Williamson Victoria, Greenberg Neil, Murphy Dominic
King's Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
Research Department, Combat Stress, Leatherhead, UK.
Eur J Psychotraumatol. 2019 Jan 14;10(1):1562842. doi: 10.1080/20008198.2018.1562842. eCollection 2019.
: Moral injury has been found to adversely affect US veteran mental health, and the mental health difficulties resulting from moral injury can be particularly challenging to treat. Yet little is known about the impact of moral injury on the well-being of UK armed forces (AF) veterans and how moral injury is currently addressed in treatment. : The aim of this study was to examine UK AF veterans' experiences of moral injury, and the perceptions and challenges faced by clinicians in treating moral injury-related mental health difficulties. : Six veterans who reported moral injury exposure and four clinicians who had treated veterans with moral injury were recruited from Combat Stress. Semi-structured qualitative interviews were conducted and data were analysed using thematic analysis. : Moral injury was perceived by clinicians to be common in UK AF veterans and, where present, had a considerable negative impact on mental health. Clinicians reported a lack of a manualized approach for treating cases of moral injury and, instead, used a combination of several non-post-traumatic stress disorder (PTSD)-specific therapies. Providing treatment for morally injured veterans could be challenging given the limited number of sessions that clinicians were able to provide. Moreover, moral injury was thought to be poorly understood among UK AF veteran clinical care teams. : This study provides some of the first insight into the impact of moral injury on UK AF veteran well-being as well as clinician views of delivering psychological care following moral injury. These findings highlight that moral injury is experienced by UK AF veterans, and further examination of the prevalence of moral injury and whether current treatment approaches are appropriate and efficacious is needed.
道德伤害已被发现对美国退伍军人的心理健康产生不利影响，且道德伤害所导致的心理健康问题在治疗上可能极具挑战性。然而，对于道德伤害对英国武装部队（AF）退伍军人福祉的影响以及目前在治疗中如何应对道德伤害，人们知之甚少。
本研究的目的是调查英国AF退伍军人的道德伤害经历，以及临床医生在治疗与道德伤害相关的心理健康问题时所面临的认知和挑战。
从战斗压力组织招募了六名报告有道德伤害经历的退伍军人和四名治疗过有道德伤害退伍军人的临床医生。进行了半结构化定性访谈，并使用主题分析法对数据进行了分析。
临床医生认为道德伤害在英国AF退伍军人中很常见，一旦出现，会对心理健康产生相当大的负面影响。临床医生报告称，缺乏针对道德伤害病例的手册化治疗方法，而是采用了几种非创伤后应激障碍（PTSD）特定疗法的组合。鉴于临床医生能够提供的治疗疗程有限，为有道德伤害的退伍军人提供治疗可能具有挑战性。此外，英国AF退伍军人临床护理团队对道德伤害的理解普遍不足。
本研究首次提供了一些关于道德伤害对英国AF退伍军人福祉的影响以及临床医生对道德伤害后提供心理护理的看法的见解。这些发现凸显了英国AF退伍军人经历了道德伤害，需要进一步研究道德伤害的患病率以及当前的治疗方法是否合适和有效。
