Self-awareness of mental states, self-integration of personal schemas, perceived social support, posttraumatic and depression levels, and moral injury: A mixed-method study among Portuguese war veterans.

Abstract

This study analyzed the role of moral injury, self-awareness of mental states, self-integration of moral injury in personal schemas, and perceived social on the severity of Posttraumatic Stress Disorder (PTSD) and depression symptoms. The sample was composed of Portuguese war veterans (n 60) divided into 2 groups: 30 experienced chronic PTSD (nonrecovered) and 30 had remission from PTSD (recovered). A cross-sectional study was conducted using both qualitative and quantitative methods. Qualitative data were obtained through 2 interviews per participant, and the quantitative data were collected using the Impact of Event Scale–Revised and Brief Symptom Inventory. Content analysis was performed to analyze qualitative data. Multiple linear regression analyses were conducted predicting both PTSD and depression symptoms. Recovered participants showed higher frequencies on moral injury, high selfawareness of mental states, high self-integration of moral injury in personal schemas, and high perceived social support. Differences in moral injury (yes vs. no) showed no differences in both PTSD and depression symptoms. Participants who reported low self-awareness of mental states and self-integration of moral injury in personal schemas showed higher mean value for both PTSD and depression symptoms. Participants who reported low perceived social support showed higher mean value on depression symptoms. Self-integration of moral injury in personal schemas and self-awareness of mental states were predictors of both PTSD and depression symptoms. Combat exposure was a predictor of PTSD symptoms. The authors discuss the role of reconciliation of morally incongruent experiences in personal schemas and the ability to perceive and understand psychological states as key achievements in recovery from PTSD and depression symptoms among veterans.