The roles of social support and self-forgiveness in the relationship between moral injury and posttraumatic growth in combat Veterans

Abstract: The literature regarding moral injury (MI) is constantly evolving as researchers learn more about how it develops, how to define it, and how it impacts combat veterans. Although much of the literature has focused on the negative impacts that follow exposure to potentially morally injurious events (PMIEs) and subsequent MI, theorists suggest that it may also be possible for combat veterans to experience growth after committing or witnessing potentially morally injurious acts (Blackie et al., 2016). Crucial to current theoretical models of the relationship between MI and posttraumatic growth (PTG) are the roles of social support and forgiveness in facilitating a process of recovery from MI. Drawing from models of MI developed by Blackie et. al. (2016) and Litz et. al. (2009), the current study sought to better understand the growth process by exploring the relationships between MI, perceived social support, self-forgiveness, and PTG. Participants consisted of 114 combat veterans with exposure to PMIEs recruited via Amazon’s Mechanical Turk, Prolific Academic, and social media to complete a series of measures via Qualtrics online survey administration software. After answering demographic questions and providing military-specific information, participants completed the PTSD Checklist for the DSM-5 (PCL-5), Moral Injury Events Scale (MIES), Moral Injury Symptom Scale-Short Form (MISS-M-SF), self-forgiveness subscale of the Heartland Forgiveness Scale (HFS-Self), Multidimensional Scale of Perceived Social Support-Military Version (MSPSS-M), and the Posttraumatic Growth Inventory-Expanded (PTGI-X). A moderated mediation model of the relationship between MI and PTG was hypothesized in that it was expected that self-forgiveness would explain the relationship between MI and PTG among combat veterans who reported high levels of perceived social support. Analyses using model 7 of the PROCESS macro version 4.3.1 for SPSS (Hayes, 2022) found partial support for the hypothesized model. Perceived social support moderated the relationship between MI and self-forgiveness in that veterans with high levels of perceived social support endorsed more self-forgiveness while veterans with low levels of perceived social support did not demonstrate any relationship to self-forgiveness. Neither MI symptoms nor self-forgiveness, however, demonstrated significant relationships with PTG regardless of the type of PMIE exposure. Additional exploratory analyses found that the hypothesized moderated mediation model was supported when PTSD symptom severity, rather than MI symptoms, was entered as the predictor variable with perceived social support as the moderator variable and self-forgiveness as the mediator variable. Findings support the notion that increasing social support may help combat veterans experience self-forgiveness after experiencing PMIEs that lead to MI symptoms. Additionally, these results add to the literature distinguishing MI symptoms from PTSD symptoms, suggesting the need to consider exploring different mechanisms for promoting PTG for those with MI symptoms.