The Prevalence and Functional Impact of Moral Injury in Veterans

退伍军人道德伤害的患病率和功能影响

• 批准号: 10633476
• 负责人: BRETT T LITZ
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10633476
• 关键词: Affect; Behavioral; Belief; Biological; Clinical; Clinical Research; Clinical assessments; Code; Communities; Consensus; Data; Dimensions; Distress; Epidemiology; Event; Exposure to; Frustration; Household; Human; Impairment; Internet; Interview; Knowledge; Measurement; Measures; Mental Depression; Mental Health; Methods; Military Personnel; Modernization; Moral injury; Morals; Outcome; Population; Post-Traumatic Stress Disorders; Prevalence; Prevalence Study; Prevention; Probability; Psychometrics; Quality of life; Questionnaires; ROC Curve; Random Allocation; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Severities; Shame; Social Impacts; Spirituality; Surveys; Symptoms; Syndrome; Testing; Time; Trust; Vacuum; Veterans; Weight; Work; base; behavioral health; clinical care; clinically significant; design; epidemiology study; expectation; experience; functional disability; interest; military veteran; population based; prevent; protective factors; psychologic; recruit; repaired; resilience; response; service member; social; sound; standard measure; stem; stressor

Moral Injury (MI) is the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, bearing witness to, or being the victim of acts that transgress deeply held beliefs about right and wrong. There is widespread acceptance of and interest in MI, but this has outpaced scientific examination. To date, the knowledge gaps are: (1) no consensus definition of the symptoms that comprise the MI syndrome; (2) no gold standard clinical assessment measure of MI as an outcome; (3) no definition of functionally impairing clinically significant MI; (4) no epidemiological studies of the prevalence of different types of potentially morally injurious events (PMIEs) and MI; (5) insufficient evidence that MI has incremental clinical and explanatory validity; and (6) a lack of information about risk and resilience and the clinical care needs of Veterans with MI. In this project, we have the following five aims: (1) to determine the US Veteran population prevalence of exposure to different types of PMIEs. We have shown that different types of PMIEs are associated with a unique constellation of problems. We hypothesize that non-perpetration based PMIEs (e.g., high stakes betrayal by trusted others) will be most prevalent; (2) to generate an optimally efficient threshold severity score on the Moral Injury Outcome Scale (MIOS) that suggests probable functionally impairing MI. Currently, there is no method that can be used by clinicians and researchers to determine the clinical significance of MI as an outcome. This means that there is no way to distinguish moral frustration and moral distress, which are common, from MI, a low base-rate clinical problem greatly affecting functioning, quality of life, and potentially requiring treatment. A threshold score for caseness will help clinicians and researchers screen and assess MI. We will use Receiver Operating Characteristic analyses, using upper quartile scores on a quality of life and functioning measure as the criterion; (3) (primary) is to determine the prevalence of MI cases and to explore prevalence by type of PMIE (we have no predictions about whether different types of PMIEs will be associated with greater or lesser case prevalence). A secondary aim is to determine the normative mean severity (and SD) of MIOS total and subscale scores and to explore these variables by type of PMIEs (or no PMIE endorsement). We hypothesize that Veterans who endorse perpetration-based PMIEs will have higher MIOS shame scores relative to those that endorse non-perpetration-based PMIEs, and vice versa; (4) to examine the incremental validity of MI relative to PTSD and Depression, by testing the association between MIOS scores and a measure of quality of life and functioning, relative to PTSD and depression. We predict that MI symptoms will account for unique variance in functional problems; and (5) to conduct qualitative interviews of randomly selected MI cases and matched Veterans who endorse exposure to PMIEs but low MI symptoms and functional impact, to explore the PMIE and event context, as well as personal, professional, and social risk and protective factors affecting outcomes after exposure to PMIEs. This exploratory aim is designed to generate hypotheses about risk and resilience for MI and unaddressed targets for prevention and treatment to mitigate the functional impact of MI in Veterans. We will accomplish these aims by conducting a web survey of Veterans recruited from KnowledgePanel® (KP), a research panel of more than 50,000 households maintained by Ipsos. KP is the largest online panel that is representative of the US population. Ipsos currently has ~5,000 Veterans in KP and has been conducting epidemiological surveys with Veterans for 20 years. Ipsos uses random probabilistic sampling methods, which means that results will be representative of US Veterans. Sampling weights will be applied to inferential analyses to yield US Veteran population-based estimates of exposure to different types of PMIEs for Aim 1 and the prevalence of MI as an outcome for Aim 3. Aim 5 entails conducting qualitative interviews with MI cases and matched controls from the survey sample. Data will be coded themes about the impact of PMIEs and strategies to repair MI will be extracted.

