Moral Injury Appraisals in Traumatised Refugees

Refugees are often exposed to a number of traumatic experiences, that can lead to elevated rates of posttraumatic stress disorder (PTSD). While PTSD has largely been conceptualised as a fear based disorder, refugees often... [ view full abstract ]

Refugees are often exposed to a number of traumatic experiences, that can lead to elevated rates of posttraumatic stress disorder (PTSD). While PTSD has largely been conceptualised as a fear based disorder, refugees often report emotions such as anger, guilt or shame. These may be a result of moral injury, which refer to appraisals that violate deeply held moral beliefs and frameworks. This study investigated the factor structure of the Moral Injury Scale (MIS), to see if moral injury appraisals differentiated, depending on whether the appraisal was made externally (violation from others) or internally (violation from oneself). Additionally, we were interested in how these factors would be related to key predictor (age, gender, trauma exposure) and outcome (PTSD symptoms, anger, depression) variables. A diverse group of 222 refugees was used in this study. Confirmatory factor analyses revealed a two factor structure (external and internal) in line with our hypothesis. Structural equation modelling indicated that both factors were predicted by higher trauma exposure. Additionally, higher moral injury in both factors was associated with higher levels of anger and depression. Unexpectedly, if moral injury was appraised externally this was also associated with higher PTSD symptom clusters, but internal appraisals did not find this association, and in fact, predicted lower levels or re-experiencing symptoms. Therefore, the underlying mechanisms of each factor may be distinct, which will have important implications in designing treatments that are effective for moral injury.