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Williamson V, Lamb D, Hotopf M, Raine R, Stevelink S, Wessely S, Docherty M, Madan I, Murphy D, Greenberg N. Moral injury and psychological wellbeing in UK healthcare staff. J Ment Health 2023; 32:890-898. [PMID: 36883341 DOI: 10.1080/09638237.2023.2182414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 12/13/2022] [Accepted: 01/28/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Potentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury. AIM To examine the impact of PMIE on healthcare staff wellbeing. METHODS Twelve thousand nine hundred and sixty-five healthcare staff (clinical and non-clinical) were recruited from 18 NHS-England trusts into a survey of PMIE exposure and wellbeing. RESULTS PMIEs were significantly associated with adverse mental health symptoms across healthcare staff. Specific work factors were significantly associated with experiences of moral injury, including being redeployed, lack of PPE, and having a colleague die of COVID-19. Nurses who reported symptoms of mental disorders were more likely to report all forms of PMIEs than those without symptoms (AOR 2.7; 95% CI 2.2, 3.3). Doctors who reported symptoms were only more likely to report betrayal events, such as breach of trust by colleagues (AOR 2.7, 95% CI 1.5, 4.9). CONCLUSION A considerable proportion of NHS healthcare staff in both clinical and non-clinical roles report exposure to PMIEs during the COVID-19 pandemic. Prospective research is needed to identify the direction of causation between moral injury and mental disorder as well as continuing to monitor the longer term outcomes of exposure to PMIEs.
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Affiliation(s)
- Victoria Williamson
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - Danielle Lamb
- Department of Applied Health Research, NIHR ARC North Thames, UCL, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, NIHR ARC North Thames, UCL, London, UK
| | - Sharon Stevelink
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Mary Docherty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Trust and King's College London, London, UK
| | - Dominic Murphy
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Combat Stress, Tyrwhitt House, Leatherhead, UK
| | - Neil Greenberg
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
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2
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Hendrikx LJ, Williamson V, Murphy D. Adversity during military service: the impact of military sexual trauma, emotional bullying and physical assault on the mental health and well-being of women veterans. BMJ Mil Health 2023; 169:419-424. [PMID: 34697241 DOI: 10.1136/bmjmilitary-2021-001948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/12/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite making up about 11% of the UK military, there remains limited investigation on the impact of adversity women experience during their service in the UK military. Military adversity can result in a range of well-being difficulties that may persist following transition out of military. The present study therefore examined the prevalence and correlates of different types of military adversity (defined as sexual harassment, sexual assault, emotional bullying and physical assault) within a community sample of UK women veterans. METHODS Participants were recruited from a UK charity supporting women veterans. 750 women veterans completed an online survey collecting information on sociodemographic and military factors, military adversity, as well as mental health and well-being difficulties. Associations between variables were explored using multivariate logistic regressions. RESULTS The findings indicate a high prevalence of military adversity (22.5% sexual harassment, 5.1% sexual assault, 22.7% emotional bullying and 3.3% physical assault). Younger women, those who held an officer rank during service and those who reported having a combat or combat support role during service were most at risk of military adversity. All types of adversity were significantly associated with probable post-traumatic stress disorder. Sexual harassment was additionally significantly associated with physical somatisation; sexual assault with alcohol difficulties; and emotional bullying with common mental health difficulties, low social support and loneliness. CONCLUSIONS This study indicates that UK women veterans are at risk of a range of adverse experiences during military service and provides evidence of the impact of such adversities on mental health and well-being. Further research is required to better understand these relationships.
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Affiliation(s)
| | - V Williamson
- Kings Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - D Murphy
- Research Department, Combat Stress, Leatherhead, UK
- Kings Centre for Military Health Research, King's College London, London, UK
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3
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Serfioti D, Murphy D, Greenberg N, Williamson V. Professionals' perspectives on relevant approaches to psychological care in moral injury: A qualitative study. J Clin Psychol 2023; 79:2404-2421. [PMID: 37310171 DOI: 10.1002/jclp.23556] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/12/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Despite the increasing consensus that moral injury (MI) is a unique type of psychological stressor, there is an ongoing debate about best practices for psychological care. This qualitative study explored the perceptions of UK and US professionals in the field of MI investigating advances and challenges in treatment or support delivery and issues relating to treatment/support feasibility and acceptability. METHODS 15 professionals were recruited. Semi-structured, telephone/online interviews were carried out, and transcripts were analyzed using thematic analysis. RESULTS Two interconnected themes emerged: perceived barriers to appropriate care for MI cases and recommendations for providing effective care to MI patients. Professionals highlighted the challenges that occur due to the lack of empirical experience with MI, the negligence of patients' unique individual needs and the inflexibility in existing manualised treatments. CONCLUSIONS These findings illustrate the need to evaluate the effectiveness of current approaches and explore alternative pathways, which will effectively support MI patients in the long-term. Key recommendations include the use of therapeutic techniques which lead to a personalised and flexible support plan to meet patients' needs, increase self-compassion and encourage patients to reconnect with their social networks. Interdisciplinary collaborations (e.g., religious/spiritual figures), could be a valuable addition following patients' agreement.
