Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;28(1):239-250.
doi: 10.1002/cpp.2503. Epub 2020 Sep 10.

Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis

Jason A Nieuwsma  1   2 , Mira Brancu  2   3 , Jennifer Wortmann  1 , Melissa A Smigelsky  1 , Heather A King  4   5 ; VISN 6 MIRECC Workgroup  3 ; Keith G Meador  1   6
Affiliations

Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis

Jason A Nieuwsma et al. Clin Psychol Psychother. 2021 Jan.

Abstract

Moral injury merits further study to clarify its identification, prevalence, assessment and intersection with psychosocial and psychiatric problems. The present study investigated the screening potential of the Brief Moral Injury Screen (BMIS) in a sample of post-9/11 veterans (N = 315) and comparatively evaluated how this tool, the Moral Injury Events Scale (MIES), and the Moral Injury Questionnaire-Military Version (MIQ-M) relate to psychiatric diagnoses and mental illness symptom severity. Those who endorsed failing to prevent or doing something morally wrong had the highest symptomatology scores on measures of posttraumatic stress disorder, depression, suicidality, alcohol abuse and drug abuse, followed by those who reported solely witnessing a moral injury event. Posttraumatic stress disorder and depressive symptoms correlated most strongly with scores on the MIQ-M; suicidality, alcohol abuse and drug abuse scores correlated most strongly with scores on the BMIS and MIQ-M. Moral injury, as measured by three scales, was robustly correlated with worse outcomes on various symptom measures. The three scales appear to differentially predict mental illness symptomatology and diagnoses, with the BMIS predicting suicidality and alcohol and drug abuse as well as better than other measures.

Keywords: PTSD; assessment; moral injury; substance abuse; suicidality.

PubMed Disclaimer

References

REFERENCES

    1. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
    1. Brancu, M., Wagner, H. R., Morey, R. A., Beckham, J. C., Calhoun, P. S., Tupler, L. A., … McDonald, S. D. (2017). The Post-Deployment Mental Health (PDMH) study and repository: A multi-site study of US Afghanistan and Iraq era veterans. International Journal of Methods in Psychiatric Research, 26(3), e1570. https://doi.org/10.1002/mpr.1570
    1. Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2014). Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology, 20(3), 154-160. https://doi.org/10.1037/h0099852
    1. Bryan, C. J., Bryan, A. O., Anestis, M. D., Anestis, J. C., Green, B. A., Etienne, N., … Ray-Sannerud, B. (2016). Measuring moral injury: Psychometric properties of the Moral Injury Events Scale in two military samples. Assessment, 23(5), 557-570. https://doi.org/10.1177/1073191115590855
    1. Cocco, K. M., & Carey, K. B. (1998). Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients. Psychological Assessment, 10(4), 408-414. https://doi.org/10.1037/1040-3590.10.4.408

LinkOut - more resources