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Original Article

A Review of Research on Moral Injury in Combat Veterans

ORCID Icon &
Pages 318-330 | Published online: 13 Dec 2017

Keep up to date with the latest research on this topic with citation updates for this article.

Read on this site (36)

Yossi Levi-Belz, Ariel Ben-Yehuda, Yoav Levinstein & Gadi Zerach. (2024) Moral injury and pre-deployment personality factors as contributors to psychiatric symptomatology among combatants: a two-year prospective study. European Journal of Psychotraumatology 15:1.
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Bruno Messina Coimbra, Cecilia Zylberstajn, Mirjam van Zuiden, Chris Maria Hoeboer, Andrea Feijo Mello, Marcelo Feijo Mello & Miranda Olff. (2024) Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis. European Journal of Psychotraumatology 15:1.
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Victoria Williamson, Dominic Murphy, Amanda Bonson, Vicky Aldridge, Danai Serfioti & Neil Greenberg. (2023) Restore and Rebuild (R&R) – a feasibility pilot study of a co-designed intervention for moral injury-related mental health difficulties. European Journal of Psychotraumatology 14:2.
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Dominik Szabó, Vera Békés, Erika Evelyn Lévay, Ella Salgó & Zsolt Szabolcs Unoka. (2023) Moral injury in psychiatric patients with personality and other clinical disorders: development, psychometric properties, and validity of the Moral Injury Events Scale–Civilian Version. European Journal of Psychotraumatology 14:2.
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Adam T. Biggs, Todd R. Seech, Scott L. Johnston & Dale W. Russell. (2023) Psychological endurance: how grit, resilience, and related factors contribute to sustained effort despite adversity. The Journal of General Psychology 0:0, pages 1-43.
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Victoria Williamson, Danielle Lamb, Matthew Hotopf, Rosalind Raine, Sharon Stevelink, Simon Wessely, Mary Docherty, Ira Madan, Dominic Murphy & Neil Greenberg. (2023) Moral injury and psychological wellbeing in UK healthcare staff. Journal of Mental Health 32:5, pages 890-898.
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Brenton Russell, Wade Ferguson, Warwick O. Lucas & Alexander J. Mussap. (2023) Evaluating Moral Injury in Combat-Deployed and Non-Combat Military Personnel. Military Behavioral Health 11:3, pages 155-168.
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Kevin T. Hansen, Charles G. Nelson & Kenneth Kirkwood. (2023) Association Between Self-Rated Positive Mental Health and Exposure to Potentially Morally Injurious Events in Deployed Canadian Forces Personnel. Journal of Aggression, Maltreatment & Trauma 32:3, pages 414-429.
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Tine Molendijk, Willemijn Verkoren, Annelieke Drogendijk, Martin Elands, Eric-Hans Kramer, Annika Smit & Désirée Verweij. (2022) Contextual dimensions of moral injury: An interdisciplinary review. Military Psychology 34:6, pages 742-753.
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Louise Morgan & Dominic Aldington. (2022) Chronic Pain, PTSD and Moral Injury in Military Veterans: Suffering and the Compromised Self. Military Behavioral Health 10:4, pages 267-274.
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Uri Hertz, Keren L. G. Snider, Adi Levy, Daphna Canetti & Michael L. Gross. (2022) To shoot or not to shoot: experiments on moral injury in the context of West Bank checkpoints and COVID-19 restrictions enforcement. European Journal of Psychotraumatology 13:1.
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Joseph Wiinikka-Lydon. (2022) Critiquing the Subject of Moral Injury. Journal of Military Ethics 21:1, pages 39-55.
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Michael Prazak & Dellas Oliver Herbel. (2022) The role of military chaplaincy in addressing service member help avoidance: A critical review with treatment implications. Journal of Health Care Chaplaincy 28:1, pages 108-127.
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Leanne K. Knobloch, Jenny L. Owens & Robyn L. Gobin. (2021) Spiritual care for combat trauma: A qualitative evaluation of REBOOT Combat Recovery. Military Psychology 33:6, pages 392-402.
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Kathy Michaud, Cindy Suurd Ralph & Sarah Jayne A. Connick-Keefer. (2021) Operational stressors, psychological distress, and turnover intentions: The impact of potentially morally injurious experiences. Military Psychology 33:4, pages 250-263.
