Moral injury and PTSD as mediators of the associations between morally injurious experiences and mental health and substance use.

The present study examined the degree to which morally injurious experiences (MIEs; i.e., atrocities of war, psychological consequences of war, and leadership failure/betrayal) and moral injury (i.e., guilt, shame, difficulties with forgiveness, and withdrawal associated with exposure to MIEs) were associated with symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), suicidality, hazardous alcohol use, and drug abuse symptoms. In addition, we examined moral injury and PTSD symptoms as mediators of the association between MIEs and these outcomes (exploratory model). Participants (n = 244) were a predominantly veterans community-based military sample. Our primary model (i.e., single mediation model) revealed that moral injury mediated associations between two MIEs (i.e., atrocities of war and leadership failure/betrayal) and depressive symptoms, anxiety symptoms, hazardous alcohol use, and PTSD symptoms. However, our exploratory model (i.e., a dual simultaneous mediation model) revealed that moral injury was not significantly associated with any health outcomes after controlling for the effects of MIE dimensions and PTSD symptoms. Within this model, PTSD symptoms significantly mediated the effects of both atrocities of war MIEs and leadership failure/betrayal MIEs on depressive symptoms, anxiety symptoms, suicidality, and hazardous alcohol use. Findings provide preliminary support for moral injury as a mechanism linking exposure to MIEs to both mental health and hazardous alcohol use. Taken together, moral injury appears to be an important target for intervention among combat military personnel. (PsycINFO Database Record (c) 2018 APA, all rights reserved)