‘We’re all in this together’: the protective role of belongingness in the contribution of moral injury to mental health among participants in Israel’s civil protest movement

ABSTRACT

Background: Participating in long-term protests against government actions can affect protesters’ mental health and expose protesters to potentially morally injurious events (PMIEs), such as the betrayal by leaders they once trusted. This study aimed to shed light on the potential psychological buffers against the deleterious effects of exposure to PMIEs of betrayal among protesters and to examine the moderating role of belongingness in the relationships between protesters’ exposure to PMIEs and stress, PTSD and depression levels.

Method: The study sample comprised 4036 Israeli protesters (M_age= 54.27, SD = 12.45; 75.6% females) who took part in the unfolding civil protest movement against the government-led judicial and constitutional overhaul between January 2023 and August 2023. Protesters completed validated self-report questionnaires that included measures of PMIEs, stress, depressive and PTSD symptoms (PTSS).

Results: Beyond demographic and protest-related characteristics, exposure to PMIEs of betrayal was found to contribute to both PTSD and depression levels. The indirect effects of PMIE-betrayal on PTSS/depressive symptoms through stress levels were significant, particularly when belongingness levels were low. Thus, a greater sense of PMIE-betrayal contributes to stress symptoms, which, in turn, is linked to higher levels of PTSS and depressive symptoms for protesters having low levels of belongingness.

Conclusions: The study’s findings highlight the critical contribution of PMIE-betrayal to both PTSS and depression levels, which were mediated by levels of stress. Moreover, experiencing belongingness moderated these relationships. Clinicians treating protesters coping with PTSS and depressive symptoms should also adopt therapeutic aims of establishing belongingness and social support among the protesters.

HIGHLIGHTS

1. Belongingness moderates the mental health impact of betrayal-related moral injury in long-term protesters.

2. High belongingness reduces stress, PTSD, and depressive symptoms, serving as a protective factor.

3. The study highlights the importance of social support in safeguarding mental health in activism contexts.

1. Introduction

In recent years, large-scale collective protests have become more frequent across diverse sociopolitical landscapes, engaging significant portions of the population in efforts to promote societal change (Ang et al., 2014; Gardner et al., 2022; Hellmeier, 2023; Ortiz et al., 2022; Tarrow, 2011). Although such protests are vital tools for exercising democratic freedoms and advancing social reforms, sustained participation in intense protest movements can expose individuals to substantial psychological challenges, increasing the risk of posttraumatic stress symptoms (PTSS), depression, and heightened general stress (Ni et al., 2020). Research has highlighted that the psychological impact of protest involvement is shaped by variables such as the duration of participation, encounters with protest-related violence, and the depth of personal engagement with the cause (Lau & Seedat, 2016; Moussa et al., 2015). As civil protests continue to rise globally, it becomes increasingly important to investigate these risk factors and explore protective elements that may help reduce psychological distress among demonstrators.

Moral injury has emerged as a significant concept in trauma research, particularly pertinent in protest contexts. It encapsulates the deep psychological distress that occurs when individuals witness, commit, or fail to prevent acts that violate their core moral or ethical principles (Griffin et al., 2019; Litz et al., 2009). Unlike conventional trauma, which typically centers on fear or physical danger, moral injury focuses on the emotional and existential turmoil caused by transgressing deeply rooted values. Such potentially morally injurious events (PMIEs) may stem from direct involvement in harmful actions (e.g. engaging in violence), passivity in morally critical moments (e.g. not intervening), or observing others commit ethically troubling acts (Litz et al., 2009; Nash et al., 2013). Additionally, moral injury often involves a sense of betrayal by trusted leaders or institutions, triggering inner conflict that can significantly alter an individual’s self-perception and worldview (Shay, 1994). While initially studied within military contexts, where service members frequently face ethical quandaries, moral injury has been linked to enduring psychological effects, including guilt, shame, and reduced trust in others across various aspects of life (Griffin et al., 2019; Jinkerson, 2016; Levi-Belz & Zerach, 2022; Zerach & Levi-Belz, 2021).

