A scoping review of moral injury in refugees.

We review the empirical evidence about how moral injury, the experience of a transgression of one's moral framework, can be understood in refugee and asylum seekers. Systematic search identified 12 studies that utilised a range of methodologies (8 quantitative, one qualitative, one mixed methods, and one case study). Study quality was assessed using critical appraisal tools: studies varied in quality from moderate to high (75-100%) with some having methodological issues or a risk of bias. Moral injury is suggested to play a major role in psychological distress and mental health outcomes in these populations: refugees are exposed to a wide range of potentially morally injurious events (PMIEs) and suggest that it is the cognitive appraisal of the event that leads to negative psychological outcomes. Specifically, two distinct subtypes of moral injury appraisals appear pertinent to refugees: the appraisal of one's own actions as violating moral beliefs (MI-self) and the appraisal of others' actions as violating moral beliefs (MI-other). Moral injury may play a key role in understanding the psychological impact of traumatic events and stressful experiences that violate an individual's moral beliefs. Consequently, there is potential benefit in targeting moral injury appraisals in therapeutic interventions for refugee populations.