Evaluating Moral Injury in Combat-Deployed and Non-Combat Military Personnel

Abstract

The factorial structure, measurement invariance, and relevance to posttraumatic stress of the Moral Injury Event Scale (MIES) was evaluated in military personnel as a function of combat role. A total of 245 combat-deployed and 140 non-combat military personnel 19 to 83 years of age (M = 43.97, SD= 12.08) answered questions about their service role(s), deployment history, and military-related PTSD diagnosis history. They also completed the PTSD Checklist-Military Version 5, the Exposure to Danger and Combat scale, the Witnessing Consequences of War scale, and the MIES. Confirmatory factor analysis supported a three-factor model of the MIES consisting of transgressions-self, transgressions-others, and betrayal. This structure demonstrated configural but not metric or scalar invariance between combat and non-combat personnel. Clinical relevance of the measure was supported by regressions showing that the MIES subscales were associated with PTSD symptomatology and PTSD diagnosis independently of measures of combat-related physical dangers or witnessing the consequences of war. We conclude that the MIES can be used to measure three components of moral injury that are relevant to mental health outcomes in military personnel. However, failure of measurement invariance cautions against comparing MIES subscale scores between combat and non-combat personnel.