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07.09.2023 | ORIGINAL PAPER

Moral Injury is a Risk Factor for Substance Use and Suicidality Among US Military Veterans with and without Traumatic Brain Injury

verfasst von: Justin T. McDaniel, Ryan Redner, Wasantha Jayawardene, Jolie Haun, John Clapp, Dunren Che, Karen Renzaglia, Dania Abou-Jabal

Erschienen in: Journal of Religion and Health | Ausgabe 6/2023

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Abstract

A national survey of United States veterans was conducted, yielding 252 veterans with Traumatic Brain Injury (TBI) and 1235 veterans without TBI. Participants were asked questions about moral injury, suicidality, substance use, and other sociodemographic variables. Multivariable linear regression analysis was used to examine the previously described relationships. Increasing severity of moral injury was associated with higher scores on the substance use tool (b = 0.02, p = 0.04), although the magnitude of effect was not different from those without TBI (Z = − 0.57, p = 0.72). Increasing severity of moral injury was positively associated with suicidal behavior scores (b = 0.10, p < 0.01). The strength of this relationship was stronger in veterans with TBI than those without TBI (Z = 1.78, p = 0.04). Rehabilitation programs that treat veterans for TBI may need to consider the evaluation of moral injury given its association with adverse events in this population.

Adams, S. (2017). Psychopharmacology of tobacco and alcohol comorbidity: A review of current evidence. Current Addiction Reports, 4(1), 25–34. https://doi.org/10.1007/s40429-017-0129-zCrossRefPubMedPubMedCentral

Allard, C. B., Norman, S. B., Straus, E., Kim, H. M., Stein, M. B., Simon, N. M., & Rauch, S. A. M. (2021). Reductions in guilt cognitions following prolonged exposure and/or sertraline predict subsequent improvements in PTSD and depression. Journal of Behavior Therapy and Experimental Psychiatry, 73, 101666. https://doi.org/10.1016/j.jbtep.2021.101666CrossRefPubMed

Almeida, D. M., Wethington, E., & Kessler, R. C. (2002). The daily inventory of stressful events: An interview-based approach for measuring daily stressors. Assessment, 9(1), 41–55. https://doi.org/10.1177/1073191102091006CrossRefPubMed

Ames, D., Erickson, Z., Youssef, N. A., Arnold, I., Adamson, C. S., Sones, A. C., Yin, J., Haynes, K., Volk, F., Teng, E. J., Oliver, J. P., & Koenig, H. G. (2019). Moral injury, religiosity, and suicide risk in U.S. veterans and active duty military with PTSD symptoms. Military Medicine, 184(3–4), e271–e278. https://doi.org/10.1093/milmed/usy148CrossRefPubMed

Ames, D., Erickson, Z., Geise, C., Tiwari, S., Sakhno, S., Sones, A. C., Tyrrell, G., Mackay, R. B., Stelle, W., Van Hoof, T., Weinreich, H., & Koenig, H. G. (2021). Treatment of moral injury in US veterans with PTSD using a structured chaplain intervention. Journal of Religion and Health, 60, 3052–3060. https://doi.org/10.1007/s10943-021-01312-8CrossRefPubMed

Arias, E., Tejada-Vera, B., Kochanek, K. D., & Ahmad, F. B. (2022). Provisional life expectancy estimates for 2021. Vital Statistics Rapid Release, 23, 1–16. https://doi.org/10.15620/cdc:118999CrossRef

Barnes, H. A., Hurley, R. A., & Taber, K. H. (2019). Moral injury and PTSD: Often co-occurring yet mechanistically different. The Journal of Neuropsychiatry and Clinical Neurosciences, 31(2), A4-103. https://doi.org/10.1176/appi.neuropsych.19020036CrossRefPubMed

Basu, D., Ghosh, A., Hazari, N., & Parakh, P. (2016). Use of Family CAGE-AID questionnaire to screen the family members for diagnosis of substance dependence. The Indian Journal of Medical Research, 143(6), 722–730. https://doi.org/10.4103/0971-5916.191931CrossRefPubMedPubMedCentral

Bjork, J. M., & Grant, S. J. (2009). Does traumatic brain injury increase risk for substance abuse? Journal of Neurotrauma, 26(7), 1077–1082. https://doi.org/10.1089/neu.2008.0849CrossRefPubMedPubMedCentral