While moral injury was originally explored within military contexts, recent studies suggest that civilians involved in high-stakes situations, such as political protests, are also vulnerable to morally injurious experiences (Karmel & Kuburic, 2021; Levi-Belz et al., 2024). A notable example is the prolonged civil protests in Israel against the government-led judicial reform in 2023, where numerous demonstrators reported feelings of deep betrayal by political leaders they believed were compromising democratic values and core societal principles (Albin et al., 2023; Shultziner, 2023). This sense of betrayal aligns with a specific subtype of moral injury known as ‘PMIE-betrayal’ (potentially morally injurious events – betrayal), which intensifies psychological distress by undermining fundamental beliefs about justice, leadership, and societal trust. In such contexts, moral injury among protesters may stem not only from the challenges and confrontations faced during demonstrations but also from a broader disillusionment with authority figures once seen as protectors of ethical and social norms (Levi-Belz et al., 2023). Research indicates that PMIE-betrayal can lead to pervasive feelings of alienation and mistrust, amplifying emotional distress and increasing susceptibility to PTSS, depression, and other mental health difficulties.

From a different angle, social and interpersonal factors – particularly the sense of belonging – can emerge as critical buffers (Levi-Belz et al., 2024; Levi-Belz & Feigelman, 2022) that mitigate the adverse effects of moral injury. Belongingness, defined as an individual’s sense of being valued and accepted within a group, has been identified as a key factor in promoting resilience against psychological distress across various settings (Joiner et al., 2009; Van Orden et al., 2010). A strong sense of connection and support within one’s social environment fosters shared purpose and emotional security, which can help mitigate the negative effects of distressing experiences. In protest contexts, social cohesion has been shown to reduce psychological distress among participants (Ni et al., 2020). When it comes to moral injury, belongingness may serve as a crucial protective factor, enabling individuals to process and reinterpret morally injurious events within a supportive community. This network can validate their emotions and help lessen feelings of isolation and guilt, thereby facilitating psychological healing (Williamson et al., 2021).

Belongingness has also been linked to a decreased risk of depression, anxiety, and lower vulnerability to PTSS, as it cultivates a communal resilience that buffers individuals from the psychological harm caused by moral transgressions (Benatov et al., 2022). In situations where citizens encounter PMIEs involving betrayal, a strong sense of belonging may help mitigate the emotional impact by fostering meaning-making processes and sustaining trust within their community. This dynamic is especially significant in protest environments, where shared identity and solidarity among demonstrators can provide emotional support, helping them cope with the distress associated with perceived betrayal by authority figures.

1.1. The present study

The 2023 Israeli elections led to the establishment of a right-wing coalition that swiftly pursued an extensive judicial overhaul, sparking significant concerns about potential threats to the country’s democratic foundations (Albin et al., 2023). The proposed reforms, aimed at curbing judicial independence, were widely perceived as endangering democratic governance and drew parallels to political shifts in nations like Hungary, Poland, and Turkey (Shultziner, 2023). In response, Israel witnessed an unprecedented surge of mass protests, with citizens participating in continuous non-violent demonstrations and diverse forms of civil resistance for more than 40 consecutive weeks. These protests, organized to oppose the government’s legislative agenda, intensified societal divisions and fostered a deep sense of betrayal among demonstrators who saw the reforms as a direct assault on fundamental democratic values (Albin et al., 2023; Levi-Belz et al., 2023).

This study, conducted in August 2023 (during the 32nd to 34th weeks of the ongoing protests), sought to examine the psychological effects of prolonged protest participation as they related to the experience of moral injury among demonstrators (Levi-Belz et al., 2023). Our primary objective was to examine the moderating role of belongingness in the relationship between exposure to PMIE-betrayal and symptoms of stress, PTSS, and depression beyond the contribution of demographic and protest-related characteristics. Specifically, we aimed to examine whether belongingness buffers the indirect effect of PMIE-betrayal on mental health outcomes via stress levels (see Figure 1).

Figure 1.

Mediation-moderation analysis (Process, Model 58).

Based on the literature and the study’s conceptual framework, we posited the following hypotheses:

1. Greater exposure to PMIE-betrayal will be associated with higher levels of stress and increased symptoms of PTSD and depression;

2. Stress levels will mediate the relationship between exposure to PMIE-betrayal and symptoms of PTSD and depression;

3. Belongingness will moderate the indirect effect of PMIE-betrayal exposure on PTSD and depression symptoms via stress levels, such that the indirect effect will be weaker among individuals with higher levels of belongingness and stronger among individuals with lower levels of belongingness.

