Mechanisms of Moral Injury Following Military Sexual Trauma and Combat in Post-9/11 U.S. War Veterans.
Mechanisms of Moral Injury Following Military Sexual Trauma and Combat in Post-9/11 U.S. War Veterans.
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DOI：
10.3389/fpsyt.2018.00520
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发表时间：
2018
影响因子：
4.7
通讯作者：
Meyer EC
中科院分区：
文献类型：
--
作者：
Frankfurt SB;DeBeer BB;Morissette SB;Kimbrel NA;La Bash H;Meyer EC
目的：道德伤害可能源于违反根深蒂固的规范的基于实施和背叛的行为；然而，研究人员和临床医生对道德伤害事件后道德伤害综合征的具体发展路径几乎没有指导。本研究的目的是考察在一个经常被引用的精神伤害模型中提出的与两种与军事有关的创伤[经历军事性创伤(MST)和战斗暴露]有关的直接和间接途径。方法：对西南某退伍军人医疗保健系统(N=310)的911事件后退伍军人样本进行二次分析，时间跨度为两个时间点。结构方程模型测试了从MST和战斗到创伤后应激障碍抑郁因素的直接和间接路径，这些路径通过背叛、犯罪、内疚和羞耻来实现。结果：背叛与创伤后应激障碍抑郁相关(β=0.10，p&t；0.0 1，95%CI=0.0 1−0.11)，作案行为与创伤后应激障碍抑郁相关(β=0.0 7，p&t；0.0 5，95%CI=0.0 2−0.14)。从战斗到羞耻到创伤后应激障碍抑郁的间接路径显著(β=0.16，p<；0.01，95%CI=0.07−0.28)，而通过内疚的路径不显著。通过实施或背叛而导致羞耻或内疚的具体间接途径并不重要。结论：背叛和实施与MST和战斗后的创伤后应激障碍抑郁有关。结果提示，在不同的军事创伤和精神伤害事件后，精神伤害的发展有多种途径。对精神伤害的概念和治疗的含义进行了讨论。
Objective: Moral injury may result from perpetration-based and betrayal-based acts that violate deeply held norms; however, researchers and clinicians have little guidance about the moral injury syndrome's specific developmental pathways following morally injurious events. The present study's objective was to examine the direct and indirect pathways proposed in a frequently cited model of moral injury in relation to two types of military-related traumas [experiencing military sexual trauma (MST) and combat exposure]. Methods: Secondary analyses were conducted within a sample of post-9/11 veterans at a Southwestern Veterans Health Care System (N = 310) across two time-points. Structural equation modeling tested the direct and indirect pathways from MST and combat to a PTSD-depression factor via betrayal, perpetration, guilt, and shame. Results: Betrayal accounted for the association between MST and PTSD-depression (β = 0.10, p < 0.01, 95% CI = 0.01 − 0.11) and perpetration accounted for the association between combat and PTSD-depression (β = 0.07, p < 0.05, 95% CI = 0.02 − 0.14). The indirect path from combat to shame to PTSD-depression was significant (β = 0.16, p < 0.01, 95% CI = 0.07 − 0.28) but the path through guilt was not. The specific indirect paths through perpetration or betrayal to shame or guilt were non-significant. Conclusions: Betrayal and perpetration are associated with PTSD-depression following MST and combat. Results suggest multiple pathways of moral injury development following different military traumas and morally injurious events. Implications for moral injury conceptualization and treatment are discussed.
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DOI：
10.1080/10705519909540118
发表时间：
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影响因子：
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作者：
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