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Eva van Baarle & Tine Molendijk. (2021) Resilience as the Road to Mental Readiness? Reflections from an Ethics-of-care Perspective. Journal of Military Ethics 20:2, pages 129-144.
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Victoria Williamson, Dominic Murphy, Sharon A. M. Stevelink, Shannon Allen, Edgar Jones & Neil Greenberg. (2021) Delivering treatment to morally injured UK military personnel and Veterans: The clinician experience. Military Psychology 33:2, pages 115-123.
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Philip Held, Brian J. Klassen, Victoria L. Steigerwald, Dale L. Smith, Karyna Bravo, David C. Rozek, Rebecca Van Horn & Alyson Zalta. (2021) Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?. European Journal of Psychotraumatology 12:1.
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F. Jackie June ter Heide. (2020) Empathy is key in the development of moral injury. European Journal of Psychotraumatology 11:1.
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Yossi Levi-Belz, Talya Greene & Gadi Zerach. (2020) Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach. European Journal of Psychotraumatology 11:1.
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Victoria Williamson, Dominic Murphy, Sharon A. M. Stevelink, Shannon Allen, Edgar Jones & Neil Greenberg. (2020) The impact of trauma exposure and moral injury on UK military veterans: a qualitative study. European Journal of Psychotraumatology 11:1.
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Hannah C. Hamrick, Michelle L. Kelley & Adrian J. Bravo. (2020) Morally Injurious Events, Moral Injury, and Suicidality among Recent-Era Veterans: The Moderating Effects of Rumination and Mindfulness. Military Behavioral Health 8:1, pages 109-120.
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Victoria Williamson, Neil Greenberg & Dominic Murphy. (2019) Moral injury in UK armed forces veterans: a qualitative study. European Journal of Psychotraumatology 10:1.
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Anthony M. Battaglia, Alina Protopopescu, Jenna E. Boyd, Chantelle Lloyd, Rakesh Jetly, Charlene O’Connor, Heather K. Hood, Anthony Nazarov, Shawn G. Rhind, Ruth A. Lanius & Margaret C. McKinnon. (2019) The relation between adverse childhood experiences and moral injury in the Canadian Armed Forces. European Journal of Psychotraumatology 10:1.
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Adam P. McGuire, Elizabeth Nosen & Judith A. Lyons. (2019) Benefits of Moral Elevation in Veterans with PTSD and Moral Injury: A Proposed Theoretical Framework and Pilot Study. Military Behavioral Health 7:3, pages 315-326.
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Alan D. Ogle, Reed Reichwald & J. Brian Rutland. (2018) Psychological impact of remote combat/graphic media exposure among US Air Force intelligence personnel. Military Psychology 30:6, pages 476-486.
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Sheila B. Frankfurt & Michael L. Russell. (2018) Private Lives, Public Stories, and Healing from Moral Injury: Commentary on Jones (2018) and Schaff (2018). Military Behavioral Health 6:2, pages 140-142.
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Edgar Jones. (2018) Trans-Generational Transmission of Traumatic Memory and Moral Injury. Military Behavioral Health 6:2, pages 134-139.
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Christina M. Sheerin, Nadia Chowdhury, Mackenzie J. Lind, Erin D. Kurtz, Lance M. Rappaport, Erin C. Berenz, Ruth C. Brown, Treven Pickett, Scott D. McDonald, Carla Kmett Danielson & Ananda B. Amstadter. (2018) Relation between coping and posttrauma cognitions on PTSD in a combat-trauma population. Military Psychology 30:2, pages 98-107.
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Jane Fenton & Timothy B. Kelly. (2017) ‘Risk is King and Needs to take a Backseat!’ Can social workers’ experiences of moral injury strengthen practice?. Journal of Social Work Practice 31:4, pages 461-475.
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Articles from other publishers (133)

Brandon Nichter, Melanie L. Hill, Shira Maguen, Sonya B. Norman, Ian C. Fischer & Robert H. Pietrzak. (2024) Health and psychiatric impairment associated with moral injury, military sexual trauma, and their co-occurrence in U.S. combat veterans. Journal of Psychosomatic Research 179, pages 111617.
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Robyn D. Walser, Wyatt R. Evans, Jacob K. Farnsworth & Kent D. Drescher. (2024) Initial steps in developing acceptance and commitment therapy for moral injury among combat veterans: Two pilot studies. Journal of Contextual Behavioral Science 32, pages 100733.