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Affiliation(s)
- Danai Serfioti
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Dominic Murphy
- Department of Psychological Medicine, King's Centre for Military Health Research, King's College London, London, UK
- Research Department, Combat Stress, Surrey, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's Centre for Military Health Research, King's College London, London, UK
| | - Victoria Williamson
- Department of Psychological Medicine, King's Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
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4
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Zerach G, Ben-Yehuda A, Levi-Belz Y. A prospective investigation of protective factors for moral injury and psychiatric symptomatology among Israeli combatants: A Latent Class Analysis approach. Int J Soc Psychiatry 2023; 69:1134-1144. [PMID: 36734242 DOI: 10.1177/00207640231152211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In this prospective study, we examined pre-enlistment characteristics and pre-deployment protective factors of exposure to potentially morally injurious events (PMIEs) among Israeli active-duty combatants, as well as psychiatric symptomatology outcomes of exposure. METHODS A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements (T1: 12 months before enlistment, T2: 6 months following enlistment- pre deployment, and T3: 18 months following enlistment- post deployment). Participants' characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T3) between 2019 and 2021. RESULTS Latent Class Analysis (LCA) was used to identify three classes characterized by unique patterns of exposure to PMIEs (T2): Minimal Exposure (56.6%), Betrayal-Only (25.5%), and High Exposure (17.8%). Higher levels of pre-deployment psychological flexibility (T1) were associated with higher odds for inclusion in the high exposure class (T2). As compared to the minimal exposure class, both high exposure and betrayal-only classes were associated with higher levels of mental health symptoms and MI-related psychological outcomes (T2). CONCLUSIONS This is the first prospective study of antecedents and outcomes of exposure to PMIEs among active-duty combatants. Clinicians treating combatants should be aware of the different types of exposure to PMIEs and their possible psychiatric outcomes.
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Affiliation(s)
- Gadi Zerach
- Department of Psychology, Ariel University, Ariel, Israel
| | - Ariel Ben-Yehuda
- Department of Health and Well-being, Medical Corps, IDF, Tel Aviv, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
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5
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McDaniel JT. Moral injury and quality of life among military veterans. BMJ Mil Health 2023:e002457. [PMID: 37344006 DOI: 10.1136/military-2023-002457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Moral injury concerns transgressive harms and the outcomes that such experiences may cause. A gap in the literature surrounding moral injury, and an outcome that may be important to include in the mounting evidence toward the need for the formal clinical acknowledgement of moral injury, has to do with the relationship between moral injury and quality of life. No studies have examined this relationship in US military veterans-a population that is disproportionately exposed to potentially morally injurious events. METHODS A nationwide cross-sectional survey was conducted yielding 1495 military veterans. Participants were asked questions about moral injury and quality of life, among other things. Multivariable linear regression was used to characterise the adjusted relationship between moral injury and quality of life. RESULTS Moral injury (mean=40.1 out of 98) and quality-of-life (mean=69.5 out of 100) scores were calculated for the sample. Moral injury was inversely associated with quality of life in an adjusted model, indicating that worsening moral injury was associated with decreased quality of life (adjusted unstandardised beta coefficient (b)=-0.3, p<0.001). Results showed that age moderated said relationship, such that ageing veterans experienced an increasingly worse quality of life with increasingly severe moral injury (b=-0.1, p=0.003). CONCLUSIONS Results of the study showed that moral injury was inversely associated with quality of life and that this relationship rapidly worsens with age. More work is needed to more precisely understand this relationship and to determine the best strategies for intervention.
