Koenig Harold G, Ames Donna, Youssef Nagy A, Oliver John P, Volk Fred, Teng Ellen J, Haynes Kerry, Erickson Zachary D, Arnold Irina, O'Garo Keisha, Pearce Michelle
Departments of Medicine and Psychiatry, Duke University Medical Center, 201 Trent Drive, Durham, NC.
Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Mil Med. 2018 Nov 1;183(11-12):e659-e665. doi: 10.1093/milmed/usy017.
To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD.
A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two. In the first half (n = 214), exploratory factor analysis identified the highest loading item on each of the 10 MISS scales (guilt, shame, moral concerns, loss of meaning, difficulty forgiving, loss of trust, self-condemnation, religious struggle, and loss of religious faith) to form the 10-item MISS-M-SF; confirmatory factor analysis was then performed to replicate results in the second half of the sample (n = 213). Internal reliability, test-retest reliability, and convergent, discriminant, and concurrent validity were examined in the overall sample. The study was approved by the institutional review boards and the Research & Development (R&D) Committees at Veterans Administration medical centers in Durham, Los Angeles, Augusta, Houston, and San Antonio, and the Liberty University and Duke University Medical Center institutional review boards.
The 10-item MISS-M-SF had a median of 50 and a range of 12-91 (possible range 10-100). Over 70% scored a 9 or 10 (highest possible) on at least one item. Cronbach's alpha was 0.73 (95% CI 0.69-0.76), and test-retest reliability was 0.87 (95% CI 0.79-0.92). Convergent validity with the 45-item MISS-M was r = 0.92. Discriminant validity was demonstrated by relatively weak correlations with social, religious, and physical health constructs (r = 0.21-0.35), and concurrent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms (r = 0.54-0.58).
The MISS-M-SF is a reliable and valid measure of MI symptoms that can be used to screen for MI and monitor response to treatment in veterans and active duty military with PTSD.
开发一个45项多维道德伤害症状量表-军事版（MISS-M）的简短形式（SF），用于筛查退伍军人和现役军人创伤后应激障碍（PTSD）中的道德伤害并监测治疗反应。
从佐治亚州奥古斯塔、加利福尼亚州洛杉矶、北卡罗来纳州达勒姆、得克萨斯州休斯顿和得克萨斯州圣安东尼奥的退伍军人事务医疗中心，以及弗吉尼亚州林奇堡的自由大学招募了总共427名有PTSD症状的退伍军人和现役军人。样本被随机分成两组。在第一组（n = 214）中，探索性因素分析确定了10个MISS量表（内疚、羞耻、道德关注、意义丧失、难以宽恕、信任丧失、自我谴责、宗教挣扎和宗教信仰丧失）中每个量表上负荷最高的项目，以形成10项MISS-M-SF；然后进行验证性因素分析，以在样本的后半部分（n = 213）中复制结果。在整个样本中检查了内部信度、重测信度以及聚合效度、区分效度和同时效度。该研究得到了达勒姆、洛杉矶、奥古斯塔、休斯顿和圣安东尼奥退伍军人事务医疗中心的机构审查委员会以及研究与发展（R&D）委员会，以及自由大学和杜克大学医学中心机构审查委员会的批准。
10项MISS-M-SF的中位数为50，范围为12 - 91（可能范围10 - 100）。超过70%的人在至少一个项目上得分为9或10（最高分）。克朗巴哈系数为0.73（95%置信区间0.69 - 0.76），重测信度为0.87（95%置信区间0.79 - 0.92）。与45项MISS-M的聚合效度为r = 0.92。与社会、宗教和身体健康结构的相关性相对较弱（r = 0.21 - 0.35），证明了区分效度，与PTSD、抑郁和焦虑症状的强相关性（r = 0.54 - 0.58）表明了同时效度。
MISS-M-SF是一种可靠且有效的道德伤害症状测量工具，可用于筛查退伍军人和现役军人创伤后应激障碍中的道德伤害并监测治疗反应。