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Walter J Sowden & Rachell L Jones. (2024) Amplified PTSD Symptoms From Self-Attributed Moral Transgressions are Linked to Internalized Moral Identity During Military Deployment. Military Medicine.
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Elizabeth L. Wetzler, Ryan G. Erbe, James F. M. Cornwell & Michael D. Wood. (2024) Dispositional mindfulness moderates the links between potentially morally injurious event exposure and symptoms of anxiety and depression but not suicidal ideation. Journal of Traumatic Stress.
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Chloe J Brennan, Carl Roberts & Jon C Cole. (2024) Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis. BMJ Open 14:2, pages e071776.
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Sheldene Simola. (2023) Exploring Agape in the Organizational Prevention of Work-Related Moral Injury. Humanistic Management Journal 8:3, pages 355-377.
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Jeffrey M. Pyne, Joseph Currier, Kent D. HinksonJr.Jr., Timothy J. Usset, Lynn A. Abeita, Paul Dordal, Taimur Kouser, Rania Awaad, Marcela C. Weber & Brandon J. Griffin. (2023) Addressing Religious and Spiritual Diversity in Moral Injury Care: Five Perspectives. Current Treatment Options in Psychiatry 10:4, pages 446-462.
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Erhan TUNÇ & Gülşah CANDEMİR. (2023) Guilt and Shame As a Result of Violating Beliefs: “Moral Injury”. Spiritual Psychology and Counseling 8:3, pages 387-404.
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Danai Serfioti, Dominic Murphy, Neil Greenberg & Victoria Williamson. (2023) Professionals' perspectives on relevant approaches to psychological care in moral injury: A qualitative study. Journal of Clinical Psychology 79:10, pages 2404-2421.
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Michelle A. Weiss, Lataya Hawkins & Jeffrey Scott Yarvis. (2023) Moral injury in women military members and Veterans: What do we really know?. Journal of Military, Veteran and Family Health 9:4, pages 129-136.
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Natasha Biscoe, Amanda Bonson, Angela Nickerson & Dominic Murphy. (2023) Factors associated with exposure to potentially morally injurious events (PMIEs) and moral injury in a clinical sample of veterans. European Journal of Trauma & Dissociation 7:3, pages 100343.
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Gadi Zerach, Ariel Ben-Yehuda & Yossi Levi-Belz. (2023) A prospective investigation of protective factors for moral injury and psychiatric symptomatology among Israeli combatants: A Latent Class Analysis approach. International Journal of Social Psychiatry 69:5, pages 1134-1144.
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Gadi Zerach & Yossi Levi‐Belz. (2022) Exposure to potentially morally injurious events, disruption in assumptive world, moral injury symptoms, and psychological distress among Israeli female veterans. Stress and Health 39:3, pages 651-662.
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Jan Grimell & Hazel R. Atuel. (2023) Beyond PTSD: A Multi-Case Study Exploring Identity, Moral Injury, and Spiritual Injury. Journal of Veterans Studies 9:3, pages 9-22.
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Victoria Williamson, D Murphy, S AM Stevelink, E Jones, S Allen & N Greenberg. (2023) Family and occupational functioning following military trauma exposure and moral injury. BMJ Military Health 169:3, pages 205-211.
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Gadi Zerach, Ariel Ben-Yehuda & Yossi Levi-Belz. (2023) Pre-deployment aggressiveness, combat exposure and moral injury as contributors to posttraumatic stress symptoms among combatants: A two-year prospective study. Journal of Psychiatric Research 161, pages 158-164.
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Tine Molendijk. (2023) Moral Coping or Simply Uncomplicated Soldiering? How Soldiers Avoid Moral Injury Through Simplification, Justification, Rationalization, and Compartmentalization. Armed Forces & Society, pages 0095327X2311659.
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Natasha Benfer, Maya Bina N. Vannini, Breanna Grunthal, Benjamin C. Darnell, Gadi Zerach, Yossi Levi-Belz & Brett T. Litz. (2023) Moral injury symptoms and related problems among service members and Veterans: A network analysis. Journal of Military, Veteran and Family Health 9:2, pages 52-71.
