Measuring Moral Injury: Further Validation of the MIES-C and EMIS-C in a Civilian Population

Abstract

Moral injury among civilians has garnered increased recognition in recent years. However, most moral injury measures have focused on military experiences, with language being military specific. This study aimed to further validate two self-report measures of civilian moral injury, the Moral Injury Events Scale - Civilian (MIES-C) and Expressions of Moral Injury Scale - Civilian (EMIS-C). Participants were 312 adults (99 males, 212 females, Mage = 37.24) who completed the MIES-C, EMIS-C, and a battery of associated measures on two occasions. For the MIES-C, four Confirmatory Factor Analysis (CFA) models were examined. A three-factor model, with covaried items, provided the best fit to the data. For the EMIS-C, three CFAs were examined. A two-factor model, with covaried items, and the bi-factor model provided the best fit to the data, with the two-factor model being preferred for reasons of parsimony and its absence of weak and negative item loadings. Both measures demonstrated acceptable test-retest reliability and convergent validity with associated measures of psychological distress. This study provides psychometrically sound tools for clinicians and researchers of civilian moral injury.