Military and Veterans Psychology
The mediating role of pursuing meaning in the relationship between moral injury and suicidal behaviors
Samantha K. Berg, B.S.
Clinical Psychology Doctoral Student
University of Maryland, Baltimore County
Winter Springs, Florida
Moral injury refers to the psychological damage that comes from acting, failing to prevent, or witnessing an action that goes against one’s deeply held values or being betrayed by someone trusted (Litz et al., 2009; Shay, 2014). The concept of moral injury was theorized to explain poorer functioning among combat veterans whose traumatic events involved perpetrating (e.g., killing) or failing to prevent perpetration of some kind as opposed to combat veterans whose traumas were fear-based (Frankfurt & Frazier, 2016). Moral injury is particularly concerning because of its association with negative mental health outcomes such as suicidality in veterans (Hall et al., 2021; Jinkerson, 2016). Research that has examined influential factors in the relationship between moral injury and suicidality has suggested mindfulness and social connectedness as possible protective factors (Kelley et al., 2019). Further, low spirituality and meaning are potential causes of moral injury (Bremault-Phillips et al., 2019).
The current study aims to explore the mediating role of pursuing meaning in the relationship between moral injury and suicidal behaviors. Participants (N = 1,495; Mage = 50.05; SD = 13.41) were Unites States veterans who served post-Vietnam and who were part of a larger cross-sectional study collecting information regarding psychosocial antecedents of health and wellness (Desmarais & Cacace, 2020). They completed the Moral Injury Symptom Scale – Military Version Short Form, the Pursuing Purpose, Meaning, and Value Scale (PPMV) , and the Suicide Behaviors Questionnaire-Revised (Koenig et al., 2018; CHAMP; Osman et al., 2001). The PPMV focuses on participants’ ability to recognize, know, continually align with, and develop core beliefs. Mediation analysis was conducted to examine the mediating effect of pursuing meaning via the PPMV on the relationship between moral injury and suicidal behaviors. Moral injury significantly predicted pursuing meaning, b = -0.01, t(1,495) = -7.20, p = < .001, and pursuing meaning significantly predicted suicidal behaviors, b = -0.44, t(1,495) = -2.89, p = .004. The indirect effect of moral injury on suicidal behaviors via pursuing meaning was significant, t(1,495) = 2.72, p = .006. This indicates that pursuing meaning or having spiritual health may be a protective factor against suicidality in veterans with moral injury. Future studies should examine active-duty military in a longitudinal design to ascertain the directionality of the results.