Moral Injury, Mental Health, and Behavioral Health Outcomes: A Systematic Review of the Literature.

@article{Hall2021MoralIM,
  title={Moral Injury, Mental Health, and Behavioral Health Outcomes: A Systematic Review of the Literature.},
  author={Nicole A Hall and Adam T Everson and Madison R Billingsley and Mary Beth Miller},
  journal={Clinical psychology \& psychotherapy},
  year={2021}
}
BACKGROUND Despite a burgeoning of research on moral injury in the past decade, existing reviews have not explored the breadth of consequences and the multitude of pathways through which moral injury and potentially morally injurious experiences (PMIEs) influence mental and behavioral health outcomes. PURPOSE To identify associations between moral injury on mental and behavioral health. PROCEDURE Literature searches of psychological and medical databases were conducted through April 2020… 
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References

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Occupational moral injury and mental health: systematic review and meta-analysis
TLDR
Moderator analyses indicated that methodological factors, demographic characteristics and PMIE variables did not affect the association between a PMIE and mental health outcomes, and most studies examined occupational PMIEs in military samples and additional studies investigating the effect ofPMIEs on civilians are needed.
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TLDR
Scientific research about moral injury is reviewed, summarizing lessons from the literature and offering recommendations for future research.
Moral Injury and PTSD as Mediators of the Associations Between Morally Injurious Experiences and Mental Health and Substance Use
The present study examined the degree to which morally injurious experiences (MIEs; i.e., atrocities of war, psychological consequences of war, and leadership failure/betrayal) and moral injury
Morally injurious experiences and mental health: The moderating role of self-compassion.
TLDR
Self-compassion significantly moderated the relationship between exposure to morally injurious experiences and posttraumatic stress disorder, depression severity, and deliberate self-harm versatility, indicating the potential clinical utility of self-comp compassion in military mental health.
Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review
TLDR
Two multidimensional measures assess MI symptoms alone (not events) and may be useful for determining if treatments directed at MI may both reduce symptoms and impact other mental health outcomes including PTSD and future research is needed to identify cutoff scores and clinically significant change scores.
Sex Differences in Mental Health Symptoms and Substance Use and Their Association With Moral Injury in Veterans
TLDR
Potential sex differences in 3 types of experiences that may result in moral injury are examined and moral injury significantly positively predicted all negative mental health symptoms and hazardous alcohol use, but not drug abuse symptoms.
Rumination as a Mediator of the Associations Between Moral Injury and Mental Health Problems in Combat-Wounded Veterans.
TLDR
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.
Moral injury, meaning making, and mental health in returning veterans.
TLDR
Preliminary evidence is provided that difficulties with meaning making could serve as a mediating pathway for how MIEs increase the risk for adjustment problems after warzone service, but that other factors associated with moral injury also have a bearing on psychological functioning among Veterans.
A Longitudinal Investigation of Moral Injury Appraisals Amongst Treatment-Seeking Refugees
TLDR
Findings suggest that different types of moral injury appraisals may be associated with differential psychological outcomes, highlighting the importance of targeting cognitive factors in the maintenance and treatment of psychological distress, and considering the post-migration context when working with refugees.
Moral injury, posttraumatic stress disorder, and religious involvement among U.S. veterans.
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TLDR
MI has a strong positive relationship with PTSD symptoms and an inverse relationship with RI, and among non-Middle Eastern war theater veterans, a significant buffering effect of religiosity was found.
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