Boska, R. L., Dunlap, S., Kopacz, M., Bishop, T. M., & Harris, J. I. (2021). Understanding moral injury morbidity: A qualitative study examining chaplain’s perspectives. Journal of Religion and Health, 60, 3090–3099. https://doi.org/10.1007/s10943-021-01414-3CrossRefPubMedPubMedCentral

Braitman, A. L., Battles, A. R., Kelley, M. L., Hamrick, H. C., Cramer, R. J., Ehlke, S., & Bravo, A. J. (2018). Psychometric properties of a modified moral injury questionnaire in a military population. Traumatology, 24(4), 301–312. https://doi.org/10.1037/trm0000158CrossRefPubMedPubMedCentral

Bravo, A. J., Kelley, M. L., Mason, R., Ehlke, S. J., Vinci, C., & Redman, J. C. (2020). Rumination as a mediator of the associations between moral injury and mental health problems in combat-wounded veterans. Traumatology, 26(1), 52–60. https://doi.org/10.1037/trm0000198CrossRefPubMed

Brown, R. L., & Rounds, L. A. (1995). Conjoint screening questionnaires for alcohol and other drug abuse: Criterion validity in a primary care practice. Wisconsin Medical Journal, 94(3), 135–140.PubMed

Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2014). Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology, 20(3), 154–160. https://doi.org/10.1037/h0099852CrossRef

Buhagar, D. C. (2021). The forgiveness interview protocol: A narrative therapy writing-process model for the treatment of moral injury. Journal of Religion and Health, 60, 3100–3129. https://doi.org/10.1007/s10943-021-01395-3CrossRefPubMed

Cacace, S., Smith, E. J., Cramer, R. J., Meca, A., & Desmarais, S. L. (2022). Military self-stigma as a mediator of the link between military identity and suicide risk. Military Psychology, 34(2), 237–251. https://doi.org/10.1080/08995605.2021.1994329CrossRef

Capone, C., Tripp, J. C., Trim, R. S., Davis, B. C., Haller, M., & Norman, S. B. (2020). Comparing exposure- and coping skills–based treatments on trauma-related guilt in veterans with co-occurring alcohol use and posttraumatic stress disorders. Journal of Traumatic Stress, 33, 603–609. https://doi.org/10.1002/jts.22538CrossRefPubMed

Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/

Clogg, C. C., Petkova, E., & Haritou, A. (1995). Statistical methods for comparing regression coefficients between models. American Journal of Sociology, 100(5), 1261–1293. https://doi.org/10.1086/230638CrossRef

Cramer, R. J., Franks, M., Cunningham, C. A., & Bryan, C. J. (2022). Preferences in information processing: Understanding suicidal thoughts and behaviors among active duty military service members. Archives of Suicide Research, 26(1), 169–186. https://doi.org/10.1080/13811118.2020.1760156CrossRefPubMed

Davies, R. L., Prince, M. A., Bravo, A. J., Kelley, M. L., & Crain, T. L. (2019). Moral injury, substance use, and posttraumatic stress disorder symptoms among military personnel: An examination of trait mindfulness as a moderator. Journal of Traumatic Stress, 32, 414–423. https://doi.org/10.1002/jts.22403CrossRefPubMedPubMedCentral

Falk, D. E., Yi, H. Y., & Hiller-Sturmhöfel, S. (2006). An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health, 29(3), 162–171.

Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017). A functional approach to understanding and treating military-related moral injury. Journal of Contextual Behavioral Science, 6, 391–397. https://doi.org/10.1016/j.jcbs.2017.07.003CrossRef

Fleming, W. H. (2021). Moral injury and the absurd: The suffering of moral paradox. Journal of Religion and Health, 60, 3012–3033. https://doi.org/10.1007/s10943-021-01227-4CrossRefPubMed

Forkus, S. R., Breines, J. G., & Weiss, N. H. (2019). Morally injurious experiences and mental health: The moderating role of self-compassion. Psychological Trauma: Theory, Research, Practice, and Policy, 11(6), 630–638. https://doi.org/10.1037/tra0000446CrossRefPubMed

Gunnarsson, K. F., Whiting, S. W., & Sims, C. (2018). Delay discounting in traumatic brain injury: A potential avenue for growth in experimental analysis. Behavior Analysis: Research and Practice, 18(4), 354–361. https://doi.org/10.1037/bar0000115CrossRef