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Kimber J. Parry, Bret L. Hicken, Wei Chen, Jianwei Leng, Steven Allen & Zachary Burningham. (2022) Impact of moral injury and posttraumatic stress disorder on health care utilization and suicidality in rural and urban veterans. Journal of Traumatic Stress 36:1, pages 117-128.
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Shannon Louise Allen, Gavin Eric Oxburgh & Matthew Donal Kiernan. (2023) Investigating the Moral Challenges Experienced by UK Service Police Veterans. Journal of Veterans Studies 9:1, pages 31-45.
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Rachel A. Plouffe, Bethany Easterbrook, Aihua Liu, Margaret C. McKinnon, J. Don Richardson & Anthony Nazarov. (2021) Psychometric Evaluation of the Moral Injury Events Scale in Two Canadian Armed Forces Samples. Assessment 30:1, pages 111-123.
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Eric Vermetten, Rakesh Jetly, Lorraine Smith-MacDonald, Chelsea Jones & Suzette Bremault-Phillip. 2023. Veteran and Military Mental Health. Veteran and Military Mental Health 231 261 .
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Victoria Williamson, Dominic Murphy & Neil Greenberg. (2022) Veterinary professionals’ experiences of moral injury: A qualitative study. Veterinary Record 192:2.
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Shefaly Shorey & Phyllis Zhi En Wong. (2021) Vicarious Trauma Experienced by Health Care Providers Involved in Traumatic Childbirths: A Meta-Synthesis. Trauma, Violence, & Abuse 23:5, pages 1585-1598.
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Deana Goldin, Carissa Cabán-Alemán & Heidi von Harscher. (2022) Moral Injury and Telemental Health Services: An Overview on Clinician Impact. Journal of Psychosocial Nursing and Mental Health Services 60:11, pages 49-54.
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Rachel M. Ranney, Shira Maguen, Paul A. Bernhard, Nicholas Holder, Dawne Vogt, John R. Blosnich & Aaron I. Schneiderman. (2022) Moral injury and chronic pain in veterans. Journal of Psychiatric Research 155, pages 104-111.
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Joanna Rak. (2022) The Impact of Morally Injurious Events on the Dynamics of Mobilization for Women’s Rights in Poland. Przegląd Politologiczny:3, pages 35-45.
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Sonya B. Norman, Brandon Nichter, Shira Maguen, Peter J. Na, Paula P. Schnurr & Robert H. Pietrzak. (2022) Moral injury among U.S. combat veterans with and without PTSD and depression. Journal of Psychiatric Research 154, pages 190-197.
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Anna C. Rivera, Cynthia A. LeardMann, Rudolph P. Rull, Adam Cooper, Steve Warner, Dennis Faix, Edwin Deagle, Rob Neff, Ryan Caserta & Amy B. Adler. (2022) Combat exposure and behavioral health in U.S. Army Special Forces. PLOS ONE 17:6, pages e0270515.
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Sophia L. Roth, Aamna qureshi, Heather M. Moulden, Gary A. Chaimowitz, Ruth A. Lanius, Bruno J. Losier & Margaret C. Mckinnon. (2021) “Trapped in their Shame”: A Qualitative Investigation of Moral Injury in Forensic Psychiatry Patients. Criminal Justice and Behavior 49:4, pages 593-612.
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Teun Eikenaar. (2022) Relating to moral injuries: Dutch mental health practitioners on moral injury among military and police workers. Social Science & Medicine 298, pages 114876.
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Imelu G. Mordeno, Debi S. Galela, Dame Lent L. Dingding, Levin R. Torevillas & Kharissa B. Villamor. (2022) Meaning Making and Change in Situational Beliefs Serially Mediate the Relationship Between Moral Injury and Posttraumatic Stress Disorder. Psychological Studies 67:1, pages 63-71.
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Alexander Puhalla, Aidan Flynn & Amanda Vaught. (2021) Shame as a Mediator in the Association Between Emotion Dysregulation and Posttraumatic Stress Disorder Symptom Reductions Among Combat Veterans in a Residential Treatment Program. Journal of Traumatic Stress 35:1, pages 302-307.
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Yossi Levi-Belz, Neta Dichter & Gadi Zerach. (2020) Moral Injury and Suicide Ideation Among Israeli Combat Veterans: The Contribution of Self-Forgiveness and Perceived Social Support. Journal of Interpersonal Violence 37:1-2, pages NP1031-NP1057.
