Table 1.
Papers on moral injury in the European Journal of Psychotraumatology 2019–2022.
| Author | Year | Study type | Country | Population | N (% men) | MI assessment | Results |
|---|---|---|---|---|---|---|---|
| Military Personnel | |||||||
| Williamson | 2019 | qualitative | UK | military personnel | 6 (100) | Interviews | PMIE exposure was reported related to veterans’ own actions or to those of others, and consistently led to psychological distress |
| Williamson | 2020 | qualitative | UK | military personnel | 30 (100) | Interviews | events experienced by UK veterans can simultaneously be morally injurious and traumatic or life-threatening |
| Denov | 2022 | other | Canada | military personnel | n.a. | n.a. | Military personnel who encounter child soldiers during a military deployment may be at risk for MI |
| Hertz | 2022 | other | Israel | military personnel | 615 (100) | MIES | Vignettes of killing an innocent led to more shame and guilt than vignettes of killing a person carrying a bomb |
| Battaglia | 2019 | quantitative | Canada | military personnel | 33 (87.9) | MIES | A significant relation between childhood emotional abuse and the presence of MI in adulthood |
| Levi-Belz | 2020 | quantitative | Israel | military personnel | 191 (85.4) | MIES | Strong bridge associations between the PTSD nodes and most of the PMIES nodes |
| Healthcare Workers | |||||||
| Berkhout | 2022 | qualitative | Canada, UK | healthcare workers | 21 (23.8) | Interviews | MI underpins sources of healthcare worker distress |
| Hegarty | 2022 | qualitative | UK | healthcare workers | 30 (33.3) | Interviews | HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal and feeling unable to fulfil their duty of care |
| Maftei | 2021 | quantitative | Romania | healthcare workers | 115 (24.6) | MIES* | Almost 50% of the participants reported high levels of PMIE exposure |
| Zerach | 2021 | quantitative | Israel | healthcare workers | 296 (22.4) | MIES* | Three subgroups: high exposure, betrayal-only, minimal exposure. The first two classes were associated with perceived stress and symptom severity |
| Refugees | |||||||
| Hoffman | 2019 | quantitative | Australia | refugees | 221 (46.2) | MIAS | A three-profile solution: MI-Other, MI-Other + Self, no-MI. MI profiles were associated with trauma experience, living difficulties and greater psychopathology |
| Passardi | 2022 | qualitative | Australia | refugees | 13 (30.8) | Interviews | In my country they torture your body but in Australia they kill your mind |
| Other | |||||||
| Fani | 2021 | quantitative | USA | civilians | 81 (8.4) | MIES* | Greater exposure and distress related to PMIEs were associated with higher trauma exposure as well as post-traumatic and depressive psychopathology |
| Williamson | 2022 | quantitative | UK | veterinary professionals | 90 (22.3) | MIES* | Exposure to PMIEs was reported by almost all veterinary professionals and was significantly associated with symptoms of PTSD |
| Ter Heide | 2020 | other | Netherlands | n.a. | n.a. | n.a. | Factors involved in the perception-action model of empathy may help explain the development of moral injury |
| Treatment | |||||||
| Nazarov | 2020 | quantitative | Canada | military personnel | 4854 (89.2) | CES | Deployed members exposed to PMIEs were more likely to seek help from their family doctor, paraprofessionals, non-professionals, and the civilian health care system |
| Held | 2021 | quantitative | USA | military personnel | 161 (91.3) | MIES | PMIE exposure and the type of index trauma did not predict changes in symptom outcomes |
| De la Rie | 2021 | case study | Netherlands | refugees | 1 (100) | MIAS | BEP-MT is a promising treatment protocol for patients suffering from PTSD after moral trauma |
| Williamson | 2022 | other | UK | military personnel | n.a. | n.a. | An intervention for MI-related mental health difficulties in UK military veterans will be developed |
Note: MI: moral injury; MIES: Moral Injury Events Scale; MIES*: adapted version of the Moral Injury Events Scale; MIAS: Moral Injury Appraisals Scale; BEP-MT: Brief Eclectic Psychotheray for Moral Trauma; HCW: healthcare worker; PMIE: potentially morally injurious event; PTSD: posttraumatic stress disorder; CES: Combat Experiences Scale.