@article{ref1,
title="Morally injurious events and psychological distress among veterans: examining the mediating role of religious and spiritual struggles",
journal="Psychological trauma: theory, research, practice, and policy",
year="2018",
author="Evans, Wyatt R. and Stanley, Melinda A. and Barrera, Terri L. and Exline, Julie J. and Pargament, Kenneth I. and Teng, Ellen J.",
volume="10",
number="3",
pages="360-367",
abstract="OBJECTIVE: Potentially morally injurious events (PMIEs)-violations (perpetrated or witnessed) of one's deeply held beliefs or values-have been associated with several forms of psychological distress. The values violated by PMIEs are often influenced by one's religion/spirituality (r/s). Struggles with one's r/s beliefs and/or practices may also contribute to elevated psychological distress. To further develop a framework for understanding and treating the sequelae of PMIE exposure, we examined the role of r/s struggles in the relation between PMIE exposure and psychological distress. <br><br>METHOD: A diverse sample of 155 veterans at a large Veterans Affairs medical center completed questionnaires assessing PMIE exposure, r/s struggles, and psychological distress. <br><br>RESULTS: Findings revealed greater PMIE exposure predicted elevated r/s struggles as well as elevated symptoms of anxiety and posttraumatic stress disorder (PTSD). Likewise, greater r/s struggles predicted elevated anxiety, PTSD, and depression symptoms. Regression analyses revealed r/s struggles fully mediated the relation between PMIE exposure and anxiety as well as PTSD, and a significant indirect effect of PMIE exposure on depression symptoms through r/s struggles was observed. Follow-up analyses revealed that no specific domain of r/s struggles accounted for the relation between PMIE exposure and psychological distress; rather, the overarching construct of r/s struggles accounted for this relation. <br><br>CONCLUSION: These findings advance the evolving theoretical framework of moral injury, elucidating the salience of r/s struggles in the development of distress. Implications for moral injury intervention call for attention to potential dissonance between actions (witnessed or perpetrated) and r/s underpinnings of the individual's moral framework. (PsycINFO Database Record<br><br>(c) 2017 APA, all rights reserved).<p /> <p>Language: en</p>",
language="en",
issn="1942-9681",
doi="10.1037/tra0000347",
url="http://dx.doi.org/10.1037/tra0000347"
}