MANIFESTATIONS OF MORAL INJURY SYMPTOMS IN MILITARY PERSONNEL AND CIVILIAN PERSONS IN THE WAR PERIOD
Abstract
The purpose of our research is a theoretical-empirical study of the symptoms of moral injury (MI) inthree groups: the civilian persons, military personnel participating in the protection of critical infrastructurefacilities, and active combatants during the full-scale Russian military invasion into Ukraine in 2022.Methods. They took part in the study students and teachers of the Lutsk Pedagogical College (n=105),teachers of secondary schools of Volyn region (n=6), service members of the National Guard of Ukraine(n=90) and pilots of the tactical aviation brigade (n=80), totally 281 persons, participated in the study. Themethods as follows were used in the study: questionnaires to determine the impact of post-traumatic stressdisorder (PTSD), (PCL-5), symptoms depression severity (Patient Health Questionnaire, PHG-9), anxietylevel (A Brief Measure for Assessing Generalized Anxiety Disorder, GAD-7) and moral trauma symptoms(Moral Injury Symptom Scale – Military Version Short Form, MISS-M-SF). The data were analyzed usingthe statistical method – one-factor analysis of ANOVA, SPSS v.24.0 (IBM Corp. Released 2016) variance. Results. MI is a construct expressing experiences because of actions that contradict the inner convictionsor the moral code of an individual. This type of injury is mostly studied in military personnel because theyperform combat tasks and are exposed to prolonged traumatic stress. Regardless of the specifics, there aremore studies of moral traumatization of the civilian persons, including medical personnel engaged with variouspatients. The results of our research indicate that the most morally traumatized persons are military personnelwho took part in and are participating in military operations (М=39,70, SD=10,50). The results indicate thatNational Guard soldiers have the lowest rates of moral injury (M=29,94, SD=9,29). This may be because theyguard critical infrastructure facilities and the state border in places where active hostilities are not taking place.Conclusions. The results of the study indicate that МI during full-scale Russian military invasion intoUkraine is not only received by military personnel performing combat tasks, but also by the civilian persons,since civilians were not prepared psychologically before the start of the war.
References
2. Засєкіна Л., Козігора М. Крос-культурна адаптація та стандартизація шкали симптомів моральної травми. Психологічні перспективи : наук. збірник. Луцьк. 2022. Вип. 39. С. 139–152. URL: https://doi.org/10.29038/2227-1376-2022-39-zas
3. Кокун О.М., Агаєв Н.А., Пішко І.О. Психологічна оцінка суїцидального ризику у військовослужбовців.: метод. посіб. Київ : НДЦ ГП ЗСУ, 2019. С. 106–108.
4. Barnes H. A., Hurley R. A., & Taber K. H. Moral injury and PTSD: Often co-occurring yet mechanistically different. The Journal of neuropsychiatry and clinical neurosciences, 2019. Vol. 31(2). Рр. A4–103. URL: https://doi.org/10.1176/appi.-neuropsych.19020036
5. Bartzak P. J. Moral injury is the wound: PTSD is the manifestation. Medsurg Nurs, 2015. Vol. 24(3). Рр. 10–11.
6. Bezsheiko V. Adaptation of the Clinician-Administered PTSD Scale and PTSD Checklist for Ukrainian population. Psychosomatic Medicine and General Practice, 2016. URL: https://dev-ojs.e-medjournal.com/index.php/psp/article/view/8 (дата звернення: 15.07.2022).
7. Blanchard E. B., Jones-Alexander J., Buckley T. C., & Forneris C. A. Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 1996. Vol. 34(8). Рр. 669–673. URL: https://doi.org/10.1016/0005-7967(96)00033-2
8. Bryan C. J., Bryan A. O., Roberge E., Leifker F. R., & Rozek D. C. Moral injury, posttraumatic stress disorder, and suicidal behavior among National Guard personnel. Psychological Trauma: Theory, Research, Practice, and Policy, 2018. Vol. 10(1), Рр. 36–45. URL: https://doi.org/10.1037/tra0000290.