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Affiliation(s)
- Justin Tyler McDaniel
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, Illinois, USA
- Dale and Deborah Smith Center for Alzheimer's Research and trEatment (CARE), Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Randles R, Burroughs H, Green N, Finnegan A. Prevalence and risk factors of suicide and suicidal ideation in veterans who served in the British Armed Forces: a systematic review. BMJ Mil Health 2023:e002413. [PMID: 37328264 DOI: 10.1136/military-2023-002413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/08/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Research into the factors resulting in suicide in the military veteran population has yet to reach a consensus. Available research is concentrated on a small number of countries, and there is a lack of consistency with contradictory conclusions. The USA has produced a significant amount of research in a country where suicide is identified as a national health crisis, but in the UK, there is little research regarding veterans from the British Armed Forces. METHODS This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Corresponding literature searches were conducted in PsychINFO, MEDLINE and CINAHL. Articles that discussed suicide, suicidal ideation, prevalence or risk factors among British Armed Forces veterans were eligible for review. A total of 10 articles met the inclusion criteria and were analysed. RESULTS Veterans' suicide rates were found to be comparable to those of the general UK population. The method of suicide used was most commonly found to be hanging and strangulation. Firearms was recorded in 2% of suicide cases. Demographic risk factors were often contradictory with some research stating that there was risk in older veterans and some in younger. However, female veterans were found to be at higher risk than female civilians. Those who had deployed on combat operations were at lower risk of suicide, with research finding that veterans who took longer to seek help for mental health (MH) difficulties reported more suicidal ideation. CONCLUSIONS Peer-reviewed research publications have revealed that UK veteran suicide prevalence is broadly comparable to the general population while highlighting differences across international armed forces. Veteran demographics, service history, transition and MH have all been identified as potential risk factors of suicide and suicidal ideation. Research has also indicated that female veterans are at higher risk than that of their civilian counterparts due to veterans being predominantly male; this could skew results and requires investigation. Current research is limited and further exploration of suicide prevalence and risk factors in the UK veteran population is required.
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Affiliation(s)
- Rebecca Randles
- Westminster Centre for Research in Veterans, Faculty of Health and Social Care, University of Chester, Chester, UK
| | - H Burroughs
- Westminster Centre for Research in Veterans, Faculty of Health and Social Care, University of Chester, Chester, UK
| | - N Green
- Westminster Centre for Research in Veterans, Faculty of Health and Social Care, University of Chester, Chester, UK
| | - A Finnegan
- Westminster Centre for Research in Veterans, Faculty of Health and Social Care, University of Chester, Chester, UK
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Misca G, Augustus J, Russell J, Walker J. Meaning(s) of transition(s) from military to civilian life at the intersection with mental health: implications for clinical settings. Front Psychol 2023; 14:1142528. [PMID: 37228334 PMCID: PMC10203708 DOI: 10.3389/fpsyg.2023.1142528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 05/27/2023] Open
Abstract
The experiences of military personnel moving into civilian life can be varied for the individual, families and communities. This paper aims to shed light on the various meanings of the multiple and "nested" transitions of military personnel to civilian life in the context of attending a mental health service in the UK. This was achieved through secondary analysis of semi-structured interviews with veterans who were engaging with a mental health service in the UK and a further interview with the mental health service lead. A thematic analysis was employed based on a descriptive phenomenological approach. Results indicate that an appropriate support infrastructure needs to be put in place for veterans prior to, during and after the transition to civilian life. The support appropriateness includes themes specific to connectedness to others, support service accessibility, mental health professionals' military culture awareness and mental health stigma. Although the findings suggest that community services need an awareness of veterans' specific needs, many of the themes are similar to those of the general population. Therefore, the need for an integrated healthcare system is essential in the transition of military service personnel to civilian life. Drawing on international evidence as well as the current findings, implications for policy and practice are highlighted throughout.
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Affiliation(s)
- Gabriela Misca
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Jo Augustus
- Institute of Health, University of Cumbria, Cumbria, United Kingdom
| | - Jade Russell
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Janet Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Serfioti D, Murphy D, Greenberg N, Williamson V. Effectiveness of treatments for symptoms of post-trauma related guilt, shame and anger in military and civilian populations: a systematic review. BMJ Mil Health 2022:e002155. [PMID: 36442888 DOI: 10.1136/military-2022-002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Individuals who have been exposed to a traumatic event can develop profound feelings of guilt, shame and anger. Yet, studies of treatments for post-traumatic stress disorder (PTSD) have largely investigated changes in PTSD symptoms relating to a sense of ongoing fear or threat and the effectiveness of such treatments for post-trauma related guilt, shame or anger symptom reduction is comparatively not well understood. METHODS This review systematically examined the effectiveness of existing treatment approaches for three symptoms associated with exposure to traumatic events: guilt, shame and anger. Studies included had to be published after 2010 with a sample size of n=50 or greater to ensure stable treatment outcome estimates. RESULTS 15 studies were included, consisting of both civilian and (ex-) military population samples exposed to a wide range of traumatic events (eg, combat-related, sexual abuse). Findings indicated a moderate strength of evidence that both cognitive-based and exposure-based treatments are similarly effective in reducing symptoms. Cognitive-based treatments were found to effectively reduce post-trauma related guilt and anger, while exposure-based treatments appeared effective for post-trauma related guilt, shame and anger. CONCLUSIONS The findings suggest the importance of confronting and discussing the traumatic event during therapy, rather than using less directive treatments (eg, supportive counselling).Nonetheless, while these results are promising, firm conclusions regarding the comparative effectiveness and long-term impact of these treatments could not be drawn due to insufficient evidence. Further empirical research is needed to examine populations exposed to traumatic events and investigate which treatment approaches (or combination thereof) are more effective in the long-term.
