@article{84a848cc84c449c4a179fc69443a8896,
title = "Examining the Overlap between Moral Injury and PTSD in US Veterans and Active Duty Military",
abstract = "Moral injury (MI) is a syndrome thought to be separate from posttraumatic stress disorder (PTSD), yet having some overlap. To determine the overlap, we examined the relationship between MI and the four DSM-5 PTSD symptom clusters (B, C, D, E) in US veterans and active duty military (ADM). The 45-item Moral Injury Symptom Scale (MISS-M) was administered to 591 veterans and ADM who had served in a combat theater and had PTSD symptoms. PTSD symptoms were measured with the PTSD Symptom Checklist-5, which assesses the four PTSD symptom clusters. Total MISS-M scores were more strongly associated with PTSD symptom cluster D (negative cognitions and emotions) in both bivariate and multivariate analyses. Findings for a 10-item version of the MISS-M (MISS-M-SF) closely followed those of the MISS-M. Although the overlap between MI and PTSD occurs to some extent across all PTSD symptoms clusters, the largest overlap tends to be with the negative cognitions and emotions cluster.",
keywords = "Moral injury, active duty military, overlap, posttraumatic stress disorder, symptom clusters, veterans",
author = "Koenig, {Harold G.} and Youssef, {Nagy A.} and Donna Ames and Teng, {Ellen J.} and Hill, {Terrence D.}",
note = "Funding Information: This work was funded by a grant received from the Augusta Biomedical Research Institute (Nagy Youssef), Augusta, GA, and by departmental funds from the Department of Counselor Education and Family Studies, School of Behavioral Sciences, Liberty University, Lynchburg, Virginia, and from the Center for Aging and Development, Duke University Medical Center, Durham, NC. Funding Information: A special thanks to Fred Volk, PhD, at the Department of Counselor Education and Family Studies, School of Behavioral Sciences, Liberty University, Lynchburg, Virginia; Rev. John P. Oliver, DMin, BCC, at Pastoral Services, Duke University Medical Center, Durham, NC; and Kerry Haynes, DMin, BCC, at the South Texas Veterans Healthcare System, San Antonio, TX, for their leadership in data collection at each of these sites. This material is the result of work supported with resources and the use of facilities at the VA Greater Los Angeles Healthcare System (Los Angeles, CA), Charlie Norwood VA Medical Center (Augusta, GA), South Texas Veterans Healthcare System (San Antonio, TX), Michael E. DeBakey VA Medical Center (Houston, TX), and Durham Veterans Affairs Health Care System (Durham, NC). Funding Information: Data were collected from 591 veterans (n = 488) and ADM (n = 103). Veterans completed in-person questionnaires at outpatient Veterans Administration (VA) hospital clinics in Augusta, GA (n = 201), Los Angeles, CA (n = 99), Durham, NC (n = 92), San Antonio, TX (n = 48), and Houston, TX (n = 48). ADM completed online questionnaires and consisted of two groups, those taking classes at Liberty University (n = 54) and those identified through Qualtrics (Provo, UT), an online data collection platform (n = 49). Eligibility criteria were history of deployment to a combat theater, having PTSD symptoms, and for those completing in-person questionnaires, providing written informed consent (except veterans at the Greater Los Angeles VA Healthcare System, who received a study information sheet and provided verbal consent). For completing the questionnaires either online or in-person, participants received a $25 gift card for their time and effort. This study was approved by the participating VA Health Systems, Duke University, and Liberty University. The present analysis involved an expanded sample from a project originally designed to assess MI (n = 427). Publisher Copyright: {\textcopyright} Wolters Kluwer Health, Inc. All rights reserved.",
year = "2020",
month = jan,
day = "1",
doi = "10.1097/NMD.0000000000001077",
language = "English (US)",
volume = "208",
pages = "7--12",
journal = "Journal of Nervous and Mental Disease",
issn = "0022-3018",
publisher = "Lippincott Williams and Wilkins",
number = "1",
}