2. Method

2.1. Participants

This cross-sectional study surveyed 4,036 Israeli adults (75.9% female) who participated in the civilian protests opposing the government’s proposed judicial reform between January and August 2023. Eligibility criteria required participants to be at least 18 years old and to have actively taken part in the demonstrations during this time in Israel. Demographic and protest-related characteristics of the sample are outlined in Table 1. For a more comprehensive description of the sample, refer to Levi-Belz et al. (2023).

Table 1.

Characteristics of the study participants (N = 4036).

Variables		M (SD)	n (%)
Socio-Demographic Characteristics
Age		54.27 (12.45)
Education (years)		16.09 (1.81)
Gender	Male		968 (%24.0)
	Female		3050 (%75.6)
Country of birth	Israel		3614 (89.9%)
	FSU countries		80 (2.0%)
	America		156 (3.9%)
	Europe		111 (2.8%)
	Africa		27 (.7%)
	Other		32 (.8%)
SES	Far below average		204(7.6%)
	Below average		502 (15.0%)
	Average		708 (22.5%)
	Above average		1155 (36.8%)
	Far above average		537 (17.1%)
Marital Status	Single		401 (10.0%)
	Married		2565 (63.6%)
	In relationship		553 (13.7%)
	Divorced		375 (9.3%)
	Widowed		95 (2.4%)
	Other		41 (1.0%)
Religiosity	Secular		3557 (88.5%)
	Traditional		381 (9.5%)
	Religious		70 (1.7%)
	Orthodox		13 (0.3%)
Protests-related characteristics
Involvement duration (months)		6.99 (1.60)
Extent of active involvement (protests per month)		5.41 (4.16)
Personal exposure to violence by the police	Not at all		3277 (83.7%)
	One time		386 (9.9%)
	Several times		209 (5.3%)
	Many times		43 (1.1%)
Being arrested by the police during protests	Not at all		3838 (98.3%)
	Once		49 (1.3%)
	Several times		18 (0.5%)
	Many times		5 (0.1%)
Involvement in active civil protests in the past	No		1946 (48,3%)
	Yes		1942 (48.2%)
	Not sure		145 (3.2%)

2.2. Measures

2.2.1. The Moral Injury Events Scale-Civilian version (MIES-C; Morriss & Berle, 2023)

The MIES-C is a self-report questionnaire comprising nine items developed to evaluate moral injury experiences in civilian settings. Adapted from the original military-oriented scale, this version has been modified to more accurately capture morally injurious events encountered by civilians. It includes three distinct subcategories that capture different dimensions of moral injury: Self, Other and Betrayal. The focus of this study was on the MIES-betrayal dimension, which consists of three items measuring feelings of betrayal by trusted individuals. Responses are rated on a 6-point Likert scale, ranging from 1 (strongly disagree) to 6 (strongly agree). The subscales have demonstrated strong internal reliability, with Cronbach’s alpha values of .75 for MIES-Self, .71 for MIES-Other, and .80 for MIES-Betrayal.

2.2.2. Perceived Stress Scale (PSS-10; Cohen et al., 1983)

The PSS-10 Scale was used to assess participants’ levels of perceived stress. It measures the frequency of stress-related thoughts and feelings experienced over the past month (e.g. ‘In the last month, how often have you felt nervous and stressed?’). The scale includes 10 items rated on a 5-point Likert scale (0 = never to 4 = very often). Of the 10 items, six assess negative experiences, while four positive items are reverse-scored. Total scores range from 0 to 40, with higher scores reflecting greater perceived stress (Cohen et al., 1983). In the current sample, the scale demonstrated good internal consistency, with a Cronbach’s alpha of α = .79.

2.2.3. The Belongingness subscale of the Interpersonal Needs Questionnaire (INQ; Joiner et al., 2009)

Belongingness was assessed using the belongingness subscale of the Interpersonal Needs Questionnaire (INQ; Joiner et al., 2009). This subscale comprises nine items (e.g. ‘These days, other people care about me’) that evaluate the extent to which respondents feel connected and valued by others. Participants rated each statement on a 7-point Likert scale ranging from 1 (Not at all true for me) to 7 (Very true for me). For this study, only the nine items measuring belongingness were used, excluding the thwarted belongingness items included in the original INQ (Joiner et al., 2009). Higher scores indicate greater levels of belongingness. The subscale demonstrated good internal consistency in the current sample, with a Cronbach’s alpha of α = .86.