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Affiliation(s)
- Danai Serfioti
- University of Derby, Derby, UK
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- Nottingham Trent University, Nottingham, UK
| | | | - N Greenberg
- Academic Department for Military Mental Health, King's College London, London, UK
| | - V Williamson
- KCMHR, Institute of Psychiatry Psychology and Neuroscience Department of Basic and Clinical Neuroscience, London, UK
- University of Oxford, Oxford, UK
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Williamson V, Murphy D, Aldridge V, Bonson A, Seforti D, Greenberg N. Development of an intervention for moral injury-related mental health difficulties in UK military veterans: a feasibility pilot study protocol. Eur J Psychotraumatol 2022; 13:2138059. [PMID: 36340009 PMCID: PMC9629100 DOI: 10.1080/20008066.2022.2138059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Experiencing potentially morally injurious events (PMIEs) has been found to be significantly associated with poor mental health outcomes in military personnel/veterans. Currently, no manualised treatment for moral injury-related mental health difficulties for UK veterans exists. This article describes the design, methods and expected data collection of the Restore & Rebuild (R&R) protocol, which aims to develop procedures to treat moral injury related mental ill health informed by a codesign approach. Methods: The study consists of three main stages. First, a systematic review will be conducted to understand the best treatments for the symptoms central to moral injury-related mental ill health (stage 1). Then the R&R manual will be co-designed with the support of UK veteran participants with lived experience of PMIEs as well as key stakeholders who have experience of supporting moral injury affected individuals (stage 2). The final stage of this study is to conduct a pilot study to explore the feasibility and acceptability of the R&R manual (stage 3). Results: Qualitative data will be analysed using thematic analysis. Conclusions: This study was approved by the King's College London's Research Ethics Committee (HR-20/21-20850). The findings will be disseminated in several ways, including publication in academic journals, a free training event and presentation at conferences. By providing information on veteran, stakeholder and clinician experiences, we anticipate that the findings will not only inform the development of an acceptable evidence-based approach for treating moral injury-related mental health problems, but they may also help to inform broader approaches to providing care to trauma exposed military veterans.
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Affiliation(s)
| | - Dominic Murphy
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Department, Combat Stress, Surrey, UK
| | | | | | - Danai Seforti
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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10
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Jovarauskaite L, Murphy D, Truskauskaite-Kuneviciene I, Dumarkaite A, Andersson G, Kazlauskas E. Associations between moral injury and ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD among help-seeking nurses: a cross-sectional study. BMJ Open 2022; 12:e056289. [PMID: 35534083 PMCID: PMC9086640 DOI: 10.1136/bmjopen-2021-056289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate how moral injury (MI), traumatic experiences and daily stressors were related to the symptoms of post-traumatic stress disorder (PTSD) and International Classification of Diseases 11th revision specific complex PTSD (CPTSD) symptoms of disturbances in self-organisation (DSO) in a treatment-seeking sample of nurses. DESIGN A cross-sectional study. SETTING Nurses from all regions of Lithuania participated in the study. The data were collected between April and May 2021. PARTICIPANTS A total of 206 nurses, mean age 42.34 years (SD=11.68), 97.1% women and with 65% >10 years of work experience. RESULTS The prevalence of PTSD and CPTSD in the treatment-seeking sample of nurses was 9.2% and 10.2%, respectively. The results of structural equation modelling indicated an acceptable model fit for the model regarding the links between trauma exposure, daily stressors, MI, PTSD and DSO symptoms, (χ2 (df)=219.718 (123), p<0.001, Comparative Fit Index/Tucker-Lewis Index=0.937/0.922, root mean square error of approximation (90% CI)=0.062 (0.048 to 0.075), standardised root mean square residual=0.049). MI had a large effect on DSO symptoms, β=0.667, p<0.001, and a medium effect on PTSD symptoms, β=0.394, p<0.001. Daily stress but not trauma exposure was significantly related to MI, β=0.618, p<0.001. CONCLUSIONS The prevalence of PTSD and CPTSD in a treatment-seeking sample of nurses inform healthcare administrators, policymakers and medical staff about the demand for psychosocial interventions for healthcare workers focused on stress management to address their daily stressors and mitigate effects on MI or trauma-focused treatments for PTSD/CPTSD. TRIAL REGISTRATION NUMBER NCT04817995; Pre-results.
