The Moral Injury Symptom Scale-Military Version

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

22 Citations (Scopus)

Abstract

The purpose of this study was to develop a multi-dimensional measure of moral injury symptoms that can be used as a primary outcome measure in intervention studies that target moral injury (MI) in Veterans and Active Duty Military with PTSD. This was a multi-center study of 427 Veterans and Active Duty Military with PTSD symptoms recruited from VA Medical Centers in Augusta, Los Angeles, Durham, Houston, and San Antonio, and from Liberty University in Lynchburg. Internal reliability of the Moral Injury Symptom Scale-Military Version (MISS-M) was examined along with factor analytic, discriminant, and convergent validity. Participants were randomly split into two equal samples, with exploratory factor analysis conducted in the first sample and confirmatory factor analysis in the second. Test–retest reliability was assessed in a subsample of 64 Veterans. The 45-item MISS-M consists of 10 theoretically grounded subscales assessing guilt, shame, moral concerns, religious struggles, loss of religious faith/hope, loss of meaning/purpose, difficulty forgiving, loss of trust, and self-condemnation. The Cronbach’s alpha of the overall scale was.92 and of individual subscales ranged from.56 to.91. The test–retest reliability was.91 for the total scale and ranged from.78 to.90 for subscales. Discriminant validity was demonstrated by relatively weak correlations with other psychosocial, religious, and physical health constructs, and convergent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms. The MISS-M is a reliable and valid multi-dimensional symptom measure of moral injury that can be used in studies targeting MI in Veterans and Active Duty Military with PTSD symptoms and may also be used by clinicians to identify those at risk.

Original languageEnglish (US)
Pages (from-to)249-265
Number of pages17
JournalJournal of Religion and Health
Volume57
Issue number1
DOIs
StatePublished - Feb 1 2018

Fingerprint

Veterans
Post-Traumatic Stress Disorders
Wounds and Injuries
Statistical Factor Analysis
Hope
Shame
Guilt
Los Angeles
Military
Anxiety
Outcome Assessment (Health Care)
Depression
Health
Religion
Test-retest Reliability

Keywords

  • Active Duty Military
  • Internal conflict
  • Moral injury
  • Post-traumatic stress disorder
  • Veterans

ASJC Scopus subject areas

  • Nursing(all)
  • Religious studies

Cite this

Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., ... Pearce, M. (2018). The Moral Injury Symptom Scale-Military Version. Journal of Religion and Health, 57(1), 249-265. https://doi.org/10.1007/s10943-017-0531-9

The Moral Injury Symptom Scale-Military Version. / 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: Journal of Religion and Health, Vol. 57, No. 1, 01.02.2018, p. 249-265.

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, 'The Moral Injury Symptom Scale-Military Version', Journal of Religion and Health, vol. 57, no. 1, pp. 249-265. https://doi.org/10.1007/s10943-017-0531-9
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. / The Moral Injury Symptom Scale-Military Version. In: Journal of Religion and Health. 2018 ; Vol. 57, No. 1. pp. 249-265.
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