Hall, N. A., Everson, A. T., Billingsley, M. R., & Miller, M. B. (2022). Moral injury, mental health and behavioural health outcomes: A systematic review of the literature. Clinical Psychology & Psychotherapy, 29(1), 92–110. https://doi.org/10.1002/cpp.2607CrossRef

Hodgson, T. J., & Carey, L. B. (2017). Moral injury and definitional clarity: Betrayal spirituality and the role of chaplains. Journal of Religion and Health, 56(4), 1212–1228. https://doi.org/10.1007/s10943-017-0407-z

Hodgson, T. J., Carey, L. B., & Koenig, H. G. (2021). Moral injury, Australian veterans and the role of chaplains: An exploratory qualitative study. Journal of Religion and Health, 60(5), 3061–3089. https://doi.org/10.1007/s10943-021-01417-0CrossRefPubMed

Hoffman, J., Liddell, B., Bryant, R. A., & Nickerson, A. (2019). A latent profile analysis of moral injury appraisals in refugees. European Journal of Psychotraumatology, 10(1), 1686805. https://doi.org/10.1080/20008198.2019.1686805CrossRefPubMedPubMedCentral

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys. Research in Aging, 26(6), 655–672. https://doi.org/10.1177/016402750426857CrossRef

Jamieson, N., Carey, L. B., Jamieson, A., & Maple, M. (2023). Examining the association between moral injury and suicidal behavior in military populations: A systematic review. Journal of Religion and Health. [Online] https://doi.org/10.1007/s10943-023-01885-6CrossRefPubMed

Jobson, J. D., & Gentry, C. (2021). The mortality rate of 100% service-connected U.S. veterans. SOCRA Source, 108, 31–39.PubMedPubMedCentral

Johansen, R. B., Laberg, J. C., & Martinussen, M. (2013). Measuring military identity: Scale development and psychometric evaluations. Social Behavior and Personality, 41(5), 861–880. https://doi.org/10.2224/sbp.2013.41.5.861CrossRef

Kelley, M. L., Bravo, A. J., Davies, R. L., Hamrick, H. C., Vinci, C., & Redman, J. C. (2019). Moral injury and suicidality among combat-wounded veterans: The moderating effects of social connectedness and self-compassion. Psychological Trauma: Theory, Research, Practice, and Policy, 11(6), 621–629. https://doi.org/10.1037/tra0000447CrossRefPubMed

Koenig, H. G., & Al Zaben, F. (2021). Moral injury: An increasingly recognized and widespread syndrome. Journal of Religion and Health, 60, 2989–3011. https://doi.org/10.1007/s10943-021-01328-0CrossRefPubMedPubMedCentral

Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., Haynes, K., Erickson, Z. D., Arnold, I., O’Garo, K., & Pearce, M. (2018). Screening for moral injury: The moral injury symptom scale—military version short form. Military Medicine, 183(11–12), 659–665. https://doi.org/10.1093/milmed/usy017CrossRef

Kohut, S. J. (2017). Interactions between nicotine and drugs of abuse: A review of preclinical findings. The American Journal of Drug and Alcohol Abuse, 43(2), 155–170. https://doi.org/10.1080/00952990.2016.1209513CrossRefPubMed

Lee, H., Aldwin, C. M., & Kang, S. (2020). Do different types of war stressors have independent relations with mental health? Findings from the Korean Vietnam Veterans Study. Psychological Trauma: Theory, Research, Practice, and Policy, 14(5), 840–848. https://doi.org/10.1037/tra0000557CrossRefPubMed

Litz, B. T., Plouffe, R. A., Nazarov, A., Murphy, D., Phelps, A., Coady, A., Houle, S. A., Dell, L., Frankfurt, S., Zerach, G., Levi-Belz, Y., Moral Injury Outcome Scale Consortium. (2022). Defining and assessing the syndrome of moral injury: Initial findings of the moral injury outcome scale consortium. Frontiers in Psychiatry, 13, 923928. https://doi.org/10.3389/fpsyt.2022.923928CrossRefPubMedPubMedCentral

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003CrossRefPubMed

Madsen, T., Erlangsen, A., Orlovska, S., Mofaddy, R., Nordentoft, M., & Benros, M. E. (2018). Association between traumatic brain injury and risk of suicide. Journal of the American Medical Association, 320(6), 580–588. https://doi.org/10.1001/jama.2018.10211CrossRefPubMed

Maguen, S., & Norman, S. B. (2022). Moral injury. PTSD Research Quarterly, 33(1), 1–9.

