Psychology Department, University of South Alabama, Mobile, AL, USA.
Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA.
Clin Psychol Psychother. 2018 May;25(3):474-488. doi: 10.1002/cpp.2170. Epub 2017 Dec 28.
There is consensus that military personnel can encounter a far more diverse set of challenges than researchers and clinicians have historically appreciated. Moral injury (MI) represents an emerging construct to capture behavioural, social, and spiritual suffering that may transcend and overlap with mental health diagnoses (e.g., post-traumatic stress disorder and major depressive disorder). The Expressions of Moral Injury Scale-Military Version (EMIS-M) was developed to provide a reliable and valid means for assessing the warning signs of a MI in military populations. Drawing on independent samples of veterans who had served in a war-zone environment, factor analytic results revealed 2 distinct factors related to MI expressions directed at both self (9 items) and others (8 items). These subscales generated excellent internal consistency and temporal stability over a 6-month period. When compared to measures of post-traumatic stress disorder, major depressive disorder, and other theoretically relevant constructs (e.g., forgiveness, social support, moral emotions, and combat exposure), EMIS-M scores demonstrated strong convergent, divergent, and incremental validity. In addition, although structural equation modelling findings supported a possible general MI factor in Study 2, the patterns of associations for self- and other-directed expressions yielded evidence for differential validity with varying forms of forgiveness and combat exposure. As such, the EMIS-M provides a face valid, psychometrically validated tool for assessing expressions of apparent MI subtypes in research and clinical settings. Looking ahead, the EMIS-M will hopefully advance the scientific understanding of MI while supporting innovation for clinicians to tailor evidence-based treatments and/or develop novel approaches for addressing MI in their work.
人们普遍认为，军人所面临的挑战远比研究人员和临床医生以往所认识到的更加多样化。道德伤害（MI）是一个新兴的概念，用于捕捉可能超越并与心理健康诊断（例如创伤后应激障碍和重度抑郁症）重叠的行为、社会和精神痛苦。《军人道德伤害表达量表-军事版》（EMIS-M）的开发旨在为评估军人中 MI 的预警信号提供一种可靠和有效的方法。基于曾在战区环境中服役的退伍军人的独立样本，因素分析结果显示，有 2 个与 MI 表达相关的独特因素，分别指向自己（9 个项目）和他人（8 个项目）。这两个分量表在 6 个月的时间内表现出了极好的内部一致性和时间稳定性。与创伤后应激障碍、重度抑郁症和其他理论相关的构念（例如，宽恕、社会支持、道德情感和战斗暴露）相比，EMIS-M 得分表现出了很强的聚合、发散和增量有效性。此外，尽管结构方程模型的研究结果在研究 2 中支持了一种可能的一般 MI 因素，但自我和他人导向表达的关联模式为不同形式的宽恕和战斗暴露提供了具有差异有效性的证据。因此，EMIS-M 为在研究和临床环境中评估明显的 MI 亚型的表达提供了一种有效的、心理测量学验证的工具。展望未来，EMIS-M 将有望增进对 MI 的科学理解，同时支持临床医生创新，以针对 MI 采用基于证据的治疗方法和/或开发新的方法。