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Jesse Kirkpatrick. (2022) Moral Injury and Revisionist Just War Theory. Ethics & International Affairs 36:1, pages 27-35.
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Aviya Ashwal-Malka, Keren Tal-Kishner & Daniel Feingold. (2022) Moral injury and cannabis use disorder among Israeli combat veterans: The role of depression and perceived social support. Addictive Behaviors 124, pages 107114.
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Nicole A. Hall, Adam T. Everson, Madison R. Billingsley & Mary Beth Miller. (2021) Moral injury, mental health and behavioural health outcomes: A systematic review of the literature. Clinical Psychology & Psychotherapy 29:1, pages 92-110.
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Тетяна Гордовська. (2021) ОСОБЛИВОСТІ ПСИХОЛОГІЧНОЇ ТРАВМАТИЗАЦІЇ НАЩАДКІВ І СВІДКІВ ГОЛОДОМОРУ. Psychological Prospects Journal:38.
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Victoria Williamson, Dominic Murphy, Sharon A. M. Stevelink, Shannon Allen, Edgar Jones & Neil Greenberg. (2021) The impact of moral injury on the wellbeing of UK military veterans. BMC Psychology 9:1.
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Doron Amsalem, Amit Lazarov, John C. Markowitz, Aliza Naiman, Thomas E. Smith, Lisa B. Dixon & Yuval Neria. (2021) Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era. BMC Psychiatry 21:1.
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Victoria Williamson, D Murphy, S A M Stevelink, E Jones, S Wessely & N Greenberg. (2021) Confidentiality and psychological treatment of moral injury: the elephant in the room. BMJ Military Health 167:6, pages 451-453.
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Alanna Coady, L. T. C. Lataya Hawkins, Ruth Chartoff, Brett Litz & Sheila Frankfurt. (2021) Trauma, Spirituality, and Moral Injury: Assessing and Addressing Moral Injury in the Context of PTSD Treatment. Current Treatment Options in Psychiatry 8:4, pages 186-195.
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Gadi Zerach, Yossi Levi-Belz, Brandon J. Griffin & Shira Maguen. (2021) Patterns of exposure to potentially morally injurious events among Israeli combat veterans: A latent class analysis approach. Journal of Anxiety Disorders 79, pages 102378.
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Victoria Williamson, Neil Greenberg & Dominic Murphy. (2021) Predictors of moral injury in UK treatment seeking veterans. Child Abuse & Neglect 112, pages 104889.
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Gadi Zerach & Yossi Levi-Belz. (2021) Moral injury and mental health outcomes among Israeli health and social care workers during the COVID-19 pandemic: a latent class analysis approach. European Journal of Psychotraumatology 12:1.
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Jason A. Nieuwsma, Mira Brancu, Jennifer Wortmann, Melissa A. Smigelsky, Heather A. King & Keith G. Meador. (2020) Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis. Clinical Psychology & Psychotherapy 28:1, pages 239-250.
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Nikki Jamieson, Myfanwy Maple, Dorothy Ratnarajah & Kim Usher. (2020) Military moral injury: A concept analysis. International Journal of Mental Health Nursing 29:6, pages 1049-1066.
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Victoria Williamson, N Greenberg & D Murphy. (2020) Impact of moral injury on the lives of UK military veterans: a pilot study. BMJ Military Health 166:5, pages 302-306.
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Timothy J. Usset, Erika Gray, Brandon J. Griffin, Joseph M. Currier, Marek S. Kopacz, John H. Wilhelm & J. Irene Harris. (2020) Psychospiritual Developmental Risk Factors for Moral Injury. Religions 11:10, pages 484.
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Kim P Norman, Anita Govindjee, Seth R Norman, Michael Godoy, Kimberlie L Cerrone, Dustin W Kieschnick & William Kassler. (2020) Natural Language Processing Tools for Assessing Progress and Outcome of Two Veteran Populations: Cohort Study From a Novel Online Intervention for Posttraumatic Growth. JMIR Formative Research 4:9, pages e17424.
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Natalie M. Richardson, Angela L. Lamson, Maggie Smith, Sheena M. Eagan, Anisa M. Zvonkovic & Jakob Jensen. (2020) Defining Moral Injury Among Military Populations: A Systematic Review. Journal of Traumatic Stress 33:4, pages 575-586.
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