Screening for Moral Injury: The Moral Injury Symptom Scale - Military Version Short Form

Harold G. Koenig, Donna Ames, Nagy Adel Youssef, John P. Oliver, Fred Volk, Ellen J. Teng, Kerry Haynes, Zachary D. Erickson, Irina Arnold, Keisha O'Garo, Michelle Pearce

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD. Methods: A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two. In the first half (n = 214), exploratory factor analysis identified the highest loading item on each of the 10 MISS scales (guilt, shame, moral concerns, loss of meaning, difficulty forgiving, loss of trust, self-condemnation, religious struggle, and loss of religious faith) to form the 10-item MISS-M-SF; confirmatory factor analysis was then performed to replicate results in the second half of the sample (n = 213). Internal reliability, test-retest reliability, and convergent, discriminant, and concurrent validity were examined in the overall sample. The study was approved by the institutional review boards and the Research & Development (R&D) Committees at Veterans Administration medical centers in Durham, Los Angeles, Augusta, Houston, and San Antonio, and the Liberty University and Duke University Medical Center institutional review boards. Findings: The 10-item MISS-M-SF had a median of 50 and a range of 12-91 (possible range 10-100). Over 70% scored a 9 or 10 (highest possible) on at least one item. Cronbach's alpha was 0.73 (95% CI 0.69-0.76), and test-retest reliability was 0.87 (95% CI 0.79-0.92). Convergent validity with the 45-item MISS-M was r = 0.92. Discriminant validity was demonstrated by relatively weak correlations with social, religious, and physical health constructs (r = 0.21-0.35), and concurrent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms (r = 0.54-0.58). Discussion: The MISS-M-SF is a reliable and valid measure of MI symptoms that can be used to screen for MI and monitor response to treatment in veterans and active duty military with PTSD.

Original languageEnglish (US)
Article numberusy017
Pages (from-to)E659-E665
JournalMilitary medicine
Volume183
Issue number11-12
DOIs
StatePublished - Jan 1 2018

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Post-Traumatic Stress Disorders
Wounds and Injuries
Veterans
Los Angeles
Research Ethics Committees
Reproducibility of Results
Statistical Factor Analysis
Shame
United States Department of Veterans Affairs
Guilt
Anxiety
Depression
Health
Therapeutics
Research

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., ... Pearce, M. (2018). Screening for Moral Injury: The Moral Injury Symptom Scale - Military Version Short Form. Military medicine, 183(11-12), E659-E665. [usy017]. https://doi.org/10.1093/milmed/usy017

Screening for Moral Injury : The Moral Injury Symptom Scale - Military Version Short Form. / Koenig, Harold G.; Ames, Donna; Youssef, Nagy Adel; Oliver, John P.; Volk, Fred; Teng, Ellen J.; Haynes, Kerry; Erickson, Zachary D.; Arnold, Irina; O'Garo, Keisha; Pearce, Michelle.

In: Military medicine, Vol. 183, No. 11-12, usy017, 01.01.2018, p. E659-E665.

Research output: Contribution to journalArticle

Koenig, HG, Ames, D, Youssef, NA, Oliver, JP, Volk, F, Teng, EJ, Haynes, K, Erickson, ZD, Arnold, I, O'Garo, K & Pearce, M 2018, 'Screening for Moral Injury: The Moral Injury Symptom Scale - Military Version Short Form', Military medicine, vol. 183, no. 11-12, usy017, pp. E659-E665. https://doi.org/10.1093/milmed/usy017
Koenig, Harold G. ; Ames, Donna ; Youssef, Nagy Adel ; Oliver, John P. ; Volk, Fred ; Teng, Ellen J. ; Haynes, Kerry ; Erickson, Zachary D. ; Arnold, Irina ; O'Garo, Keisha ; Pearce, Michelle. / Screening for Moral Injury : The Moral Injury Symptom Scale - Military Version Short Form. In: Military medicine. 2018 ; Vol. 183, No. 11-12. pp. E659-E665.
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N2 - Introduction: To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD. Methods: A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two. In the first half (n = 214), exploratory factor analysis identified the highest loading item on each of the 10 MISS scales (guilt, shame, moral concerns, loss of meaning, difficulty forgiving, loss of trust, self-condemnation, religious struggle, and loss of religious faith) to form the 10-item MISS-M-SF; confirmatory factor analysis was then performed to replicate results in the second half of the sample (n = 213). Internal reliability, test-retest reliability, and convergent, discriminant, and concurrent validity were examined in the overall sample. The study was approved by the institutional review boards and the Research & Development (R&D) Committees at Veterans Administration medical centers in Durham, Los Angeles, Augusta, Houston, and San Antonio, and the Liberty University and Duke University Medical Center institutional review boards. Findings: The 10-item MISS-M-SF had a median of 50 and a range of 12-91 (possible range 10-100). Over 70% scored a 9 or 10 (highest possible) on at least one item. Cronbach's alpha was 0.73 (95% CI 0.69-0.76), and test-retest reliability was 0.87 (95% CI 0.79-0.92). Convergent validity with the 45-item MISS-M was r = 0.92. Discriminant validity was demonstrated by relatively weak correlations with social, religious, and physical health constructs (r = 0.21-0.35), and concurrent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms (r = 0.54-0.58). Discussion: The MISS-M-SF is a reliable and valid measure of MI symptoms that can be used to screen for MI and monitor response to treatment in veterans and active duty military with PTSD.

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