2.2.4. International Trauma Questionnaire (ITQ) for PTSD (Cloitre et al., 2018)

The ITQ, aligned with ICD-11 standards, was selected for its brevity and clarity. This study used six PTSD-specific items assessing re-experiencing, avoidance, and sense of threat (two items each) on a 5-point Likert scale (0 = not at all to 4 = extremely), along with three items on functional impairment (social, occupational, daily life). PTSD was measured both continuously (score range: 0–24) and categorically (probable PTSD required one symptom from each cluster and functional impairment). The ITQ showed strong internal reliability (α = .86).

2.2.5. The Patient Health Questionnaire-2 (PHQ-2; Kroenke et al., 2003)

The PHQ-2 is a brief depression screening tool based on DSM-5 criteria, featuring two items from the broader PHQ-9 (e.g.: ‘Little interest or pleasure in doing things’). Items are rated on a 4-point scale (0 = not at all to 3 = nearly every day), with total scores ranging from 0 to 6. A score of 3 or above indicates probable depression. In this study, the PHQ-2 showed good reliability (α = .78).

2.2.6. Sociodemographic and protest-related characteristics

We collected demographic data, including age, gender, residence, socioeconomic status, family status, religious affiliation, and education. Protest-related variables included protest duration (0–8 months), level of involvement (number of demonstrations attended monthly), and prior protest experience (Yes/No). Exposure to direct violence was assessed with three items on police and civilian violence (e.g. ‘Were you a victim of physical violence by a police officer?’), rated on a 4-point scale (0 = not at all to 3 = many times), with a total exposure score calculated.

2.3. Procedure

Participants were recruited in August 2023 through online communities and social media groups focused on the civil protests. The recruitment post outlined the study’s aim to explore ‘experiences, emotional aspects, and attitudes related to the civil protests,’ with a detailed explanation and survey link (via Qualtrics) provided to interested individuals. Participation required explicit consent through survey engagement. As an incentive, ten $50 vouchers were raffled among respondents who completed the survey. The study received ethical approval from the (erased for blind review) internal review boards.

2.4. Data analysis

Descriptive statistics and prevalence rates of PMIEs, PTSD, and depression were calculated. Pearson correlation analyses were then conducted to examine relationships between variables. The hypothesized mediation-moderation model (Figure 1) was tested using the PROCESS macro in SPSS (Model 58; Hayes, 2018), with moderated effects assessed at varying levels and bootstrapped confidence intervals provided. Full information maximum likelihood (FIML) was used to handle missing data without biasing estimates (Schafer & Graham, 2002). All analyses were performed using IBM SPSS Version 26.

3. Results

3.1. Prevalence of exposure to PMIE dimensions, PTSD and depressive disorder

Probable PTSD and depression rates were assessed using self-report measures with validated cut-offs. Based on ITQ criteria, 10.6% (n = 426) met the threshold for probable PTSD. Using the PHQ-2 cut-off (≥3; Manea et al., 2016), 44.6% (n = 1,786) met criteria for probable depression. Additionally, 75.9% (n = 3,083) reported high or extreme daily functional difficulties due to psychological symptoms. Notably, these impairments reflect subjective distress and are not limited to those meeting clinical PTSD or depression thresholds, highlighting the broader psychological impact on protesters.

A total of 96.6% of participants (n = 3,905) endorsed at least one MIES item at the agree or definitely agree level, indicating exposure to PMIEs. The most commonly endorsed betrayal subscale item was ‘I feel betrayed by leaders I once trusted’ (59.5%). Overall, 63.9% (n = 2,577) endorsed at least one MIES-betrayal item at the agree or definitely agree level.

3.2. Interrelationships between study variables

As part of the preliminary data analysis, correlations between the study variables were examined. Means, standard deviations, and intercorrelations are summarized in Table 2.

Table 2.

Pearson correlations between the study variables (N = 4036).

	1	2	3	4	5	6	7
1. PMIE-Self (MIES)	-
2. PMIE-Other (MIES)	.09***	-
3. PMIE-Betrayal (MIES)	.16***	.18***	-
4. Stress (PSS-10)	.22***	.14***	.25***	-
5. Belongingness	−.17***	−.01	−.21***	−.31***	-
6. Depression (PHQ-2)	.13***	.12***	.25***	.52***	−.22***	-
7. PTSS (ITQ)	.13***	.18***	.32***	.41***	−.17***	.41***	-
M	10.46	7.25	7.01	3.02	5.60	6.42	2.56
SD	2.45	3.80	2.28	.66	1.44	4.83	1.71

Note. *p < .05; **p < .01; ***p < .001. MIES = Moral injury event scale – Civilian; PHQ = Patient Health Questionnaire; PSS = Perceived stress scale; PTSS = Post traumatic stress symptoms assessed in the ITQ.

