Moral Injury Australia, Brisbane, Queensland, Australia.
Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.
J Relig Health. 2023 Dec;62(6):3904-3925. doi: 10.1007/s10943-023-01885-6. Epub 2023 Aug 17.
The increasing number of suicides among military populations cannot be fully accounted for by conventional risk factors like Post-Traumatic Stress Disorder (PTSD). As a result, researchers and theorists propose that delving into the concept of Moral Injury could offer a more comprehensive understanding of the phenomenon of suicide. Moral Injury is not currently a recognized mental health disorder but can be associated with PTSD. Moral Injury is a multi-dimensional issue that profoundly affects emotional, psychological, behavioral, social, and spiritual well-being. The objective of this systematic review is to examine the association between Moral Injury and suicidal behavior (suicide ideation, plans and or suicide attempt) within military populations. The review will specifically concentrate on identifying and analyzing studies that have investigated the connection between these variables, with a specific focus on the context of military personnel both serving and former serving members. Of the 2214 articles identified as part of this review, 12 studies satisfied the research criteria with a total participant sample having an average age of 40.7 years. The male population accounted for 78.6% of the overall sample. Two studies were identified as high-quality, while the remaining ten were rated as moderate. The analysis of these twelve studies consistently affirms a connection between Moral Injury and suicidal behavior; most obviously, that exposure to morally injurious events substantially amplify the risk of suicide, with higher levels of potential exposure being linked to increased Moral Injury and heightened levels of suicidal behavior. Our review uncovered noteworthy findings regarding the association between Moral Injury and suicidal behavior, marking a pioneering effort in exploring this association and offering valuable insights into this emerging issue. Several limitations are noted regarding this review and recommendations are made concerning the need to prioritize, expand and employ longitudinal research designs that include non-military populations such as first responders (e.g., police, paramedics, firefighters) and medical, nursing, or allied health professionals-all disciplines known to be impacted by Moral Injury.
军人自杀人数的增加不能完全用创伤后应激障碍（PTSD）等传统风险因素来解释。因此，研究人员和理论家提出，深入研究道德伤害的概念可以更全面地理解自杀现象。道德伤害目前不是一种公认的心理健康障碍，但可能与 PTSD 有关。道德伤害是一个多维度的问题，它深刻地影响着情感、心理、行为、社会和精神健康。本系统综述的目的是研究军人中道德伤害与自杀行为（自杀意念、计划和/或自杀企图）之间的关系。本综述将特别关注确定和分析研究这些变量之间联系的研究，特别关注现役和退役军人的背景。在作为本综述一部分确定的 2214 篇文章中，有 12 项研究符合研究标准，总参与者的平均年龄为 40.7 岁。男性占总样本的 78.6%。有两项研究被认为是高质量的，其余 10 项研究被评为中等质量。对这 12 项研究的分析一致证实了道德伤害与自杀行为之间的联系；最明显的是，暴露于道德伤害事件会大大增加自杀风险，潜在暴露程度越高，与道德伤害和自杀行为水平的升高相关。我们的综述发现了道德伤害与自杀行为之间关联的一些值得注意的发现，这标志着探索这种关联的开创性努力，并为这一新兴问题提供了有价值的见解。本综述注意到一些局限性，并建议需要优先考虑、扩大和采用包括非军人人口（如急救人员，如警察、护理人员、消防员）和医学、护理或相关健康专业人员等非军事人群的纵向研究设计，所有这些学科都被认为受到道德伤害的影响。
