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29-01-2025 | Original Research

Prevalence of Moral Injury in Nationally Representative Samples of Combat Veterans, Healthcare Workers, and First Responders

Authors: Shira Maguen, PhD, Brandon J. Griffin, PhD, Robert H. Pietrzak, PhD, Carmen P. McLean, PhD, Jessica L. Hamblen, PhD, Sonya B. Norman, PhD

Published in: Journal of General Internal Medicine

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Abstract

Background

Moral injury affects a variety of populations who make ethically complex decisions involving their own and others’ well-being, including combat veterans, healthcare workers, and first responders. Yet little is known about occupational differences in the prevalence of morally injurious exposures and outcomes in nationally representative samples of such populations.

Objective

To examine prevalence of potentially morally injurious event (PMIE) exposure and clinically meaningful moral injury in three high-risk groups.

Design

Cross-sectional survey with responses weighted to national geodemographic benchmarks.

Participants

Combat veterans, healthcare workers, and first responders (N=1232) in the USA.

Main Measure

Moral Injury and Distress Scale (MIDS).

Key Results

Many combat veterans (49.3%), healthcare workers (50.8%), and first responders (41.6%) endorsed exposure to a PMIE. Clinically meaningful moral injury symptoms were endorsed by 6.5% of combat veterans, 7.3% of healthcare workers, and 4.1% of first responders. After adjusting for age, gender, race, and ethnicity, relative to first responders, combat veterans were more likely to endorse transgressing their values by what they did and healthcare workers were more likely to endorse witnessing others’ wrongful acts. Additionally, combat veterans (adjusted risk ratio (aRR) = 2.18, 95% confidence interval (95% CI) = 1.09, 2.16) and healthcare workers (aRR = 2.02, 95% CI = 1.03, 3.83) were over twice as likely to screen positive for clinically meaningful moral injury in comparison to first responders. No differences in exposures or outcomes emerged between combat veterans and healthcare workers.

Conclusions

Results from these nationally representative samples of three high-risk populations suggest that exposure to PMIEs is common and a sizable minority report clinically meaningful moral injury.
Appendix
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Literature
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go back to reference Lentz L, Smith-MacDonald L, Malloy DC, et al. A qualitative analysis of the mental health training and educational needs of firefighters, paramedics, and public safety communicators in Canada. Int J Environ Res Public Health. 2022;19(12). https://doi.org/10.3390/ijerph19126972 Lentz L, Smith-MacDonald L, Malloy DC, et al. A qualitative analysis of the mental health training and educational needs of firefighters, paramedics, and public safety communicators in Canada. Int J Environ Res Public Health. 2022;19(12). https://​doi.​org/​10.​3390/​ijerph19126972
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go back to reference Norman SB, Griffin BJ, Pietrzak RH, McLean C, Hamblen JL, Maguen S. The Moral Injury and Distress Scale: Psychometric evaluation and initial validation in three high-risk populations. Psychological Trauma: Theory, Research, Practice, and Policy. Published online June 22, 2023. https://doi.org/10.1037/tra0001533 Norman SB, Griffin BJ, Pietrzak RH, McLean C, Hamblen JL, Maguen S. The Moral Injury and Distress Scale: Psychometric evaluation and initial validation in three high-risk populations. Psychological Trauma: Theory, Research, Practice, and Policy. Published online June 22, 2023. https://​doi.​org/​10.​1037/​tra0001533
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Metadata
Title
Prevalence of Moral Injury in Nationally Representative Samples of Combat Veterans, Healthcare Workers, and First Responders
Authors
Shira Maguen, PhD
Brandon J. Griffin, PhD
Robert H. Pietrzak, PhD
Carmen P. McLean, PhD
Jessica L. Hamblen, PhD
Sonya B. Norman, PhD
Publication date
29-01-2025
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-024-09337-x

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