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）是犯罪行为造成的持久的心理、生物、精神、行为和社会影响， 未能防止、见证或成为违反根深蒂固的权利信念的行为的受害者 也是错的人们对MI有着广泛的接受和兴趣，但这已经超过了科学检查。 迄今为止，知识的差距是：（1）没有共识的定义，包括MI综合征的症状; (2)无MI作为结局的金标准临床评估指标;（3）无功能性 损害有临床意义的心肌梗死;（4）没有对不同类型的心肌梗死的患病率进行流行病学研究， 潜在道德损害事件（PMIE）和MI;（5）没有足够的证据表明MI具有增加的临床 和解释有效性;（6）缺乏有关风险和弹性以及临床护理需求的信息， 患有心肌梗塞的退伍军人。在本项目中，我们有以下五个目标：（1）确定美国退伍军人人口 暴露于不同类型PMIE的流行率。我们已经表明，不同类型的PMIE是 与一系列独特的问题有关。我们假设，非犯罪为基础的PMIE（例如， 高风险的背叛信任他人）将是最普遍的;（2）产生一个最佳效率的阈值 精神损伤结局量表（米奥斯）的严重程度评分，提示可能存在功能损害MI。 目前，临床医生和研究人员还没有一种方法可以用来确定临床 MI作为结局的重要性。这意味着没有办法区分道德挫折和道德 MI是一种低基础率的临床问题，极大地影响了功能、 生命，并可能需要治疗。病例的阈值评分将有助于临床医生和研究人员 筛选和评估MI。我们将使用受试者操作特征分析，使用上四分位数评分， 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，并探索PMIE类型的患病率（我们无法预测不同类型的PMIE是否 PMIE将与更高或更低的病例患病率相关）。第二个目的是确定 米奥斯总评分和子量表评分的标准平均严重程度（和SD），并按 PMIE（或无PMIE认可）。我们假设，支持基于犯罪的PMIE的退伍军人将 相对于那些支持非基于犯罪的PMIE的人，有更高的米奥斯羞耻分数，反之亦然; (4)通过检验MI与PTSD和抑郁症之间的相关性， 米奥斯分数与生活质量和功能之间的关系，相对于PTSD和抑郁症。我们 预测MI症状将解释功能问题的独特差异;（5）进行定性分析， 对随机选择的MI病例和支持暴露于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PMIE暴露后结果的社会风险和保护因素。这一探索性目标是 旨在生成关于MI风险和复原力的假设以及未解决的预防目标， 治疗，以减轻退伍军人MI的功能影响。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，这是一个由50，000多名研究人员组成的研究小组 由Ipsos管理的家庭。KP是代表美国人口的最大在线小组。 益普索目前在KP拥有约5，000名退伍军人，并一直在与退伍军人进行流行病学调查， 20年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，以产生基于美国退伍军人人群的 目标1的不同类型PMIE暴露估计值和目标3的MI患病率结局。 目标5需要进行定性访谈MI病例和匹配的控制从调查样本。 数据将被编码的PMIE的影响和战略，以修复MI的主题将被提取。