Measuring and Characterizing Moral Injury in Vulnerable Populations

Abstract

Moral injury is a relatively new psychological syndrome characterized by profound emotional, cognitive, and social pain following perceived moral violations. Though often overlapping, moral violations can involve either the perpetration of a moral transgression (via action or inaction) or the experience of a moral betrayal by a trusted other. In each case, symptoms of moral injury may include guilt, shame, anger, loss of trust and meaning, and social withdrawal. To date, the study of moral injury has remained nearly exclusive to the military arena. In turn, the aim of this thesis is to highlight the relevance of moral injury to other populations vulnerable to its effects. These include: 1) justice-involved individuals found Not Criminally Responsible on Account of Mental Disorder who may experience moral injury after regaining insight into their offending behaviour; and 2) Public Safety Personnel who are often exposed to morally ambiguous situations while under high levels of social responsibility. To appreciate the impact of moral injury for these populations, adequate tools must first be developed to measure and assess it. The three studies included in this dissertation outline the key steps to instrument development using a mixed-method approach: first, a qualitative investigation with justice-involved individuals explores the unique emotional consequences following a criminal offence that will inform subsequent phases of instrument development; second, quantitative inquiries are taken to construct, evaluate, and employ a new moral injury assessment for Public Safety Personnel to uncover important causes and consequences of moral injury in this group. This dissertation serves as a strong indicator that moral injury is a unique and costly health outcome relevant across societal groups.