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European Journal of Psychotraumatology Volume 14, 2023 - Issue 1
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Clinical Research Article

Moral injury associated with increased odds of past-year mental health disorders: a Canadian Armed Forces examination

Daño moral asociado con mayores probabilidades de trastornos de salud mental en el último año: un estudio de las Fuerzas Armadas Canadienses

与过去一年心理健康障碍几率增加相关的道德伤害：对加拿大武装部队的考查

Bethany Easterbrooka MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada;b Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada;c Homewood Research Institute, Guelph, ON, CanadaView further author information
,
Rachel A. Plouffea MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada;d Department of Psychiatry, Western University, London, ON, CanadaView further author information
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Stephanie A. Houlee School of Psychology, University of Ottawa, Ottawa, ON, CanadaView further author information
,
Aihua Liuf Douglas Mental Health University Institute, Montreal, QC, CanadaView further author information
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Margaret C. McKinnonc Homewood Research Institute, Guelph, ON, Canada;g Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, CanadaORCID Iconhttps://orcid.org/0000-0002-8315-7657View further author information
ORCID Icon,
Andrea R. Ashbaughe School of Psychology, University of Ottawa, Ottawa, ON, CanadaView further author information
,
Natalie Motah Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada;i Department of Psychiatry, University of Manitoba, Winnipeg, MB, CanadaView further author information
,
Tracie O. Afifii Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada;j Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, CanadaView further author information
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Murray W. Ennsi Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada;k Deer Lodge Centre Operational Stress Injury Clinic, Winnipeg, MB, CanadaView further author information
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J. Don Richardsona MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada;b Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada;d Department of Psychiatry, Western University, London, ON, CanadaView further author information
&
Anthony Nazarova MacDonald Franklin Operational Stress Injury Research Centre, London, ON, Canada;b Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada;d Department of Psychiatry, Western University, London, ON, CanadaCorrespondence[email protected]
View further author information
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Article: 2192622 | Received 12 Oct 2022, Accepted 22 Feb 2023, Published online: 30 Mar 2023
 
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ABSTRACT

Background: Potentially morally injurious experiences (PMIEs) are common during military service. However, it is unclear to what extent PMIEs are related to well-established adverse mental health outcomes.

Objective: The objective of this study was to use a population-based survey to determine the associations between moral injury endorsement and the presence of past-year mental health disorders in Canadian Armed Forces (CAF) personnel and Veterans.

Methods: Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS). With a sample of 2,941 respondents, the weighted survey sample represented 18,120 active duty and 34,380 released CAF personnel. Multiple logistic regressions were used to assess the associations between sociodemographic characteristics (e.g. sex), military factors (e.g. rank), moral injury (using the Moral Injury Events Scale [MIES]) and the presence of specific mental health disorders (major depressive episode, generalized anxiety disorder, panic disorder, social anxiety disorder, PTSD, and suicidality).

Results: While adjusting for selected sociodemographic and military factors, the odds of experiencing any past-year mental health disorder were 1.97 times greater (95% CI = 1.94–2.01) for each one-unit increase in total MIES score. Specifically, PTSD had 1.91 times greater odds (95% CI = 1.87–1.96) of being endorsed for every unit increase in MIES total score, while odds of past-year panic disorder or social anxiety were each 1.86 times greater (95% CI = 1.82–1.90) for every unit increase in total MIES score. All findings reported were statistically significant (p < .001).

Conclusion: These findings emphasize that PMIEs are robustly associated with the presence of adverse mental health outcomes among Canadian military personnel. The results of this project further underscore the necessity of addressing moral injury alongside other mental health concerns within the CAF.

HIGHLIGHTS

  • Potentially morally injurious experiences are common during military service, but it is poorly understood how these experiences are related to other mental health disorders in Canadian Armed Forces members and Veterans.

  • Following a series of multiple logistic regressions, the odds of experiencing a past-year mental health disorder were 1.97 (95% CI: = 1.94–2.01) times greater per unit increase in total Moral Injury Events Scale score.

  • This emphasizes the association between morally injurious events and deleterious mental health outcomes in Canadian military personnel, and further highlights the importance of addressing moral injury in this population.

Antecedentes: Experiencias potencialmente dañinas para la moral (PMIEs por sus siglas en inglés) son frecuentes durante el servicio militar. Sin embargo, no está claro en qué medida las PMIEs se relacionan con las consecuencias adversas de salud mental bien establecidas.

