Gender differences in prevalence and outcomes of exposure to potentially morally injurious events among post-9/11 veterans.

Our goal was to identify gender differences in the prevalence and outcomes of exposure to potentially morally injurious events (PMIEs) in a sample of U.S. military veterans. In a national sample of post-9/11 veterans (n = 7200) weighted to reflect the larger population of newly separated U.S. veterans, we conducted gender-stratified analyses of the prevalence of exposure to PMIEs and their associations with psychological and functional problems. Veterans reported exposures stemming from witnessing (27.9%), perpetrating (18.8%), and being betrayed (41.1%). Women more frequently reported witnessing- and betrayal-based PMIEs, but no gender differences were observed for perpetration-based PMIEs. Psychological distress was associated with witnessing and betrayal among women and with witnessing, betrayal, and perpetration among men. Whereas betrayal was most consistently associated with functional impairment across domains for women, perpetration was most consistently associated with functional impairment for men. Moral injury contributes to psychological and functional problems among a significant minority of military veterans, although effects vary based on PMIE type and gender. Implications for veterans and other populations who experience moral injury are discussed.