Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Psychol Med. 2023 Aug;53(11):5136-5145. doi: 10.1017/S003329172200215X. Epub 2022 Aug 1.
Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2).
Participants recruited from a public hospital and/or community advertisements (Study 1, = 72, 87.5% Black, 83.3% women; Study 2, = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome.
Childhood sexual abuse emerged as the only significant predictor of MIE, = 0.38, < 0.001; childhood sexual abuse, = 0.26, < 0.05, and adulthood sexual assault, = 0.23, < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, = -0.10, s.e. = 0.06, 95%CI (-0.232 to -0.005).
Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.
道德伤害暴露（MIE）和痛苦（MID）可能会间接地影响创伤暴露与平民自主调节变化之间的关系[通过高频心率变异性（hfHRV）评估]，但这在以前的研究中尚未得到检验。我们进行了两项探索性研究，以检查平民医疗患者中的创伤类型与 MIE 和 MID 的关联（研究 1），并探讨这些方面如何可能间接地影响寻求心理健康服务的平民中的创伤类型与 hfHRV 之间的关系（研究 2）。
从一家公立医院和/或社区广告中招募参与者（研究 1，n=72，87.5%为黑人，83.3%为女性；研究 2，n=46，71.7%为黑人，97.8%为女性），完成评估创伤类型、MIE 和 MID 的措施。在研究 1 中，将作为 MIE 和 MID 显著相关因素的创伤类型分别纳入线性回归分析。将确定的创伤类型作为自变量纳入间接效应模型，以 MIE 或 MID 为中介，静息 hfHRV（通过心电图测量）为结果。
童年性虐待是 MIE 的唯一显著预测因子，β=0.38，<0.001；童年性虐待，β=0.26，<0.05，和成年期性侵犯，β=0.23，<0.05，是 MID 的显著预测因子。MIE 和 MID 较大的参与者表现出较低的 hfHRV。成年期性侵犯通过 MID 对 hfHRV 产生间接影响，β=-0.10，s.e.=0.06，95%CI（-0.232 至-0.005）。
道德伤害与平民中的性暴力和较低的 hfHRV 独特相关。数据突出了道德伤害作为自主神经功能障碍出现的途径及其在创伤治疗选择中的重要性。