Objetivo: El objetivo de este estudio fue utilizar una encuesta basada en la población para determinar las asociaciones entre la atribución del daño moral y la presencia de trastornos de salud mental en el último año en los veteranos y personal de las Fuerzas Armadas Canadienses (CAF por sus siglas en inglés).

Métodos: Los datos se obtuvieron de la Encuesta de Seguimiento de Salud Mental de los Veteranos y Miembros de las Fuerzas Armadas Canadienses del 2018 (CAFVMHS). Con una muestra de 2.941 encuestados, la muestra ponderada de la encuesta representó 18.120 miembros en servicio activo y 34.380 liberados de la CAF. Se utilizaron regresiones logísticas múltiples para evaluar las asociaciones entre las caracteristicas sociodemográficas (ej., sexo), factores militares (ej., rango), daño moral (utilizando la Escala de Eventos de Daño Moral [MIES por sus siglas en inglés]) y la presencia de trastornos de salud mental específicos (episodio depresivo mayor, trastorno de ansiedad generalizada, trastorno de pánico, trastorno de ansiedad social, TEPT y suicidalidad).

Resultados: Al ajustar por factores sociodemográficos y militares seleccionados, la probabilidad de experimentar cualquier trastorno de salud mental en el último año fueron 1.97 veces mayores (IC95%= 1.94-2.01) para cada aumento de una unidad en la puntuación total del MIES. Específicamente, el TEPT tenia 1,91 veces más probabilidades (IC 95%= 1.87-1.96) de ser atribuido por cada aumento de unidad en la puntuación total del MIES, mientras que la probabilidad de trastorno de pánico o ansiedad social del último año fueron 1,86 veces mayores (IC 95%= 1.82-1.90) por cada aumento de unidad en la puntuación total del MIES. Todos los hallazgos reportados fueron estadísticamente significativos (p< 0,001).

Conclusiones: Estos hallazgos enfatizan que las PMIEs se asocian fuertemente con la presencia de consecuencias de salud mental adversas entre el personal militar Canadiense. Los resultados de este proyecto subrayan aún más la necesidad de abordar el daño moral junto con otros problemas de salud mental dentro de las CAF.

背景：潜在的道德伤害经历 (PMIE) 在服兵役期间很常见。 然而，PMIE 在多大程度上与公认的不良心理健康结果相关仍不清楚。

目的：本研究旨在使用基于人群调查来确定加拿大武装部队 (CAF) 人员和退伍军人的道德伤害认可与过去一年心理健康障碍之间的关联。

方法：数据来自 2018 年加拿大武装部队成员和退伍军人心理健康随访调查 (CAFVMHS)。 样本为 2,941 名受访者，加权调查样本代表了 18,120 名现役人员和 34,380 名退役 CAF 人员。使用多元逻辑回归评估社会人口特征（例如性别）、军事因素（例如军衔）、道德伤害（使用道德伤害事件量表 [MIES]）和特定心理健康障碍（重性抑郁发作、广泛性焦虑障碍、惊恐发作、社交焦虑障碍、创伤后应激障碍和自杀倾向）之间的关联。

结果：在针对选定的社会人口学和军事因素进行调整时，MIES 总分每增加一个单位，过去一年经历任何精神健康障碍的几率就会增加 1.97 倍（95% CI = 1.94-2.01）。 具体而言，MIES 总分每增加一个单位，PTSD 发生几率高 1.91 倍 (95% CI = 1.87-1.96)，而MIES 总分每增加一个单位，过去一年恐慌障碍或社交焦虑障碍的几率分别高 1.86 倍 (95% CI = 1.82-1.90)。 报告的所有结果均统计显著 (p < .001)。

结论：这些研究结果强调，PMIE 与加拿大军人中不良心理健康结果的存在密切相关。 本项目的结果进一步强调了在 CAF 内解决道德伤害以及其他心理健康问题的必要性。

This article is part of the following collections:
Stress, Trauma, and Related Conditions in Military, First Responders, Healthcare Professionals and their Families

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data can be accessed in Canada with permission from Statistics Canada through the Statistics Canada Research Data Centres. Statistics Canada collected and provided the data for academic purposes, but the analyses are the sole responsibility of the authors. The opinions expressed do not represent the views of Statistics Canada.

Additional information

Funding

This work was supported by Canadian Institutes of Health Research [Canadian Graduate Doctoral Scholarship].
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