A latent profile analysis of moral injury appraisals in refugees

Figures & data

Table 1. Goodness-of-fit indices for unconditional latent profile models.

Model	Log-Likelihood	AIC	BIC	SSBIC	Entropy	LMR-LRT	B-LRT
1 Profile	−2933.81	5903.62	5964.71	5907.67
2 Profile	−2403.39	4862.77	4957.79	4869.06	0.97	<.001	.001
3 Profile	−2196.73	4469.45	4598.41	4477.99	0.96	.001	<.001
4 Profile	−2037.65	4171.3	4334.19	4182.08	0.96	.324	<.001
5 Profile	−1965.8	4047.6	4244.43	4060.63	0.97	.163	<.001
6 Profile	−1944.78	4025.57	4256.34	4040.84	0.97	.591	<.001
7 Profile	−1906.15	3968.29	4233	3985.81	0.94	.380	<.001

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

Table 2. Moral injury items means and standard deviations by latent profiles.

	Profile 1 No-MI	Profile 2 MI-Others	Profile 3 MI-Others + Self
I am troubled by morally wrong things done by other people	1.90 (0.10)	3.52 (0.08)	3.41 (0.10)
I am troubled because I saw other people do things that were morally wrong	1.63 (0.10)	3.27 (0.09)	3.47 (0.09)
I am troubled because I heard about other people doing things that were morally wrong	1.76 (0.11)	3.49 (0.07)	3.40 (0.10)
I am troubled because other people have acted against important moral rules	1.71 (0.10)	3.51 (0.07)	3.42 (0.10)
I am troubled because I did things that were morally wrong	1.35 (0.07)	1.49 (0.10)	3.27 (0.12)
I am troubled because I acted against important moral rules	1.24 (0.06)	1.14 (0.04)	3.27 (0.12)
I am troubled by morally wrong things I have done	1.26 (0.09)	1.21 (0.06)	3.41 (0.11)
I went against my own morals by failing to do something I should have done	1.24 (0.07)	1.22 (0.06)	2.89 (0.11)
I am troubled because I acted in ways that went against my own moral code or values	1.27 (0.10)	1.21 (0.06)	3.39 (0.08)

MI = Moral Injury.

Table 3. Factor pattern matrix loading on trauma events.

	Factor loadings
	Factor 1: Deprivation/lack of basic needs	Factor 2: Exposure to abuse/pain	Factor 3: Witness to conflict/killing
Lack of food or water	.687	−.001	.253
Ill health without access to medical care	.671	.285	.002
Lack of shelter	.813	.011	.162
Imprisonment	.035	.290	.482
Serious injury	.049	.602	.206
Combat situation	.114	.050	.615
Brain washing	.097	.467	.175
Rape or sexual abuse	−.082	.446	.291
Forced isolation from others	−.094	.888	.067
Being close to death	.145	.765	−.026
Forced separation from family members	−.013	1.027	−.143
Murder of family or friend	−.203	−.027	1.030
Unnatural death of family or friend	−.000	−.165	1.067
Murder of stranger or strangers	−.333	.029	.905
Lost or kidnapped	−.004	.459	.405
Torture	.092	.498	.283

Table 4. Factor pattern matrix loading on living difficulties.

