Moral injury appraisals and posttraumatic stress symptoms in trauma-exposed police officers: a latent class analysis

Figures & data

Table 1. Descriptive statistics of demographic variables and clinical characteristics.

Characteristics	N	%	Mean	SD	Range
Age in years			46.1	11.3	21.3–75.9
Gender
Male	294	69.8
Female	127	30.2
Years of employment			21.3	11.2	1–48
PTSD severity			28.6	13.5	7–70
General psychopathology			1.4	0.7	0.1–3.6
Moral injury appraisals			17.6	6.7	9–36

Note. PTSD = Posttraumatic Stress Disorder.

Table 2. Descriptive statistics of qualitative analysis of potentially traumatic events.

Potentially traumatic events (PTEs)	Total
	N (%)
Suicide	103 (16.6)
Road traffic accidents	85 (13.7)
Resuscitation	60 (9.7)
Shooting incidents	55 (8.9)
Physical violence (in absence of a weapon)	47 (7.6)
Finding a corpse (not in relation to suicide)	30 (4.8)
Stabbing incidents	24 (3.9)
Threatened with the death (verbal or physical with weapon) without actual harm	22 (3.5)
Drowning	20 (3.2)
Riot / violence by crowd	19 (3.1)
Murder or liquidation	17 (2.7)
Fire / explosion	13 (2.1)
Fateful accidents (e.g. falling from stairs)	11 (1.8)
Family incidents (e.g. parents kill themselves and children)	10 (1.6)
Confrontation with a victim of sexual violence	8 (1.3)
Sexual violence	8 (1.3)
Hostage	8 (1.3)
Bad news conversations	7 (1.1)
Accident or violence with an animal	5 (0.8)
A (potential) HIV contamination	2 (0.3)
PTE could not be categorized	63 (10.2)

Table 3. Goodness-of-fit indices for 6 profiles.

Model	Log-likelihood	AIC	BIC	SSBIC	B-LRT	p-value	LMR-A	p-value	Entropy
1 profile	−7021.253	14100.506	14217.743	14125.717	–	–	–	–	1.000
2 profiles	−6246.280	12610.559	12849.075	12661.849	1549.947	.0000	1541.444	.0000	0.928
3 profiles	−5889.931	11957.862	12317.657	12035.232	712.697	.0000	708.787	.0000	0.946
4 profiles	−5726.787	11691.575	12172.648	11795.024	326.288	.0000	324.498	.0000	0.935
5 profiles	−5610.205	11518.409	12120.762	11647.938	233.165	.0000	231.886	.0334	0.934
6 profiles	−5531.802	11421.603	12145.235	11577.211	156.806	.0000	155.946	.0523	0.923

Note. AIC = Akaike information criterion; BIC = Bayesian information criterion; SS-BIC = sample size-adjusted Bayesian information criterion; LMR-A = Lo-Mendell-Rubin-likelihood ratio adjusted; B-LRT = bootstrap-likelihood ratio test of model fit.

Figure 1. Symptom endorsement probability for the five-class solution.

Table 4. Descriptive statistics for the five-class solution.

Measure	Class 1: Low MI, high PTSD			Class 2: High MI, low PTSD			Class 3: High MI, high PTSD			Class 4: Low MI, low PTSD			Class 5: High MI-other, high PTSD
	N(%)	M	SD	N(%)	M	SD	N(%)	M	SD	N(%)	M	SD	N(%)	M	SD
Age	119	44.9	11.4	46	49.6	10.7	72	47.2	10.7	71	44.3	12.1	113	46.4	11.0
Gender	119			46			72			71			113
Female	35 (29.4)			8 (17.4)			24 (33.3)			19 (26.8)			41 (36.3)
Male	84 (70.6)			38 (82.6)			48 (66.7)			52 (73.2)			72 (63.7)
Years of employment	119	20.2	11.0	46	24.8	11.2	72	21.9	11.3	71	19.6	12.1	113	21.8	11.0
PTSD severity	119	31.8	7.8	44	13.4	6.2	71	37.9	10.4	68	10.1	6.1	112	36.6	8.8
General psychopathology	119	1.3	0.6	46	1.1	0.7	72	1.8	0.6	71	0.8	0.4	107	1.7	0.6
Moral injury appraisals	119	12.2	3.3	46	22.3	4.6	72	27.1	4.3	71	12.2	3.1	113	18.6	3.3

Note. PTSD = Posttraumatic Stress Disorder; MI = Moral Injury.

Table 5. Summary of multinomial regression analyses with sociodemographic variables.

	Reference profile
	Class 1: Low MI, high PTSD (N = 119)				Class 2: High MI, low PTSD (N = 46)				Class 3: High MI, high PTSD (N = 72)				Class 4: Low MI, low PTSD (N = 71)
Comparison profile	B	SE	CI	p- value	B	SE	CI	p- value	B	SE	CI	p- value	B	SE	CI	p- value
Class 2: High MI, low PTSD (N = 46)
Age	0.036	0.018	2.046	.041
Gender	−0.510	0.498	−1.023	.306
Class 3: High MI, high PTSD (N = 72)
Age	0.022	0.014	1.567	.117	−0.015	0.019	−0.787	.431
Gender	0.318	0.339	0.939	.348	0.828	0.526	1.575	.115
Class 4: Low MI, low PTSD (N = 71)
Age	−0.007	0.016	−0.465	.642	−0.044	0.020	−2.140	.032	−0.029	0.016	−1.782	.075
Gender	−0.154	0.363	−0.423	.672	0.356	0.541	0.659	.510	−0.472	0.382	−1.234	.217
Class 5: High MI-other, high PTSD (N = 113)
Age	0.017	0.013	1.338	.181	−0.019	0.018	−1.071	.284	−0.004	0.014	−0.312	.755	0.025	0.015	1.615	.106
Gender	0.428	0.311	1.375	.169	0.937	0.502	1.867	.062	0.109	0.336	0.325	.745	0.581	0.351	1.657	.098

Note. PTSD = Posttraumatic Stress Disorder; MI = Moral Injury.

