Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.
Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA.
J Trauma Stress. 2019 Jun;32(3):350-362. doi: 10.1002/jts.22362. Epub 2019 Jan 28.
Individuals who are exposed to traumatic events that violate their moral values may experience severe distress and functional impairments known as "moral injuries." Over the last decade, moral injury has captured the attention of mental health care providers, spiritual and faith communities, media outlets, and the general public. Research about moral injury, especially among military personnel and veterans, has also proliferated. For this article, we reviewed scientific research about moral injury. We identified 116 relevant epidemiological and clinical studies. Epidemiological studies described a wide range of biological, psychological/behavioral, social, and religious/spiritual sequelae associated with exposure to potentially morally injurious events. Although a dearth of empirical clinical literature exists, some authors debated how moral injury might and might not respond to evidence-based treatments for posttraumatic stress disorder (PTSD) whereas others identified new treatment models to directly address moral repair. Limitations of the literature included variable definitions of potentially morally injurious events, the absence of a consensus definition and gold-standard measure of moral injury as an outcome, scant study of moral injury outside of military-related contexts, and clinical investigations limited by small sample sizes and unclear mechanisms of therapeutic effect. We conclude our review by summarizing lessons from the literature and offering recommendations for future research.
个体可能会经历暴露于违背其道德价值观的创伤性事件，导致严重的痛苦和功能障碍，这被称为“道德伤害”。在过去的十年中，道德伤害引起了心理健康护理提供者、精神和信仰社区、媒体和公众的关注。关于道德伤害的研究，尤其是在军人和退伍军人中的研究也大量涌现。在这篇文章中，我们回顾了关于道德伤害的科学研究。我们确定了 116 项相关的流行病学和临床研究。流行病学研究描述了与接触潜在道德伤害事件相关的广泛的生物、心理/行为、社会和宗教/精神后果。尽管实证临床文献稀缺，但一些作者讨论了道德伤害可能以及可能不会对创伤后应激障碍（PTSD）的基于证据的治疗方法产生反应，而另一些作者则确定了新的治疗模式来直接解决道德修复问题。文献的局限性包括潜在道德伤害事件的定义变量、缺乏道德伤害的共识定义和黄金标准衡量标准作为结果、在军事相关背景之外对道德伤害的研究甚少，以及临床研究受到样本量小和治疗效果机制不明确的限制。我们通过总结文献中的经验教训并为未来的研究提供建议来结束我们的综述。
