Citation

Bravo AJ, Kelley ML, Mason R, Ehlke SJ, Vinci C, Redman JC. Traumatology 2020; 26(1): 52-60.

Copyright

(Copyright © 2020, Green Cross Academy of Traumatology, Publisher APA Journals)

DOI

10.1037/trm0000198

PMID

unavailable

Abstract

Moral injury is hypothesized to develop from witnessing or engaging in events that violate one's beliefs about oneself and has been shown to be associated with negative mental health symptoms. Although there has been an increase in research examining moral injury among military veterans, mechanisms that link moral injury to mental health outcomes are not well understood. The present study examined rumination subcomponents (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) as possible mediators of the associations between moral injury (both self-directed and other-directed symptoms) and negative mental health symptoms (i.e., depression, anxiety, suicidality, sleep disturbance, memory problems, and posttraumatic stress disorder symptoms). Participants were 189 combat-wounded veterans (180 men; Mage = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability (n = 176, 93.1%), with the average participant reporting a 90% total Veterans Affairs (VA) disability ranking, and most participants had received a purple heart (n = 163, 86.2%). Within our comprehensive mediation model, we found eight significant mediation effects, with the most consistent mediator being problem-focused thoughts. Specifically, both self-directed and other-directed moral injury were associated with increased problem-focused thoughts, which in turn was associated with higher reported symptoms of depression, anxiety, and posttraumatic stress disorder. Taken together, rumination, and in particular, problem-focused thoughts, is relevant to understand the increased vulnerability of military veterans to exhibit poor mental health outcomes when experiencing moral injury. (PsycINFO Database Record (c) 2020 APA, all rights reserved)

Language: en