9. Čartolovni A., Stolt M., Scott P. A., & Suhonen R. Moral injury in healthcare professionals: a scoping review and discussion. Nursing ethics, 2021. Vol. 28(5). Рр. 590–602. URL: https://doi.org/10.1177/0969733020966776
10. Chesnut R. P., Richardson C. B., Morgan N. R., Bleser J. A., Perkins D. F., Vogt D., ... & Finley E. Moral injury and social well-being: a growth curve analysis. Journal of traumatic stress, 2020. Vol. 33(4). Pp. 587–597. URL: https://doi.org/10.1002/jts.22567
11. Fani N., Currier J. M., Turner M. D., Guelfo A., Kloess M., Jain J., ... & Turner J. A. Moral injury in civilians: associations with trauma exposure, PTSD, and suicide behavior. European journal of psychotraumatology, 2021. Vol. 12(1). URL: https://doi.org/10.1080/20008198.2021.1965464
12. Griffin B. J., Purcell N., Burkman K., Litz B. T., Bryan C. J., Schmitz M., ... & Maguen S. Moral injury: An integrative review. Journal of Traumatic Stress. 2019. Vol. 32(3). Рр. 350–362. URL: https://doi.org/10.1002/jts.22362
13. Hodgson T. J., Carey L. B., & Koenig H. G. Moral injury, Australian veterans and the role of chaplains: An exploratory qualitative study. Journal of religion and health, 2021. Vol. 60(5), Рр. 3061–3089. URL: https://doi.org/10.1007/s10943-021-01417-0
14. IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.
15. Koenig H. G., & Al Zaben F. Moral injury: An increasingly recognized and widespread syndrome. Journal of religion and health, 2021. Vol. 60(5). Рр. 2989–3011. URL: https://doi.org/10.1007/s10943-021-01328-0.
16. Koenig H. G., Ames D., Youssef N. A., Oliver J. P., Volk F., Teng E. J., ... & Pearce M. Screening for moral injury: the moral injury symptom scale–military version short form. Military medicine, 2018. Vol. 183(11–12). Рр. 659–665. URL: https://doi.org/-10.1093/milmed/usy017
17. Kroenke K., Spitzer R. L., & Williams J. B. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 2001. Vol. 16(9). Рр. 606–613. URL: https://doi.org/10.1046/j.1525-1497.2001.016009606.x
18. Litz B. T., Stein N., Delaney E., Lebowitz L., Nash W. P., Silva C., Maguen S. Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review. 2009. Vol. 29(8). Pp. 695–706. URL: https://doi.org/10.1016/j.cpr.2009.07.003
19. Martin R. L., Houtsma C., Bryan A. O., Bryan C. J., Green B. A., & Anestis M. D. The impact of aggression on the relationship between betrayal and belongingness among U.S. military personnel. Military Psychology, 2017. Vol. 29(4). Рр. 271–282. URL: https://doi.org/10.1037/mil0000160
20. Nash W. P., & Litz B. T. (2013). Moral injury: A mechanism for war-related psychological trauma in military family members. Clinical child and family psychology review, 2013. Vol. 16(4). Рр. 365–375. URL: https://doi.org/10.1007/s10567-013-0146-y
21. Prykhodko I. I., Bielai S. V., Hrynzovskyi A. M., Zhelaho A. М., Hodlevskyi S. O., & Kalashchenko S. I. Medical and psychological aspects of safety and adaptation of military personnel to extreme conditions. Wiadomosci lekarskie (Warsaw, Poland: 1960), 2020. Vol. 73(4). Рр. 679–683. URL: https://doi.org/10.36740/-WLek202004110
22. Prykhodko I., Matsehora Y., Bielai S., Hunbin K., & Kalashchenko S. Classification of coping strategies influencing mental health of military personnel having different combat experience. Georgian Medical News, 2019. Vol. 297, Рр. 130–135.
23. Shay, J. Achilles in Vietnam: Combat trauma and the undoing of character. New York, NY : Scribner, 1994. Р. 246.
24. Shay, J. Moral injury. Psychoanalytic Psychology, 2014. Vol. 31. Рр. 182–191. URL: https://doi.org/10.1037/a0036090
25. Spitzer R. L., Kroenke K., Williams J. B., & Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 2006. Vol. 166(10). Рр. 1092–1097. URL: https://doi.org/10.1001/archinte.166.10.1092
26. Zasiekina L., Zasiekin S. Verbal Emotional Disclosure of Moral Injury in Holodomor Survivors. Psycholinguistics, 2020. Vol. 28(1). Рр. 41–58. URL: https://doi.org/10.31470/2309-1797-2020-28-1-41-58