As seen in Table 2, all PMIE dimensions were positively related to stress, PTSS, and depression levels. PMIE-self and PMIE-betrayal were also negatively related to belongingness levels. Similarly, PTSS and depression were significantly and negatively related to belongingness. Female gender, high protest involvement levels, and exposure to violence were significantly and positively related to stress, PTSS, and depressive symptoms. Thus, these three variables were entered into the moderated mediation model as covariates. Associations of the other demographic and protest-related variables with the outcome measures were not significant.

3.3. A moderated mediation model

We tested the moderated mediation hypothesis using Hayes’s (2018) conditional indirect effect approach with 5,000 bias-corrected bootstrapped confidence intervals (Model 58). This model assessed whether stress mediates the link between PMIE dimensions and PTSS/depression across high, moderate, and low belongingness levels (Figure 1). Analyses controlled for gender, protest involvement, and exposure to violence. As models for PMIE-self and PMIE-other were non-significant, we focus on the PMIE-betrayal model.

3.3.1. PTSS as an outcome measure

Our findings indicate that the model explained 21.9% of the variance of PTSS, F(6,3758) = 264.02, p < .001. As seen in Table 3, a positive relationship between PMIE-betrayal and stress levels was found, as well as a significant interaction between PMIE-betrayal and belongingness on stress levels. As hypothesized, the effect of PMIE-betrayal and stress levels was subject to belongingness levels: This relationship was significant at all belongingness levels but stronger at low levels (Beta = .05, t = 11.10, p < .001) and moderate levels (Beta = .04, t = 11.99, p < .001) than at high belongingness levels (Beta = .02, t = 6.18, p < .001).

Table 3.

Conditional indirect effects of belongingness on the associations between exposure to PMIEs-betrayal and PTSS/depression symptoms through perceived stress levels.

Total and direct effects
Predictors	b	SE	t	BCa 95% CI [Lower, Upper]	b	SE	t	BCa 95% CI [Lower, Upper]
Mediator variable model (DV = stress levels)
Exposure to PMIEs-betrayal (Path a)	.06	.01	5.73***	[.04,.08]
Belongingness (Path m1)	−.08	.02	−4.01***	[−.11, −.03]
Exposure to PMIEs-betrayal X belongingness (Path m1a)	−.02	.01	2.51***	[.03, .01]
Dependent variable model (DV = PTSS)					Dependent variable model (DV = Depression)
Exposure to PMIEs-betrayal (Path c’)	.29	.02	14.85**	[.25, .33]	.05	.01	1.18***	[−.05, .05]
Perceived stress (Path b)	3.57	.41	8.60***	[2.75, 4.38]	1.87	.13	13.49***	[−.07, .08]
Belongingness (Path m2)	.48	.22	2.15*	[.04, .91]	.28	.07	3.74***	[.61, 1.62]
Perceived stress X belongingness (Path m2b)	−.18	.07	−2.55*	[−.31, −.04]	−.11	.02	−4.66***	[.03, .15]
Conditional effects at varying levels of thwarted belongingness
	b	SE	t	BCa 95% CI [Lower, Upper]	b	SE	t	BCa 95% CI [Lower, Upper]
Dependent variable model (DV = stress levels)
−1 SD	.05	.00	11.11***	[.03, .06]
M	.04	.00	11.99***	[.02, .05]
+1 SD	.02	.00	6.18***	[.01, .03]
Dependent variable model (DV = PTSS)					Dependent variable model (DV = Depression)
−1 SD	2.82	.15	18.12***	[2.51, 3.13]	1.41	.05	27.21***	[1.33, 1.56]
M	2.57	.11	22.63***	[2.35, 2.79]	1.26	.03	33.29***	[1.15, 1.33]
+1 SD	2.12	.14	14.99***	[1.92, 2.57]	1.09	.05	21.43***	[.98, 1.19]
Conditional indirect effects at varying levels of thwarted belongingness
−1 SD	.11	.01	[.09, .14]		−.05	.00		[.04, .07]
M	.09	.01	[.07, .10]		.04	.00		[.03, .05]
+1 SD	.04	.01	[.02, .06]		.02	.00		[.01, .03]

Note: *p < .05, **p < .01, ***p < .001.