McDaniel, J. T. (2023). Moral injury and quality of life among military veterans. BMJ Military Health. https://doi.org/10.1136/military-2023-002457CrossRefPubMed

Meadows, S. O., Engel, C. C, Collins, R. L, Beckman, R. L., Cefalu, M., Hawes-Dawson, J., Waymouth, M., Kress, A. M., Sontag-Padilla, L. S., Ramchand, R., & Williams, K.M. (2018). Health Related Behaviors Survey: Substance Use Among U.S. Active-Duty Service Members. RAND Corporation. Retrieved from https://www.rand.org/pubs/research_briefs/RB9955z7.html

National Institute on Drug Abuse (NIDA). (2019). Substance Use and Military Life Drug Facts. Retrieved from https://nida.nih.gov/publications/drugfacts/substance-use-military-life

Nichter, B., Norman, S. B., Maguen, S., & Pietrzak, R. H. (2021). Moral injury and suicidal behavior among US combat veterans: Results from the 2019–2020 National Health and Resilience in Veterans Study. Depression and Anxiety, 38, 606–614. https://doi.org/10.1002/da.23145CrossRefPubMed

Odani, S., Agaku, I. T., Graffunder, C. M., Tynan, M. A., & Armour, B. S. (2018). Tobacco product use among military veterans—United States, 2010–2015. Morbidity and Mortality Weekly Report, 67(1), 7–17.CrossRefPubMedPubMedCentral

Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The suicidal behaviors questionnaire-revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–453. https://doi.org/10.1177/107319110100800409CrossRefPubMed

Payne, J. M., Sullivan, S., Abraham, T. H., Rabalais, A., Jaques, M., & Griffin, B. (2021). Mental health clinician community clergy collaboration to address moral injury symptoms: A feasibility study. Journal of Religion and Health, 60, 3034–3051. https://doi.org/10.1007/s10943-021-01257-yCrossRef

Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. The Psychiatric Clinics of North America, 37(1), 1–11. https://doi.org/10.1016/j.psc.2013.11.004CrossRefPubMedPubMedCentral

Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Veteran’s Primary Substance of Abuse is Alcohol in Treatment Admissions, The CBHSQ Report. Retrieved from https://www.samhsa.gov/data/sites/default/files/report_2111/Spotlight-2111.html

Stein, M. B., Jain, S., Giacino, J. T., Levin, H., Dikmen, S., Nelson, L. D., Vassar, M. J., Okonkwo, D. O., Diaz-Arrastia, R., Robertson, C. S., Mukherjee, P., McCrea, M., Mac Donald, C. L., Yue, J. K., Yuh, E., Sun, X., Campbell-Sills, L., Temkin, N., Manley, G. T., … TRACK-TBI Investigators. (2019). Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury: A TRACK-TBI study. JAMA Psychiatry, 76(3), 249–258. https://doi.org/10.1001/jamapsychiatry.2018.4288CrossRefPubMedPubMedCentral

Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: Prevalence and treatment challenges. Substance Abuse and Rehabilitation, 8, 69–77. https://doi.org/10.2147/SAR.S116720CrossRefPubMedPubMedCentral

The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558. https://doi.org/10.1017/S0033291798006667CrossRef

U. S. Department of Veterans Affairs, VA Suicide Prevention Program. (2016). Facts About Veteran Suicide. Retrieved from https://www.va.gov/health-care/health-needs-conditions/mental-health/suicide-prevention/

U. S. Department of Veterans Affairs, Veterans Health Administration, Office of Mental Health and Suicide Prevention. (2018). Veteran suicide data report, 2005–2016. Retrieved from https://www.mentalhealth.va.gov/docs/data-sheets/OMHSP_National_Suicide_Data_Report_2005-2016_508-compliant.pdf

Titel: Moral Injury is a Risk Factor for Substance Use and Suicidality Among US Military Veterans with and without Traumatic Brain Injury
verfasst von: Justin T. McDaniel
Ryan Redner
Wasantha Jayawardene
Jolie Haun
John Clapp
Dunren Che
Karen Renzaglia
Dania Abou-Jabal
Publikationsdatum: 07.09.2023
Verlag: Springer US
Erschienen in: Journal of Religion and Health / Ausgabe 6/2023
Print ISSN: 0022-4197
Elektronische ISSN: 1573-6571
DOI: https://doi.org/10.1007/s10943-023-01905-5

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