Moral injury, posttraumatic stress disorder, and religious involvement among U.S. veterans

BACKGROUND: Traumatic experiences can cause ethical conflicts. "Moral injury" (MI) has been used to describe this emotional/cognitive state, and could contribute to the development of posttraumatic stress disorder (PTSD) or block its recovery. We examine the relationship between MI and PTSD, and the impact of religious involvement (RI) on that relationship. METHODS: We conducted a study of 120 veterans enrolled at the Charlie Norwood VA Medical Center in Augusta, Georgia. Standard measures of PTSD symptoms, MI, and RI were administered. Regression models were used to examine correlates of PTSD symptoms and the moderating or mediating effects of RI. RESULTS: A strong relationship was found between MI and PTSD symptoms (r = 0.54, P ≤ .0001), and between MI and RI (r = -.41, P ≤ .0001), but only a weak relationship was found between RI and PTSD symptoms (r = -.17, P = .058). RI did not mediate or moderate the relationship between MI and PTSD symptoms in the overall sample. However, among non-Middle Eastern war theater veterans, a significant buffering effect of religiosity was found. CONCLUSIONS: MI has a strong positive relationship with PTSD symptoms and an inverse relationship with RI. RI did not mediate or moderate the relationship between MI and PTSD in the overall sample, but it moderated this relationship in non-Middle Eastern war theater veterans.