	Factor loadings
	F1	F2	F3	F4	F5
Difficulties communicating with other people	.444	.174	.079	.275	−.027
Discrimination or conflict with other people in Australia	.865	.357	−.052	−.098	−.032
Discrimination or conflict with other ethnic groups in Australia	.813	.333	.011	−.049	.074
Conflict within your community	.630	−.011	.357	.144	−.025
Conflict with your family and friends	.677	−.076	.066	.057	.024
Separation from your family	.123	.035	.665	.290	.016
Worry about family back home	−.166	.029	.664	.310	−.033
Being unable to return home in an emergency	−.025	−.025	.750	.106	.046
Difficulties with the family reunion process	−.055	.361	626	−.033	.090
Not being allowed to work	−.298	.477	.194	−.041	.429
Not being able to find work	−.122	.462	.009	.102	.423
Bad working conditions	−.006	.439	−.058	.237	.332
Not being able to access English language training	.124	.699	−.236	.232	.220
Practical difficulties with accessing or undertaking study	.054	.534	.124	.323	.003
Difficulties with immigration officials or understanding immigration procedures	.120	.534	.124	.323	.003
Not being allowed to apply for a permanent visa	−.207	.952	−.040	.061	−.043
Difficulty accessing legal advice or support	.011	.736	.008	.201	.099
Being fearful about being sent to Australian detention centre or an off-shore processing facility.	−.294	.928	.080	−.051	.034
Being fearful of being sent back to your country of origin in the future	−.294	.785	.211	.003	−.038
Difficulties with the law, such as trouble with police or being fined	.118	.493	.062	.201	−.044
Not having access to Medicare	.038	.076	.053	.821	−.022
Difficulties accessing treatment for health or mental health problems	.135	.346	.037	.474	−.060
Not enough money to buy food, pay the rent and bills, or buy necessary clothes	−.106	.034	.018	.701	.363
Difficulty accessing public transport, or not having enough money to use public transport	−.057	.218	−.077	.623	.334
Difficulties obtaining financial assistance from Government or Charities	−.003	−.101	.042	.841	.164
Difficulties relating to housing	.029	.442	−.035	.168	.315
Isolation	.364	−.065	.491	.119	.548
Loneliness	.284	.206	.507	−.035	.429
Boredom	.065	.256	.314	−.024	.560
Worry about how refugees and asylum-seekers are presented in the media	.007	.568	.213	.194	−.018
Worry about family members or friends in detention centres or offshore processing facilities	−.238	.690	−.093	.075	−.031
Meeting financial obligations to family back home	.011	.261	.471	.014	−.317

F1 = Community related/social difficulties; F2 = Visa/settlement related concerns; F3 = Difficulties/worries due to being separated from family; F4 = Hardships related to daily living/finances; F5 = Lack of community/stimulation.

Figure 1. Means of moral injury item responses for each latent profile.

Table 5. Predictors of profile membership.

	Est	SE	Est/SE	p
MI-O vs No-MI
HTQ-F1-Deprivation/lack of basic needs	0.03	0.36	0.07	.943
HTQ-F2-Exposure to abuse/pain	−0.59	0.56	−1.04	.297
HTQ-F3-Witness to conflict/killing	0.38	0.55	0.69	.494
LDC-F1-Community related/social difficulties	0.28	0.27	1.02	.306
LDC-F2-Visa/settlement related concerns	0.89	0.35	2.53	.011
LDC-F3-Difficulties/worries of family separation	0.33	0.25	1.31	.191
LDC-F4-Hardships of daily living/finances	0.17	0.32	0.53	.598
LDC-F5-Lack of community/stimulation	−0.34	0.29	−1.15	.251
AGE	0.03	0.02	2.03	.042
SEX	0.21	0.43	0.48	.631
MI-OS vs No-MI
HTQ-F1-Deprivation/lack of basic needs	−1.13	0.42	−2.67	.008
HTQ-F2-Exposure to abuse/pain	1.37	0.57	2.40	.016
HTQ-F3-Witness to conflict/killing	−0.54	0.54	−1.00	.317
LDC-F1-Community related/social difficulties	0.36	0.28	1.27	.206
LDC-F2-Visa/settlement related concerns	0.57	0.35	1.61	.107
LDC-F3-Difficulties/worries of family separation	0.25	0.31	0.78	.433
LDC-F4-Hardships of daily living/finances	0.75	0.33	2.28	.023
LDC-F5-Lack of community/stimulation	−0.13	0.29	−0.45	.650
AGE	0.04	0.02	5.50	.013
SEX	0.75	0.47	1.59	.113
MI-OS vs. MI-O
HTQ-F1-Deprivation/lack of basic needs	−1.15	0.39	−2.97	.003
HTQ-F2-Exposure to abuse/pain	1.95	0.50	3.94	<.001
HTQ-F3-Witness to conflict/killing	−0.92	0.42	−2.18	.029
LDC-F1-Community related/social difficulties	0.08	0.24	0.35	.729
LDC-F2-Visa/settlement related concerns	−0.32	0.31	−1.00	.316
LDC-F3-Difficulties/worries of family separation	−0.08	0.29	−0.27	.786
LDC-F4-Hardships of daily living/finances	0.58	0.27	2.15	.032
LDC-F5-Lack of community/stimulation	0.21	0.29	0.71	.476
AGE	0.00	0.02	0.50	.621
SEX	0.54	0.38	1.42	.157

Est = Standardized estimate; SE = Standard Error; p = significance; MI-O = Moral Injury-Other; MI-OS = Moral Injury- Other + Self; No-MI = No Moral Injury; HTQ = Harvard Trauma Questionnaire; LDC = Post-migration living difficulties.