道德损伤（MI）是持久的心理，生物学，精神，行为和社会影响，犯罪的影响 未能阻止，见证或成为犯罪行为的受害者的受害者 错误。对MI有广泛接受和兴趣，但这已经超过了科学检查。 迄今为止，知识差距为：（1）尚无对完成MI综合征的符号的共识定义； （2）没有金标准临床评估MI作为结果； （3）功能上没有定义 损害临床意义的MI； （4）没有关于不同类型的流行率的流行病学研究 潜在的道德上有害事件（PMIES）和MI； （5）没有足够的证据表明MI具有增量临床 和剥夺有效性； （6）缺乏有关风险和韧性以及临床护理需求的信息 带有MI的退伍军人。在这个项目中，我们有以下五个目标：（1）确定美国退伍军人人口 暴露于不同类型的PMIE的患病率。我们已经表明，不同类型的PMIE是 与独特的问题星座有关。我们假设基于非强化的PMIE（例如， 值得信赖的人的高股票背叛）将最普遍； （2）生成最佳有效阈值 道德损伤结果量表（MIO）的严重程度评分，这表明有问题的功能上会损害MI。 当前，临床医生和研究人员无法使用任何方法来确定临床 MI作为结果的重要性。这意味着无法区分道德挫败感和道德 遇险是常见的，来自MI，一个低的基本临床问题极大地影响了功能，质量的质量 生活，并有可能需要治疗。 CASENEME的阈值得分将帮助临床医生和研究人员 筛选并评估MI。我们将使用接收器操作特征分析，使用上四分位数分数 生活质量和功能量度作为标准； （3）（主要）是确定MI的患病率 情况并按PMIE类型探索患病率（我们没有关于不同类型的 PMIE将与或多或少的病例患病率有关）。第二个目的是确定 MIOS总数和子量表得分的正常平均严重程度（和SD），并按类型探索这些变量 PMIE（或不认可PMIE）。我们假设认可基于犯罪的PMIE的退伍军人将 相对于认可基于非渗透的PMIE的MIO摇摇的评分较高，反之亦然。 （4）通过测试关联来检查MI相对于PTSD和抑郁的增量有效性 在MIOS分数和相对于PTSD和抑郁症的生活质量和功能的测量之间。我们 预测MI症状将解释功能问题的独特差异； （5）进行定性 随机选择的MI案件和匹配的退伍军人的访谈，他们认可暴露于PMIE但MI低 症状和功能影响，以探索PMIE和事件环境以及个人，专业 和社会风险和受保护因素影响PMIE后的结果。这个探索目的是 旨在产生有关MI的风险和韧性的假设以及预防和未解决的目标的假设 治疗以减轻MI在退伍军人中的功能影响。我们将通过执行 从知识扇区（KP）招募的退伍军人的网络调查，该研究小组超过50,000 ipsos维护的家庭。 KP是代表美国人口的最大在线面板。 ipsos目前在KP中有5,000名退伍军人，并且一直在与退伍军人进行流行病学调查 20年。 IPSOS使用随机问题采样方法，这意味着结果将为代表性 美国退伍军人。抽样权重将应用于推论分析，以产生我们的资深人群 对AIM 1的不同类型PMIS的暴露估计以及MI的普遍性作为AIM 3的结果。 AIM 5需要对MI案例进行定性访谈，并从调查样本中进行匹配的对照。 将提取有关PMIE的影响和修复MI策略的影响的数据。