Association of potential morally injurious events, moral injury and somatic symptoms of health in UK military Veterans: A cross-sectional study

Abstract:Background: Moral injury can follow exposure to three types of potentially morally injurious event (PMIE). Both PMIE exposure and moral injury are associated with poor health and functioning outcomes. Moral injury, somatic symptoms and other impaired mental health and functioning outcomes are frequently observed as co-occurring in treatment-seeking military veterans. This cross-sectional study aimed to examine the associations between moral injury, somatic symptoms and other frequent co-morbidities, and the association between the PMIE type experienced and somatic symptoms. Better understanding the relationships between these comorbidities can help inform assessment and clinical interventions in complex and comorbid populations. Methods: A total of 428 UK armed forces veterans seeking treatment for mental health difficulties from a treatment charity completed measures exploring PMIE type, moral injury, somatic symptoms, and frequently co-occurring outcomes including anger, depression and anxiety, Complex PTSD (CPTSD) and PTSD. Single and multiple linear regression models were used to analyse the relationship between co-morbid symptoms. Logistical regression models were used to explore the relationship between PMIE type and somatic symptoms. Results: Linear regressions observed significant relationships between symptoms of moral injury and somatic symptoms, anxiety and depression, anger difficulties and CPTSD. Only associations with anger difficulties and CPTSD remained significant after adjusting for other significant health outcomes. Betrayal-PMIEs were significantly associated with somatic symptoms. Co-occurring anger was significantly associated with this relationship. Conclusions: These results indicate that moral injury symptoms appeared most strongly associated with co-occurring anger and CPTSD. Different PMIEs may result in differing somatic symptoms, with the presence of anger potentially playing a moderating role. This has significance for guiding deeper understanding of patient presentations, as well as indicating possible focus for transdiagnostic therapeutic interventions. The underlying mechanisms of moral injury including as a co-morbidity and its overlap with an array of health outcomes, require further exploration.