Sexual Trauma and Moral Injury Among U.S. Military Veterans

Background and Purpose: Research has found that approximately 38% of women and 16% of men in the U.S. military report experiencing sexual harassment and/or sexual violence during their service. These experiences, together termed military sexual trauma (MST), have been found to predict suicidality, post-traumatic stress disorder (PTSD), depression, anxiety, and disability. Additionally, MST may be linked to moral injury, or feelings of moral betrayal, guilt, or shame that result from experiencing, perpetrating, or witnessing actions that transgress deeply held moral beliefs and expectations. Moral injury has been found to contribute to suicidality, PTSD, depression, anxiety, substance use, and negative social and spiritual outcomes among military veterans. However, moral injury has largely been studied in the context of combat exposure. Further research is needed to understand the relationship between moral injury and MST in nationally representative veteran samples to guide practice strategies that best support veteran wellbeing.

Methods: This study uses data from the Veterans Metrics Initiative Transitioning Veterans Survey, a survey of United States military veterans who transitioned to civilian life between 2016-2019. Veterans in the sample were asked about their experiences of sexual harassment and sexual violence in the military and their perceptions of moral injury at two time points: wave 2, collected in 2017 (n = 6,992), and wave 6, collected in 2019 (n = 4,706). Respondents’ moral injury scores at each wave were calculated and regressed on military sexual harassment and violence experiences, respectively. Covariates included age, racial/ethnic identity, gender, sexual orientation, income insecurity, education, and number of active years in the military.

Results: The linear regression models showed that military sexual harassment experiences and sexual violence experiences each significantly predicted moral injury scores at both wave 2 (R² = 0.11, F(9, 6,982), p < 0.001) and wave 6 (R² = 0.13, F(9, 4,696), p < 0.001). Accounting for demographic variables and time in the military, military sexual harassment significantly predicted moral injury at wave 2 (B = 7.05, p < 0.001) and wave 6 (B = 7.02, p < 0.001), as did military sexual violence at wave 2 (B = 4.41, p < 0.001) and wave 6 (B = 4.07, p = 0.002).

Conclusions and Implications: Results from this study show that MST contributes to moral injury among U.S. military veterans. This finding in a nationally representative dataset strengthens the emergent literature on the impact of MST on veterans’ experiences of moral injury. Additionally, the similarity of results across a two-year timespan underscores the lasting moral impacts of MST. This work highlights the importance of addressing military sexual harassment and sexual violence, and suggests that a moral injury perspective is likely a viable treatment avenue for MST survivors.

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