RESEARCH ARTICLE

Defining Moral Injury Among Military Populations: A Systematic Review

Corresponding Author

Natalie M. Richardson

richardsonna17@students.ecu.edu

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

Correspondence concerning this article should be addressed to Natalie M. Richardson, Department of Human Development and Family Science, College of Health and Human Performance, 235 Rivers West, Mailstop 505 Greenville, NC 27858. E-mail: richardsonna17@students.ecu.edu

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Angela L. Lamson,

Angela L. Lamson

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Maggie Smith,

Maggie Smith

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Sheena M. Eagan,

Sheena M. Eagan

Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA

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Anisa M. Zvonkovic,

Anisa M. Zvonkovic

College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Jakob Jensen,

Jakob Jensen

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Natalie M. Richardson,

Corresponding Author

Natalie M. Richardson

richardsonna17@students.ecu.edu

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Angela L. Lamson,

Angela L. Lamson

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Maggie Smith,

Maggie Smith

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Sheena M. Eagan,

Sheena M. Eagan

Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA

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Anisa M. Zvonkovic,

Anisa M. Zvonkovic

College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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Jakob Jensen,

Jakob Jensen

Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA

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First published: 22 June 2020

https://doi.org/10.1002/jts.22553

Citations: 34

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Abstract

Military service often requires engaging in activities, witnessing acts, or immediate decision-making that may violate the moral codes and personal values to which most individuals ascribe. If unacknowledged, these factors can lead to injuries that can affect the physical, psychological, social, and spiritual health of military men and women. The term moral injury has been assigned to these soul-ceasing experiences. Although researchers have attempted to define moral injury and what leads to such experiences, inconsistencies across definitions exist. In addition, nearly all existing definitions have lacked empirical support. The purpose of the present systematic review was to explore how moral injury has been defined in research with military populations, using Cooper's approach to research synthesis as well as PRISMA guidelines. An in-depth review of 124 articles yielded 12 key definitions of moral injury across the literature. Two of these 12 definitions were grounded in empirical evidence, suggesting that much more research is needed to strengthen the face validity and reliability of the construct. Quality rankings were developed to categorize each of the included articles. The findings punctuate the need for empirical evidence to further explore moral injury, particularly among samples inclusive of service members and the biopsychosocial–spiritual experiences associated with such injuries.

Resumen

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET)

Definiendo el daño moral en poblaciones militares: una revisión sistemática

DEFINIENDO EL DAÑO MORAL

El servicio militar a menudo requiere participar en actividades, presenciar actos o tomar decisiones inmediatas que pueden violar los códigos morales y los valores personales a los que se adscriben la mayoría de las personas. Si no se reconocen, estos factores pueden provocar lesiones que pueden afectar la salud física, psicológica, social y espiritual de los hombres y mujeres militares. Se ha asignado el término daño moral a estas experiencias que quiebran el alma (soul-ceasing experiences en su expresión en inglés). Aunque los investigadores han intentado definir el daño moral y lo que conduce a tales experiencias, existen inconsistencias entre las definiciones. Además, casi todas las definiciones existentes carecen de apoyo empírico. El propósito de la presente revisión sistemática fue explorar cómo se ha definido el daño moral en la investigación con poblaciones militares, utilizando el enfoque de Cooper para la síntesis de la investigación, así como las pautas PRISMA. Una revisión en profundidad de 124 artículos arrojó 12 definiciones clave de daño moral en la literatura. Dos de estas 12 definiciones se basaron en evidencia empírica, lo que sugiere que se necesita mucha más investigación para fortalecer la validez aparente y la confiabilidad del constructo. Se desarrollaron clasificaciones de calidad para categorizar cada uno de los artículos incluidos. Los hallazgos acentúan la necesidad de evidencia empírica para explorar más a fondo el daño moral, particularmente entre muestras que incluyen a los miembros del servicio y las experiencias biopsicosociales y espirituales asociadas con tales daños.

抽象

Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS)

簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯

Defining Moral Injury Among Military Populations: A Systematic Review

Traditional Chinese

標題: 定義軍人的道德創傷:系統性文獻回顧

撮要: 從軍經常要參與及目睹一些可能違背個人道德規範和價值觀的行為或活動, 或進行可能違背個人道德規範和價值觀的即時決策。如不正視男女軍人的這些經歷, 它們可能會對軍人構成損害, 影響其身、心、社會及精神健康。「道德創傷」一詞用以描述這些損害精神的體驗。雖然研究員一直嘗試定義道德創傷及引致這種體驗的因素, 但現有的定義仍不一致。再者, 幾乎所有現有的定義均欠缺實證支持。本系統性文獻回顧採用Cooper的研究合成法及PRISMA指引, 旨在探索過往研究如何定義軍人的道德創傷。我們深入檢視124份研究文獻, 得出12個重點的道德創傷定義, 當中兩個具實證支持, 反映目前仍需更多研究以加強此構念的表面效度及可靠性。我們採用質素排名法, 把所有涵蓋的文獻分類。結果凸顯, 我們需有更多實證以進一步研究道德創傷, 尤其是有關軍人的實證, 及跟道德創傷相關的身生理、社會及精神體驗的實證。

Simplified Chinese

标题: 定义军人的道德创伤:系统性文献回顾

撮要: 从军经常要参与及目睹一些可能违背个人道德规范和价值观的行为或活动, 或进行可能违背个人道德规范和价值观的实时决策。如不正视男女军人的这些经历, 它们可能会对军人构成损害, 影响其身、心、社会及精神健康。「道德创伤」一词用以描述这些损害精神的体验。虽然研究员一直尝试定义道德创伤及引致这种体验的因素, 但现有的定义仍不一致。再者, 几乎所有现有的定义均欠缺实证支持。本系统性文献回顾采用Cooper的研究合成法及PRISMA指引, 旨在探索过往研究如何定义军人的道德创伤。我们深入检视124份研究文献, 得出12个重点的道德创伤定义, 当中两个具实证支持, 反映目前仍需更多研究以加强此构念的表面效度及可靠性。我们采用质素排名法, 把所有涵盖的文献分类。结果凸显, 我们需有更多实证以进一步研究道德创伤, 尤其是有关军人的实证, 及跟道德创伤相关的身生理、社会及精神体验的实证。

Supporting Information

References

All references that coincide with the 124 articles included in the review can be sent by the corresponding author upon request. A full list of these articles can be found in the Supplemental Materials.
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Volume33, Issue4

August 2020

Pages 575-586

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jts22553-sup-0001-Table.docx68.4 KB	Supplementary Information
jts22553-sup-0002-Reference-List.docx44 KB	Supplementary Information

Defining Moral Injury Among Military Populations: A Systematic Review

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