Stress was found to be significantly associated with PTSS, and the Stress X Belongingness interaction was also significant. As hypothesized, the effect of stress levels on PTSS was subject to belongingness levels. Stress and PTSS were found to be associated significantly at all belongingness levels; however, those with low belongingness levels were more strongly associated with stress and PTSS (Beta = 2.82, t = 18.12, p < .001) than those at moderate belongingness levels (Beta = 2.57, t = 22.63, p < .001) and particularly those at high belongingness levels (Beta = 2.12, t = 14.99, p < .001).

Finally, as seen in Table 3, we found that the indirect effect of PMIE-betrayal and PTSS through stress levels was higher among those with low levels of belongingness than among those with high levels of belongingness. This finding suggests that the relationship between PMIE-betrayal and PTSS levels, as mediated by stress levels, was more salient among those reporting lower levels of belongingness. Figure 2 presents the direct effect of PMIE-betrayal on PTSS at different levels of belongingness, which was also found significant (Beta = .29, t = 14.85, p < .001, CI = .25−.33).

Figure 2.

Conditional effects of the direct contribution of PMIE of betrayal on PTSS at varying levels of belongingness.

3.3.2. Depressive symptoms as outcome measures

Our findings indicate that the model explained 29.9% of the variance of depressive symptoms, F(6,3758) = 402.25, p < .001. As seen in Table 3, a positive relationship between PMIE-betrayal and stress levels was found, as well as a significant interaction between PMIE-betrayal and belongingness on stress levels. As hypothesized, the effect of PMIE-betrayal and stress levels was subject to belongingness levels: this relationship was stronger at low belongingness levels (Beta = .05, t = 11.10, p < .001) and at moderate belongingness levels (Beta = .04, t = 11.99, p < .001) and less so at high belongingness levels (Beta = .02, t = 6.18, p < .001).

Stress was found to be significantly associated with depressive symptoms, and the Stress X Belongingness interaction was also significant. As hypothesized, the effect of stress levels on depressive symptoms was subject to belongingness levels. Stress and depressive symptoms were related more strongly among those with low belongingness levels (Beta = 1.41, t = 27.21, p < .001) than among those with moderate belongingness levels (Beta = 1.26, t = 33.27, p < .001) and particularly than those with high belongingness levels (Beta = 1.43, t = 14.99, p < .001).

Finally, as seen in Table 3, we found that the indirect effect of PMIE-betrayal on depressive symptoms through stress levels was higher among those with low levels of belongingness than among those with high levels of belongingness. This finding suggests that the relationship between PMIE-betrayal and depressive symptoms levels mediated by stress levels is more salient among those reporting lower levels of belongingness. Figure 3 presents the direct effect of PMIE-betrayal on depressive symptoms at the different levels of belongingness, which was also found to be highly significant (Beta = .05, t = 8.10, p < .001, CI = .25−.33).

Figure 3.

Conditional effects of the direct contribution PMIE of betrayal on depressive symptoms at varying levels of belongingness.

4. Discussion

This study explored how belongingness moderates the relationship between moral injury, specifically betrayal-related PMIEs (PMIE-betrayal), and mental health outcomes among participants in Israel’s 2023 civil protests.

Our findings show that higher levels of PMIE-betrayal were linked to increased stress, which was associated with greater posttraumatic stress symptoms (PTSS) and depressive symptoms. This effect was stronger among protesters with low belongingness, highlighting the moderating role of social connectedness. The results emphasize the significant impact of moral injury on mental health in non-military contexts and the protective effect of belongingness in reducing psychological distress. Encouraging a sense of belonging within protest movements may help lessen the mental health toll of perceived betrayal by trusted leaders.

The high rates of PTSD and depression in our sample, exceeding those found in Israeli veterans (Zerach et al., 2021; Zerach & Levi-Belz, 2018), suggest that prolonged protests may expose participants to unique psychological stressors. These may result from the demonstrations’ intensity, duration, or pre-existing vulnerabilities among activists. The widespread PMIE-betrayal reported also hints at deeper societal distrust beyond recent political events. Future studies should examine how belonging and collective purpose might moderate these effects, as social cohesion could be key in managing distress within activist movements.

