Exploring associations between deployment-related events and moral injury outcomes in post-9/11 veterans.

Moral injury is a trauma-related condition that may develop following exposure to events that violate one's deeply held moral beliefs and values (termed "potentially morally injurious events" [PMIEs]). Research has not examined differential roles of the many protective and iatrogenic experiences surrounding a war-zone deployment that might influence development of moral injury after the military-to-civilian transition. In total, 309 Post-9/11 combat veterans completed a cross-sectional survey including the Deployment Risk and Resilience Inventory-2 (DRRI-2), Moral Injury Events Scale, and the Expressions of Moral Injury Scale - Military version after separating from the military. Whether focusing on childhood or pre-deployment experiences or the deployment period itself, bivariate analyses revealed veterans who endorsed moral injury outcomes generally had less relational supports and a range of adverse and potentially traumatic events. Using a multivariate regression analysis with posttraumatic stress disorder symptom severity as a covariate, exposures to PMIEs (transgression and betrayal events) were uniquely linked with greater moral injury outcomes in the presence of other stressful events and possible traumas. However, perception of greater unit support was also uniquely inversely associated with moral injury outcomes in this analysis. In combination, these results affirm the probable link between varying types of PMIE exposures and moral injury outcomes while also suggesting the vital importance of having a cohesive and supportive unit during a war-zone deployment.