The Prevalence and Functional Impact of Moral Injury in Veterans

退伍军人道德伤害的患病率和功能影响

• 批准号: 10633476
• 负责人: BRETT T LITZ
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10633476
• 关键词: Affect; Behavioral; Belief; Biological; Clinical; Clinical Research; Clinical assessments; Code; Communities; Consensus; Data; Dimensions; Distress; Epidemiology; Event; Exposure to; Frustration; Household; Human; Impairment; Internet; Interview; Knowledge; Measurement; Measures; Mental Depression; Mental Health; Methods; Military Personnel; Modernization; Moral injury; Morals; Outcome; Population; Post-Traumatic Stress Disorders; Prevalence; Prevalence Study; Prevention; Probability; Psychometrics; Quality of life; Questionnaires; ROC Curve; Random Allocation; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Severities; Shame; Social Impacts; Spirituality; Surveys; Symptoms; Syndrome; Testing; Time; Trust; Vacuum; Veterans; Weight; Work; base; behavioral health; clinical care; clinically significant; design; epidemiology study; expectation; experience; functional disability; interest; military veteran; population based; prevent; protective factors; psychologic; recruit; repaired; resilience; response; service member; social; sound; standard measure; stem; stressor

Moral Injury (MI) is the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, bearing witness to, or being the victim of acts that transgress deeply held beliefs about right and wrong. There is widespread acceptance of and interest in MI, but this has outpaced scientific examination. To date, the knowledge gaps are: (1) no consensus definition of the symptoms that comprise the MI syndrome; (2) no gold standard clinical assessment measure of MI as an outcome; (3) no definition of functionally impairing clinically significant MI; (4) no epidemiological studies of the prevalence of different types of potentially morally injurious events (PMIEs) and MI; (5) insufficient evidence that MI has incremental clinical and explanatory validity; and (6) a lack of information about risk and resilience and the clinical care needs of Veterans with MI. In this project, we have the following five aims: (1) to determine the US Veteran population prevalence of exposure to different types of PMIEs. We have shown that different types of PMIEs are associated with a unique constellation of problems. We hypothesize that non-perpetration based PMIEs (e.g., high stakes betrayal by trusted others) will be most prevalent; (2) to generate an optimally efficient threshold severity score on the Moral Injury Outcome Scale (MIOS) that suggests probable functionally impairing MI. Currently, there is no method that can be used by clinicians and researchers to determine the clinical significance of MI as an outcome. This means that there is no way to distinguish moral frustration and moral distress, which are common, from MI, a low base-rate clinical problem greatly affecting functioning, quality of life, and potentially requiring treatment. A threshold score for caseness will help clinicians and researchers screen and assess MI. We will use Receiver Operating Characteristic analyses, using upper quartile scores on a quality of life and functioning measure as the criterion; (3) (primary) is to determine the prevalence of MI cases and to explore prevalence by type of PMIE (we have no predictions about whether different types of PMIEs will be associated with greater or lesser case prevalence). A secondary aim is to determine the normative mean severity (and SD) of MIOS total and subscale scores and to explore these variables by type of PMIEs (or no PMIE endorsement). We hypothesize that Veterans who endorse perpetration-based PMIEs will have higher MIOS shame scores relative to those that endorse non-perpetration-based PMIEs, and vice versa; (4) to examine the incremental validity of MI relative to PTSD and Depression, by testing the association between MIOS scores and a measure of quality of life and functioning, relative to PTSD and depression. We predict that MI symptoms will account for unique variance in functional problems; and (5) to conduct qualitative interviews of randomly selected MI cases and matched Veterans who endorse exposure to PMIEs but low MI symptoms and functional impact, to explore the PMIE and event context, as well as personal, professional, and social risk and protective factors affecting outcomes after exposure to PMIEs. This exploratory aim is designed to generate hypotheses about risk and resilience for MI and unaddressed targets for prevention and treatment to mitigate the functional impact of MI in Veterans. We will accomplish these aims by conducting a web survey of Veterans recruited from KnowledgePanel® (KP), a research panel of more than 50,000 households maintained by Ipsos. KP is the largest online panel that is representative of the US population. Ipsos currently has ~5,000 Veterans in KP and has been conducting epidemiological surveys with Veterans for 20 years. Ipsos uses random probabilistic sampling methods, which means that results will be representative of US Veterans. Sampling weights will be applied to inferential analyses to yield US Veteran population-based estimates of exposure to different types of PMIEs for Aim 1 and the prevalence of MI as an outcome for Aim 3. Aim 5 entails conducting qualitative interviews with MI cases and matched controls from the survey sample. Data will be coded themes about the impact of PMIEs and strategies to repair MI will be extracted.