Table 6. Summary of multinomial regression analyses with PTSD severity and general psychopathology.

	Reference profile
	Class 1: Low MI, high PTSD (N = 119)				Class 2: High MI, low PTSD (N = 46)				Class 3: High MI, high PTSD (N = 72)				Class 4: Low MI, low PTSD (N = 71)
Comparison profile	B	SE	CI	p- value	B	SE	CI	p- value	B	SE	CI	p-value	B	SE	CI	p-value
Class 2: High MI, low PTSD (N = 46)
PTSD	−0.765	0.197	−3.888	.000
General psychopathology	1.956	0.799	2.448	.014
Class 3: High MI, high PTSD (N = 72)
PTSD	0.061	0.021	2.945	.003	0.826	0.197	4.197	.000
General psychopathology	0.889	0.282	3.151	.002	−1.067	0.815	−1.310	.190
Class 4: Low MI, low PTSD (N = 71)
PTSD	−0.821	0.197	−4.178	.000	−0.056	0.037	−1.523	.128	−0.882	0.197	−4.485	.000
General psychopathology	0.396	0.892	0.444	.657	−1.560	0.549	−2.839	.005	−0.493	0.904	−0.545	.586
Class 5: High MI-other, high PTSD (N = 113)
PTSD	0.042	0.018	2.308	.021	0.807	0.199	4.066	.000	−0.019	0.019	−0.980	.327	0.864	0.198	4.352	.000
General psychopathology	0.765	0.273	2.804	.005	−1.191	0.814	−1.463	.143	−0.124	0.260	−0.479	.632	0.368	0.904	0.407	.684

Note. PTSD = Posttraumatic Stress Disorder; MI = Moral Injury.

Table 7. Summary of multinomial regression analyses with four items of the BSI.

	Reference profile
	Class 1: Low MI, high PTSD (N = 119)				Class 2: High MI, low PTSD (N = 46)				Class 3: High MI, high PTSD (N = 72)				Class 4: Low MI, low PTSD (N = 71)
Comparison profile	B	SE	CI	p- value	B	SE	CI	p- value	B	SE	CI	p- value	B	SE	CI	p- value
Class 2: High MI, low PTSD (N = 46)
BSI 10*	−0.330	0.418	−0.788	.431
BSI 34*	1.959	1.987	0.986	.324
BSI 50*	−0.370	0.472	−0.784	.433
BSI 52*	−0.520	0.459	−1.133	.257
Class 3: High MI, high PTSD (N = 72)
BSI 10	0.337	0.355	0.950	.342	0.667	0.457	1.460	.144
BSI 34	3.601	1.623	2.218	.027	1.642	1.236	1.328	.184
BSI 50	−0.370	0.472	−0.784	.433	0.318	0.512	0.620	.535
BSI 52	−0.520	0.459	−1.133	.257	1.306	0.537	2.433	.015
Class 4: Low MI, low PTSD (N = 71)
BSI 10	−0.733	0.416	−1.761	.078	−0.404	0.497	−0.812	.417	−1.071	0.442	−2.425	.015
BSI 34	3.006	1.815	1.657	.098	1.047	1.542	0.679	.497	−0.595	0.936	−0.636	.525
BSI 50	−0.850	0.523	−1.626	.104	−0.480	0.620	−0.774	.439	−0.798	0.544	−1.465	.143
BSI 52	−0.860	0.417	−2.063	.039	−0.340	0.553	−0.615	.539	−1.646	0.466	−3.529	.000
Class 5: High MI-other, high PTSD (N = 113)
BSI 10	0.887	0.314	2.826	.005	1.217	0.415	2.936	.003	0.550	0.346	1.591	.112	1.621	0.397	4.079	.000
BSI 34	2.104	1.695	1.241	.215	0.144	1.304	0.111	.912	−1.498	0.542	−2.762	.006	−0.903	1.004	−0.900	.368
BSI 50	−0.205	0.344	−0.597	.550	0.165	0.481	0.342	.732	−0.153	0.386	−0.397	.692	0.644	0.521	1.236	.216
BSI 52	0.191	0.318	0.599	.549	0.711	0.473	1.501	.133	−0.595	0.394	−1.510	.131	1.050	0.416	2.524	.012

Note. *BSI 10: ‘Feeling that most people cannot be trusted’; BSI 34: ‘The idea that you should be punished for your sins’; BSI 50: ‘Feelings of worthlessness’; BSI 52: ‘Feeling of guilt’.

Data availability statement

The data are not publicly available due to their containing information that could compromise the privacy of the participants. Also, participants were not asked to give consent of saving their data in a public data repository. The MPlus output files are available at https://osf.io/6z92p/?view_only=3efc5baaf4b74bd7895dc303bed3b749.