Bravo Adrian J, Kelley Michelle L, Mason Richard, Ehlke Sarah, Vinci Christine, Redman Ret Lt Jason C
Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico.
Old Dominion University, Virginia Consortium Program in Clinical Psychology.
Traumatology (Tallahass Fla). 2020 Mar;26(1):52-60. doi: 10.1037/trm0000198. Epub 2019 May 16.
Moral injury is hypothesized to develop from witnessing or engaging in events that violate one's beliefs about themselves and has been shown to be associated with negative mental health symptoms. Although there has been an increase in research examining moral injury among military veterans, mechanisms that link moral injury to mental health outcomes are not well understood. The present study examined rumination subcomponents (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) as possible mediators of the associations between moral injury (both self-directed and other-directed symptoms) and negative mental health symptoms (i.e., depression, anxiety, suicidality, sleep disturbance, memory problems, and posttraumatic stress disorder symptoms). Participants were 189 combat wounded veterans (180 men; Mean age = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability ( = 176, 93.1%), with the average participant reporting a 90% total VA disability ranking, and most participants had received a purple heart ( = 163, 86.2%). Within our comprehensive mediation model, we found eight significant mediation effects with the most consistent mediator being problem-focused thoughts. Specifically, both self-directed and other- directed moral injury were associated with increased problem-focused thoughts, which in turn was associated with higher reported symptoms of depression, anxiety, and posttraumatic stress disorder. Taken together, rumination, and in particular, problem-focused thoughts, is relevant to understand the increased vulnerability of military veterans to exhibit poor mental health outcomes when experiencing moral injury.
道德伤害被假定为由目睹或参与违背个人自我认知的事件而引发，并且已被证明与负面心理健康症状相关。尽管对退伍军人道德伤害的研究有所增加，但将道德伤害与心理健康结果联系起来的机制仍未得到充分理解。本研究考察了沉思的子成分（以问题为中心的想法、反事实思维、重复想法和预期想法），将其作为道德伤害（自我导向和他人导向症状）与负面心理健康症状（即抑郁、焦虑、自杀倾向、睡眠障碍、记忆问题和创伤后应激障碍症状）之间关联的可能中介变量。参与者为189名受过战斗创伤的退伍军人（180名男性；平均年龄 = 43.14岁），他们经历过一次或多次部署（定义为90天或更长时间）。几乎所有参与者都报告有与服役相关的残疾（ = 176，93.1%），平均每位参与者报告的退伍军人事务部（VA）残疾评定总等级为90%，且大多数参与者都获得过紫心勋章（ = 163，86.2%）。在我们的综合中介模型中，我们发现了八种显著的中介效应，其中最一致的中介变量是以问题为中心的想法。具体而言，自我导向和他人导向的道德伤害都与以问题为中心的想法增加相关，而这又与更高的抑郁、焦虑和创伤后应激障碍症状报告相关。总之，沉思，尤其是以问题为中心的想法，对于理解退伍军人在经历道德伤害时出现不良心理健康结果的易感性增加具有重要意义。
