Moral injury in UK armed forces veterans: a qualitative study. Issue 1 (31st December 2019)

• Record Type: Journal Article
• Authors: Williamson, Victoria; Greenberg, Neil; Murphy, Dominic
• Is Part Of: European journal of psychotraumatology. Volume 10:Issue 1(2019)
• Publication Date: 2019-12-31
• Subjects: Moral injury -- veteran -- military -- mental health treatment -- clinician; daño moral -- veterano -- militar -- tratamiento de salud mental -- clínico; 道德创伤 -- 退伍老兵 -- 军队 -- 心理健康治疗 -- 临床医; Post-traumatic stress disorder -- Periodicals; Stress Disorders, Post-Traumatic; Post-traumatic stress disorder; Electronic journals; Periodicals; Periodicals; Fulltext; Internet Resources; Periodicals; 616.8521
• DOI: 10.1080/20008198.2018.1562842
• Languages: English
• ISSNs: 2000-8198

Abstract

ABSTRACT: Background : Moral injury has been found to adversely affect US veteran mental health, and the mental health difficulties resulting from moral injury can be particularly challenging to treat. Yet little is known about the impact of moral injury on the well-being of UK armed forces (AF) veterans and how moral injury is currently addressed in treatment. Objective : The aim of this study was to examine UK AF veterans' experiences of moral injury, and the perceptions and challenges faced by clinicians in treating moral injury-related mental health difficulties. Method : Six veterans who reported moral injury exposure and four clinicians who had treated veterans with moral injury were recruited from Combat Stress. Semi-structured qualitative interviews were conducted and data were analysed using thematic analysis. Results : Moral injury was perceived by clinicians to be common in UK AF veterans and, where present, had a considerable negative impact on mental health. Clinicians reported a lack of a manualized approach for treating cases of moral injury and, instead, used a combination of several non-post-traumatic stress disorder (PTSD)-specific therapies. Providing treatment for morally injured veterans could be challenging given the limited number of sessions that clinicians were able to provide. Moreover, moral injury was thought to be poorly understood among UK AF veteran clinical care teams. Conclusion : This study provides some of the first insight into the impact of moral injury on UK AF veteran well-being as well as clinician views of delivering psychological care following moral injury. These findings highlight that moral injury is experienced by UK AF veterans, and further examination of the prevalence of moral injury and whether current treatment approaches are appropriate and efficacious is needed. HIGHLIGHTS: Moral injury was perceived by clinicians to be common in UK veterans and exposure could detrimentally impact veteran mental health. Psychological treatment for moral injury included an amalgamation of several non-PTSD specific approaches, including responsibility pie charts and compassion-focused therapy. Treating moral injury was challenging for clinicians because limited number of treatment sessions they could offer, the lack of a manualized approach for treatment, and a perception that moral inujury was poorly understood by veteran clinical care teams.