The Prevalence and Functional Impact of Moral Injury in Veterans

精神伤害(MI)是犯罪行为对心理、生物、精神、行为和社会造成的持久影响。 违反根深蒂固的正确信念的不能阻止的、见证的或作为行为的受害者的 而且是错的。人们对MI有广泛的接受和兴趣，但这已经超过了科学检查。 到目前为止，知识差距是：(1)对构成MI综合征的症状没有一致的定义； (2)没有作为结果的MI的金标准临床评估标准；(3)没有对功能的定义 损害临床显著的心肌梗死；(4)没有关于不同类型心肌梗死患病率的流行病学研究 潜在精神损害事件(PMIE)和心肌梗死；(5)没有足够的证据表明心肌梗死有增量临床 和解释的有效性；以及(6)缺乏关于风险和复原力以及临床护理需求的信息 患有心肌梗塞的退伍军人。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数 暴露于不同类型的PMIE的流行率。我们已经证明了不同类型的PMIE是 与一系列独特的问题相关联。我们假设基于非实施的PMIE(例如， 高风险的背叛)将是最普遍的；(2)产生最佳有效的阈值 精神损害结局量表(MIOS)上的严重程度评分，表明可能存在功能性损害的MI。 目前还没有一种方法可以被临床医生和研究人员用来确定临床上的 作为结果的心肌梗死的意义。这意味着无法区分道德挫折和道德挫折。 心梗是一种低基准率的临床问题，极大地影响功能和质量，这是一种常见的症状 生命，可能需要治疗。干酪性的门槛评分将有助于临床医生和研究人员 筛查和评估心肌梗死。我们将使用接收器操作特性分析，使用上四分位数分数 以生活质量和功能测量为标准；(3)(主要)确定心肌梗塞的患病率 并按PMIE类型探讨患病率(我们无法预测不同类型的PMIE PMIE将与更高或更低的病例流行率相关)。次要目标是确定 MIOS总分和分量表得分的标准化平均严重程度(和SD)，并按类型探讨这些变量 PMIE(或无PMIE背书)。我们假设，支持基于承诺的PMIE的退伍军人将 MIOS羞耻感得分高于那些支持非基于实施的PMIE的人，反之亦然； (4)检验MI相对于创伤后应激障碍和抑郁的递增效度 MIOS评分与生活质量和功能的一项指标之间的关系，相对于创伤后应激障碍和抑郁症。我们 预测心肌梗死症状将解释功能问题的独特差异；以及(5)进行定性 对随机选择的MI病例和支持暴露于PMIE但MI较低的退伍军人的采访 症状和功能影响，以探索PMIE和活动背景，以及个人、专业、 以及影响暴露于PMIE后结果的社会风险和保护因素。这个探索性的目标是 旨在生成有关心肌梗死的风险和复原力的假设，以及未解决的预防和 减轻退伍军人心肌梗死对功能影响的治疗。我们将通过开展一项 对从KnowledgePanel®(KP)招募的退伍军人进行的网络调查，KnowledgePanel®是一个由50,000多人组成的研究小组 由益普索维持的家庭。KP是代表美国民众的最大在线小组。 益普索目前在KP有约5,000名退伍军人，并一直在与退伍军人进行流行病学调查，以 20年了。益普索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断分析，以得出以美国退伍军人为基础的人口 对目标1暴露于不同类型的PMIE的估计，以及作为目标3的结果的心肌梗死患病率。 目标5需要对心肌梗塞病例和调查样本中的匹配对照进行定性访谈。 将对有关PMIE影响的数据进行编码，并提取修复MI的策略。

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.