Examining Predictors of Moral Injury in Military Veterans: A General Strain Theory Perspective

Background and Purpose:

When an individual experiences, witnesses, perpetrates, or fails to prevent an act that transgresses their moral beliefs, the subsequent distress can be understood as moral injury. Moral injury is widespread in the military setting and is associated with distress and comorbidity. It requires more attention from social workers and other clinicians. While the prevalence of moral injury is unknown, surveys of active duty and veteran populations have found that the majority of respondents report having multiple indicators of moral injury. Moral injury has been associated with adverse mental health outcomes such as PTSD, depression, anxiety, suicidality, and maladaptive coping responses. There is no evidence-based treatment for moral injury and standard trauma treatments have the potential to be harmful. Therefore, it is imperative to better understand moral injury. Moral injury was first examined among military personnel and has subsequently been found in a range of occupations. Occupational characteristics, especially as they shape occupational identity, may be an important component in understanding moral injury. Social support and social integration are often used in analyses along with moral injury to predict PTSD. General Strain Theory contextualizes relationships between occupational identity, social integration, and social regulation to inform an understanding of moral injury. As such, this study poses the following question: in the context of social workers’ understanding of moral injury in military and veteran populations, what is the relationship between General Strain Theory components and moral injury?

Methods:

Using Military Health and Well-Being Project, 2020 dataset, a sample of 1,495 post-Vietnam military veterans were surveyed. The sample consisted of 1,004 (67.2%) males and 483 (32.3%) females. The dependent variable, moral injury, was measured using the Moral Injury Symptom Scale-Military Version Short Form (MISSM-SF). The independent variables included military identity in measured terms of military idealism, miliary professionalism, military individualism, and measures of social integration, social contribution, calling and purpose, loneliness, combat exposure, and suicidal ideation. Gender and race served as control variables. Ordinary Least Squares regression analysis was conducted using IBM-SPSS version 29.0.2.0 (20).

Results:

Results indicated that military idealism and military individualism had statistically significant relationships to moral injury, as did the various variables measuring concepts of social integration and social regulation. Professionalism and gender did not have a statistically significant relationship to moral injury. General Strain Theory provides a viable framework to predict moral injury and can thus contribute to its growing body of literature.

Conclusions and Implications:

The purpose of this study was to apply General Strain Theory to examine moral injury. Applying this understanding could enable social workers to develop more effective mental health interventions and support systems when addressing moral injury, especially through the lens that incorporates professional role expectations. Since social workers serve clients, including military personnel and veterans, who experience various mental health conditions and moral injury, it is crucial to better understand moral injury and its impacts.