Importance of moral appraisals in military veterans

Previous research in the field of moral injury suggests that one’s actions during combat may lead to negative outcomes if they transgress deeply held moral beliefs; however, measures of these constructs are limited in that they combine event exposure and moral appraisal. This study examines the ability of moral appraisals to predict negative outcomes above and beyond exposure to combat. Self-report measures of psychosocial outcomes, combat experiences, and moral appraisals were completed by 182 military veterans recruited using online methods. For each endorsed combat experience, participants were asked to provide a moral evaluation of their own actions and the actions of those in their unit and their unit command. Moral appraisal ratings of the self, unit, and command were highly correlated, and principal components analysis was used to form a single index of moral appraisals. Hierarchical regression analyses, with combat experiences in the first step and the moral appraisal index in the second step, demonstrated that this index had strong relationships with outcomes that are often associated with moral injury, including anger (β = .45), posttraumatic stress disorder (β = .46), depression (β = .50), guilt (β = .42), and shame (β = .41). Results indicated moral appraisals of specific combat experiences predict additional distress beyond having been exposed to combat. Clinically, our results suggest it is important to examine both environmental (event related) and individual determinants of moral evaluation and further support the need for additional measures of transgressive acts that separately assess exposure and appraisal.