Objective: This study examines potential sex differences in 3 types of experiences (i.e., atrocities of war, cognitive and emotional changes from combat, and leadership failure or betrayal) that may result in moral injury (i.e., guilt, shame, inability to forgive one's self, inability to forgive others, and withdrawn behavior associated with these three types of experiences). In addition, we examine whether moral injury results in different associations with mental health and substance use outcomes for female versus male veterans. We expected more symptoms of depression and anxiety for women and more symptoms of hazardous alcohol use and drug abuse for men. Also, we examined sex as a moderator between moral injury and outcomes, expecting stronger relationships between moral injury and symptoms of depression and anxiety among women and stronger associations between moral injury and alcohol use and drug abuse symptoms for men.
Method: Participants (n = 256; 60.9% [n = 156] males) were a community sample of recent-era military personnel who completed a measure of morally injurious experiences (MIEs) and associated moral injury.
Results: After correcting for Type I error rate, sex was not associated with mental health or substance use. Further, no Sex × Moral Injury interactions were present; however, moral injury significantly positively predicted all negative mental health symptoms (depression, anxiety, suicidality, and posttraumatic stress disorder [PTSD]) and hazardous alcohol use, but not drug abuse symptoms.
Conclusions: Results reveal the need for improved screening and treatment of moral injury and integrated treatments that may assess moral injury and associated disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).