Moral injury in psychiatric patients with personality and other clinical disorders: development, psychometric properties, and validity of the Moral Injury Events Scale-Civilian Version

Meaning in life following service among post-9/11 military veterans: A latent growth mixture model analysis

Meaning in life refers to the "sense made of, and significance felt regarding, the nature of one's being and existence." Meaningful living promotes well-being, resilience, and personal growth. Yet, much remains unknown about how meaning changes over time and determinants of meaning, particularly during major life transitions. We identified distinct trajectories of meaning using latent growth mixture models and examined prospective predictors of class membership in a military veteran cohort assessed at multiple time points throughout the first 3 years after leaving service. Three trajectories were identified: consistently high meaning (89.5%; n = 7025), diminishing meaning (6.1%; n = 479), and strengthening meaning (4.4%; n = 348). Veterans with greater posttraumatic stress symptoms, depression symptoms, and moral injury experienced increased odds of a less adaptive trajectory (i.e. diminishing and/or strengthening vs. consistently high meaning), whereas veterans who reported greater psychological resilience, community relationship satisfaction, and intimate relationship satisfaction experienced lower odds of a less adaptive trajectory. Several gender differences were also observed. Results provide insight into veteran subgroups that are more likely to experience lower meaning after leaving military service and thus may benefit from additional support to reduce their risk for poor longer-term health and well-being outcomes.

Moral Injury and Shame Mediate the Relationship Between Childhood Trauma and Borderline Personality Disorder, PTSD, and Complex PTSD Symptoms in Psychiatric Inpatients

Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample (N = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.