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Research shines spotlight on moral injury

"Every day our research expands understanding of military trauma"

The impact of moral injury on the wellbeing of UK military veterans

A new Combat Stress study* suggests veterans who experience ‘moral injury’ are more likely to experience serious mental health problems, like PTSD, depression and even suicidal thoughts.

The study, published earlier this year, surveyed 204 veterans who have served in the UK Armed Forces. Up until now, studies focused on US troops who are often younger, do longer tours and have different rules of engagement.

So, this study is helping us understand more about moral injury and the impact it can have on UK military veterans. And this, in turn, will help us develop better treatments for the veterans we help.

What is moral injury?

Moral injury is described as ‘intense psychological distress which results from actions, or lack of actions, which clash with an individual’s moral or ethical code’.

Or to put it more simply, something you did (or couldn’t do) that felt totally against your morals.

It can happen in the Armed Forces when someone is following orders or specific rules of engagement. For instance, someone might witness human suffering and not be able to stop it. They desperately want to act differently but can’t.

Moral injury is not new, but we have a lot to learn about its causes, symptoms and treatment.

Here Combat Stress veteran Davina describes how she felt traumatised by her inaction in Bosnia, when she couldn’t feed a starving child who had lost his family.

What’s the problem?

Although moral injury is not yet classified as a mental health condition, people can have profound feelings of guilt, anger, worthlessness and shame. This can make it hard for them to talk about their difficulties, which is a real barrier to recovery.

We now know it makes people more vulnerable to serious mental health issues like PTSD, depression and even suicidal thoughts. But we don’t yet know how best to treat it.

Moral injury is different from a fear-based injury like PTSD, where someone felt extreme fear during traumatic events.

With PTSD, treatment often involves reliving the trauma and the fear in a safe place while learning to process the memories properly. But with moral injury, people are traumatised by an event that’s violated their moral code. Traditional treatments often fail to help, and they can even make it worse.

How will this help veterans?

This study is boosting understanding of moral injury and the potential impact it can have on other mental health conditions.

It underscores the pressing need for a proper measure for moral injury. And, ultimately, it will help us work out the best ways of treating it.

The results of this research will translate into a new treatment, which we're piloting as part of the second phase of the study.

Research in COVID times

Moral injury is often linked to the military, but it can occur in all walks of life.

Right now, it’s affecting the NHS.

Numerous frontline staff are suffering moral injury during the pandemic, which could be brought on by the number of deaths, losing patients on their shift, or being deployed away from critical work.

Watch ‘Moral Injury: what is it all about?’

A report on the history of moral injury, based on research conducted by Combat Stress and KCMHR, King’s College London and published by Forces in Mind Trust (FiMT).

* The impact of moral injury on the wellbeing of UK military veterans, 2021. Victoria Williamson, Dominic Murphy, Sharon A. M. Stevelink, Shannon Allen, Edgar Jones and Neil Greenberg.