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Affiliation(s)
- Lina Jovarauskaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Dominic Murphy
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
- Combat Stress, Research Department, Tyrwhitt House, Leatherhead, Surrey, UK
| | | | - Austeja Dumarkaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Gerhard Andersson
- 4 Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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11
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Abstract
Background: Modern warfare in a civilian setting may expose combatants to severe moral challenges. Whereas most of these challenges are handled effectively, some potentially morally injurious events (PMIEs) may have deleterious psychological effects on the combatants, such as suicide ideation (SI). Self-disclosure, which includes sharing distressing thoughts and emotions, has been recognized as a protective factor against SI in the aftermath of stressful events. The current study is the first to examine the moderating role of self-disclosure in the relationship between PMIE exposure and SI among combat veterans. Method: A sample of 190 recently discharged Israeli combat veterans completed validated self-report questionnaires measuring combat exposure, PMIEs, depressive symptoms, SI, and self-disclosure in a cross-sectional design study. Results: PMIE dimensions and self-disclosure significantly contributed to current SI. Notably, the moderating model indicated that self-disclosure moderated the link between PMIE-Self and current SI, as PMIE-Self and current SI demonstrated a stronger association among veterans with low self-disclosure than among those with high self-disclosure. Limitations: Cross-sectional design of volunteers, the findings may not be directly generalizable to veterans' population. Conclusion: Self-disclosure, as a factor promoting a sense of belongingness, interpersonal bonding, and support, might diminish SI risk following PMIE exposure. Various mechanisms accounting for these associations are suggested, and the clinical implications of these interactions are discussed.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Sharon Shemesh
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.,Department of Clinical Psychology, Ruppin Academic Center, Emek Hefer, Israel
| | - Gadi Zerach
- Department of Behavioral Sciences and Psychology, Ariel University, Ariel, Israel
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12
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Williamson V, Murphy D, Greenberg N. Experiences and impact of moral injury in U.K. veterinary professional wellbeing. Eur J Psychotraumatol 2022; 13:2051351. [PMID: 35432782 PMCID: PMC9009941 DOI: 10.1080/20008198.2022.2051351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Veterinary professionals (VPs) are often exposed to distressing and ethically challenging events in their line of work, yet little is known about whether they may experience moral injury and the impact potentially morally injurious events (PMIEs) may have on their wellbeing. This cross-sectional study aimed to examine the association between PMIEs and the mental health outcomes of U.K. VPs. METHOD Assessments of PMIE exposure and self-report measures of common mental disorders were administered using an anonymous online questionnaire to 90 U.K. VPs between December 2020 and May 2021. RESULTS Exposure to PMIEs was reported by almost all VPs (89.0%), with acts of omission most frequently reported. Experiences of PMIEs were significantly associated with symptoms of PTSD (p < 0.01) and experiencing a betrayal event was significantly associated with PTSD symptoms (p<0.05). However, there was no significant association found between PMIE exposure and alcohol misuse or CMD (p > 0.05). CONCLUSIONS This study provides some of the first evidence that experiences of moral injury are significantly associated with adverse mental health outcomes in U.K. VPs. Future work is needed to design effective pathways for prevention and intervention for VPs exposed to highly challenging events. HIGHLIGHTS U.K. veterinary professionals were found to experience moral injury.Experiences of moral injury were significantly associated with symptoms of PTSD.
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Affiliation(s)
- Victoria Williamson
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.,Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - Dominic Murphy
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.,Combat Stress, Research Department, Surrey, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
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13
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Williamson V, Lobban J, Murphy D. Moral injury and the potential utility of art therapy in treatment. BMJ Mil Health 2021; 169:e6-e8. [PMID: 34373350 DOI: 10.1136/bmjmilitary-2021-001947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Williamson
- Psychiatry and Neuroscience, King's College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - J Lobban
- Combat Stress, Leatherhead, Surrey, UK
| | - D Murphy
- Combat Stress, Leatherhead, Surrey, UK
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