Moral injury in refugees with PTSD: An explorative study

Abstract

Background: The term ‘moral injury’ refers to ‘the lastingpsychological, biological, spiritual, behavioural, and socialimpact of perpetrating, failing to prevent, or bearing witnessto acts that transgress deeply held moral beliefs andexpectations’ (Litz et al., 2009). Although moral injury isnot observed as a psychiatric disorder, it may have greatimpact on mental health. In military populations, moralinjury is related to poor self-forgiveness, shame, guilt, posttraumatic stress disorder (PTSD), substance use and suicidality (Drescher et al., 2011; Litz et al., 2009). Although itis assumed that moral injury also occurs in other populationssuch as refugees, research has not yet systematically studiedmoral injury in this group. Therefore, little is known aboutthe psychological consequences of moral injury in this population. Objective: The aim of this study is to explore theconcept of moral injury in refugees with PTSD by meansof a semi-structuredinterview and a self-report questionnaireon moral injury (the Moral Injury Appraisals Scale;Hoffmann, Liddell, Bryant, & Nickerson, 2018). Method:The interview consists of both open-ended questions andsubjective ratings and is broadly divided into four sections:morally injurious events, emotional reactions, cognitionsand behavioural responses. Participants are asked to describeone (or more) morally injurious event(s) and describe theiremotional reactions and most important cognitions duringand after the event. Results and Conclusion: In addition,specific behaviours and coping reactions (e.g. self-harm,social support) are discussed. The study design and preliminary results will be presented at the conference.