Our findings align with previous research on moral injury in non-military settings, such as studies on healthcare workers and other high-stress civilian professions (Benatov et al., 2022; Čartolovni et al., 2021). Similar to these studies, we found that PMIE-betrayal in a civilian protest context is linked to increased psychological distress, including PTSD and depression. This supports Levi-Belz and Zerach’s (2018) findings on Israeli combat veterans, where PMIE-betrayal strongly predicted poor mental health outcomes, highlighting how betrayal by authority figures undermines resilience and trust (Jordan et al., 2017). Our study broadens this understanding by showing that moral injury also affects civilian protesters, extending beyond structured, authority-based environments to collective civil movements.

Belongingness appears to reduce psychological distress during protests, serving as a protective factor against moral injury. Research shows that a strong sense of belonging enhances psychological resilience and helps buffer the effects of stress and trauma (Williamson et al., 2021). In the context of moral injury, belongingness offers social support that aids in processing difficult experiences, reducing feelings of isolation and alienation (Benatov et al., 2022). It also helps diminish guilt and shame – common in moral injury – by providing validation and emotional support (Levi-Belz & Zerach, 2022).

The buffering effect of belongingness on moral injury is particularly relevant in protest settings, where participants may feel disconnected or disillusioned due to perceived violations of long-held values by government leaders. Thus, for protesters, belongingness within the movement may be linked to a sense of shared purpose and solidarity, potentially helping participants navigate feelings of disillusionment and perceived betrayal during confrontations with political authority figures (e.g. Wong et al., 2021). Thus, shared identity and mutual support may serve as an emotional anchor (Conner et al., 2023), allowing individuals to reframe their distressing experiences within a larger communal struggle.

The psychological advantages of belongingness in protest settings extend beyond immediate emotional support, fostering a sense of agency and collective efficacy that enables individuals to remain actively engaged without becoming overwhelmed by distress. These results emphasize the importance of cultivating strong social connections within protest movements, not only to bolster collective action but also to serve as a psychological buffer that protects participants’ mental health (e.g. Job et al., 2024). Belongingness also strengthens psychological resilience by promoting a cohesive community that upholds shared moral values and a unified commitment to the cause (Van Orden et al., 2010; Williamson et al., 2021).

This study has several limitations. Its cross-sectional design limits causal inferences regarding the relationships between PMIE exposure, belongingness, and mental health outcomes. Longitudinal studies are needed to clarify the temporal sequence of these variables and how belongingness influences mental health over time. The predominantly female sample also limits generalizability, as women may be more susceptible to moral injury (Williamson et al., 2021; Zerach & Levi-Belz, 2023). Future research should aim for gender balance to explore potential differences in moral injury experiences and the role of belongingness. Additionally, reliance on self-reported measures may introduce biases like social desirability or recall bias. Incorporating clinical interviews or physiological assessments could improve measurement accuracy in future studies.

4.1. Conclusions and implications

In conclusion, this study underscores the significant psychological toll of betrayal-related moral injury among civilian protesters. It underscores the protective role of belongingness in mitigating these effects. As moral injury becomes an increasingly relevant experience beyond traditional military contexts, understanding the factors that can buffer its impact is essential for promoting mental health resilience in high-stakes civilian settings. The findings suggest that belongingness may serve as an important resource for protesters, highlighting the need for future research to explore whether fostering social support and shared purpose can buffer against the psychological toll of morally injurious experiences. Future research should also continue to explore the mechanisms through which belongingness operates in collective action contexts, as well as develop and test interventions aimed at strengthening social cohesion within protest movements.

These findings have important implications for practitioners and policymakers. Clinicians working with protesters should be aware of the psychological risks tied to moral injury, especially PMIE-betrayal, and incorporate interventions that promote social connectedness and belonging (e.g. interpersonal therapy; Lipsitz & Markowitz, 2013). Group-based therapies that foster cohesion and validate shared emotional experiences can help reduce the impact of moral injury (Levi-Belz & Zerach, 2022). Further research is needed to assess the effectiveness of these approaches in addressing protest-related distress.

In addition to therapeutic interventions, protest leaders and community organizers can support mental well-being by creating inclusive, supportive spaces, promoting open dialogue, and establishing peer support networks. Strengthening solidarity and belonging within protest movements can boost collective resilience and offer participants vital psychological resources to manage the emotional challenges of activism (Hagerty et al., 1992). Table 3

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available upon reasonable request. Requests for access to the dataset should be directed to the corresponding author.