article
Morally Injurious Combat Events as an Indirect Risk Factor for Postconcussive Symptoms Among Veterans: The Mediating Role of Posttraumatic Stress
PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY, v 15(1)
Jan 2023
PMID: 35084915
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Clinical Impact Statement This study indicates that responses to morally injurious events (MIEs) may serve as a risk factor for postconcussive symptoms in veterans with mild traumatic brain injury (mTBI), through its association with posttraumatic stress disorder (PTSD). Upon replication of findings, researchers and clinicians should systematically develop and test interventions that mitigate this risk by reducing maladaptive emotions and beliefs associated with MIEs. Further, clinicians serving veterans with comorbid mTBI and MIE-related PTSD should implement evidence-based approaches for PTSD while tailoring such treatment to the distinct features of moral injury. Objective: Psychosocial factors, including combat-related distress (e.g., posttraumatic stress disorder [PTSD]), contribute to postconcussive symptoms (PCS) among veterans with mild traumatic brain injury (mTBI). However, research on risk factors for PCS has focused solely on life-threatening combat experiences, neglecting the morally injurious dimension of combat-related trauma and associated implications for treatment. Morally injurious events (MIEs) are associated with PTSD symptoms among veterans, a robust risk factor of PCS. Nonetheless, the interplay between MIEs, PTSD symptoms, and PCS remains poorly understood. We sought to investigate MIEs as an indirect risk factor for PCS among Veterans with mTBI. Method: This cross-sectional study of 145 veterans with mTBI used path analysis to investigate whether PTSD symptoms mediated the relationship between MIEs (transgressions and betrayals) and PCS (mood-behavioral, vestibular-sensory, and cognitive domains) among 145 veterans with mTBI. We used the Moral Injury Event Scale, PTSD Checklist-Civilian Version, and Neurobehavioral Symptom Inventory to measure MIEs, PTSD, and PCS, respectively. Results: Perceived transgressions were indirectly associated with mood-behavioral (beta = .21, p = .005), vestibular-sensory (beta = .17, p = .005), and cognitive PCS (beta = .20, p = .005), as mediated by PTSD. Greater transgressions were associated with more severe PTSD (beta = .27, p = .003), and greater PTSD was associated with more severe mood-behavioral (beta = .79, p < .001), vestibular-sensory (beta = .64, p < .001), and cognitive PCS (beta = .73, p < .001). Betrayals were not indirectly associated with PCS. Conclusions: Findings offer preliminary support for responses to MIEs being a modifiable risk factor for PCS among veterans. Interventions designed to foster veterans' recovery by targeting the unique emotions and beliefs associated with MIEs may be indicated.
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Details
- Title
- Morally Injurious Combat Events as an Indirect Risk Factor for Postconcussive Symptoms Among Veterans: The Mediating Role of Posttraumatic Stress
- Publication Details
- PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY, v 15(1)
- Publisher
- EDUCATIONAL PUBLISHING FOUNDATION-AMERICAN PSYCHOLOGICAL ASSOC; WASHINGTON
- Grant note
- This manuscript is based on work supported by the Veterans Health Administration, and the Rocky Mountain Mental Illness Research Education and Clinical Center, but does not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000746942000001
- Scopus ID
- 2-s2.0-85125069347
- Other Identifier
- 991021861285404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Psychiatry
- Psychology, Clinical