Predictors of moral injury in UK treatment seeking veterans

Background: Moral injury is known to be associated with mental health difficulties in US military populations, however its impact on wellbeing in a UK Armed Forces (AF) context is less well understood. Additionally, it is not clear whether other factors known to affect service personnel's mental health, such as adverse childhood experiences (ACEs) or military trauma, may influence whether personnel experience moral injury. Aim: To examine the relationship between moral injury and ACEs, adverse military events as well as the impact of moral injury on the mental health of UK AF veterans. Method: A nationally representative sample of UK AF veterans seeking psychological treatment (n = 177) were recruited. Participants completed self-report psychometric measures and expressions of moral injury, ACEs and traumatic in-service events. Results: Analyses yielded a significant association between ACEs and veteran expressions of moral injury (p <.001). A significant although weak relationship was found between veteran expressions of moral injury and experiencing adverse events during military service, including physical abuse (AOR 1.04; 95 % CI 1.02−1.06) and emotional abuse (AOR 1.03; 1.01−1.05). Those meeting criteria for mental health disorders, including probable posttraumatic stress disorder (AOR 1.09; 95 % CI 1.05−1.12), were significantly more likely to report expressions of moral injury. Conclusions: These results illustrate the relationship between traumatic life events, including childhood adversity, and experiencing moral injury in UK AF veterans. The findings underscore the need for a validated measurement tool appropriate for the UK AF to better understand the impact of moral injury on wellbeing and to ensure that appropriate treatment can be given to those identified as suffering post-trauma.