道德伤害 (MI) 是指以下行为造成的持久的心理、生物、精神、行为和社会影响： 未能预防、见证或成为违反根深蒂固的权利信念的行为的受害者 和错误的。人们对 MI 有着广泛的接受和兴趣，但这已经超过了科学检验的速度。 迄今为止，知识差距是：（1）对心肌梗死综合征的症状没有达成共识的定义； (2) 没有 MI 作为结果的金标准临床评估措施； (3) 没有函数定义 损害有临床意义的心梗； (4) 没有对不同类型的患病情况进行流行病学研究 潜在道德损害事件 (PMIE) 和 MI； (5) 没有足够的证据表明 MI 具有增量临床作用 和解释的有效性； (6) 缺乏有关风险和复原力以及临床护理需求的信息 患有心肌梗死的退伍军人。在这个项目中，我们有以下五个目标：（1）确定美国退伍军人人口 接触不同类型 PMIE 的普遍程度。我们已经证明不同类型的 PMIE 与一系列独特的问题相关。我们假设基于非行为的 PMIE（例如， 被信任的人的高风险背叛）将是最普遍的； (2) 生成最优有效阈值 道德伤害结果量表 (MIOS) 的严重程度评分表明可能存在功能性 MI 损害。 目前，尚无可供临床医生和研究人员使用的方法来确定临床 MI 作为结果的重要性。这意味着没有办法区分道德挫败和道德挫败。 心梗是一种常见的困扰，这是一种低基础率的临床问题，极大地影响功能和质量 生命，并可能需要治疗。案例阈值分数将帮助临床医生和研究人员 筛查和评估 MI。我们将使用接收者操作特征分析，使用上四分位分数 以生活质量和功能测量为标准； (3)（主要）是确定MI的患病率 病例并探讨按 PMIE 类型划分的患病率（我们无法预测不同类型的 PMIE 将与或多或少的病例患病率相关）。第二个目标是确定 MIOS 总分和子量表分数的规范平均严重性（和 SD），并按类型探索这些变量 PMIE（或无 PMIE 认可）。我们假设支持基于犯罪的 PMIE 的退伍军人会 相对于那些支持基于非犯罪的 PMIE 的人，MIOS 羞耻分数更高，反之亦然； (4) 通过检验关联性来检验 MI 相对于 PTSD 和抑郁症的增量有效性 MIOS 分数与相对于 PTSD 和抑郁症的生活质量和功能衡量标准之间的关系。我们 预测 MI 症状将解释功能问题的独特差异； (5) 进行定性 对随机选择的 MI 病例和认可接触 PMIE 但 MI 较低的匹配退伍军人进行访谈 症状和功能影响，探索 PMIE 和事件背景，以及个人、专业、 以及影响接触 PMIE 后结果的社会风险和保护因素。本次探索的目的是 旨在生成有关 MI 风险和复原力的假设以及未解决的预防和预防目标 减轻心肌梗死对退伍军人功能影响的治疗。我们将通过开展 对从 KnowledgePanel® (KP)（一个由超过 50,000 人组成的研究小组）招募的退伍军人进行的网络调查 由益普索 (Ipsos) 维护的家庭。 KP 是代表美国人口的最大在线小组。 益普索 (Ipsos) 目前在 KP 拥有约 5,000 名退伍军人，并一直在对退伍军人进行流行病学调查 20年。益普索 (Ipsos) 使用随机概率抽样方法，这意味着结果将具有代表性 美国退伍军人。抽样权重将应用于推理分析，以得出基于美国退伍军人群体的数据 目标 1 中不同类型 PMIE 暴露的估计值以及目标 3 中 MI 患病率的估计值。 目标 5 需要对 MI 案例进行定性访谈并与调查样本中的匹配对照进行比较。 数据将被编码为有关 PMIE 影响的主题，并提取修复 MI 的策略。