Moral Decision Making, Religious Strain, and the Experience of Moral Injury

Objective: Moral injury is the lasting psychological, spiritual, and behavioral effects of having perpetrated acts that transgress moral boundaries. Contemporary models of moral injury in military veterans examine the role of transgressive acts, moral appraisals of these acts, and the symptoms of moral injury. However, little research has examined potential pathways between these elements. The current study examined appraisals of one's acts and religious strain as potential mediators of the link between transgressive acts and symptoms of moral injury. Further, given the inherent importance of moral cognitions in the appraisal process, we tested whether the acts to appraisals link was moderated by altruism in military veterans. Method: An online survey, distributed using crowdsourcing software, was completed by military veterans. The survey included measures of transgressive acts, appraisals of these acts, religious strain, altruism, and self- and other-directed symptoms of moral injury. Mediation and moderated serial mediation were used to test the hypotheses. Results: Our results indicated appraisals and religious strain significantly mediated the acts to symptoms pathway for both self- and other-directed aspects of moral injury. This pathway was significantly moderated by altruism such that a stronger link exists between acts and appraisals at higher levels of altruism. Conclusion: Overall, these findings suggest that religious functioning and moral decision making are important aspects of the experience of moral injury and are worthy of future study. Clinical Impact Statement The present study is the first to demonstrate the role of altruism in the experience of moral injury in military veterans. This study suggests that the conceptualization and treatment of moral injury should be extended to examine the impact of moral decision making in the posttransgression appraisal process.