Defining and Measuring Moral Injury: Rationale, Design, and Preliminary Findings From the Moral Injury Outcome Scale Consortium.

In the current paper, we first describe the rationale for and methodology employed by an international research consortium, the Moral Injury Outcome Scale (MIOS) Consortium, the aim of which is to develop and validate a content-valid measure of moral injury as a multidimensional outcome. The MIOS Consortium comprises researchers and clinicians who work with active duty military service members and veterans in the United States, the United Kingdom, the Netherlands, Australia, and Canada. We describe the multiphase psychometric development process being conducted by the Consortium, which will gather phenomenological data from service members, veterans, and clinicians to operationalize subdomains of impact and to generate content for a new measure of moral injury. Second, to illustrate the methodology being employed by the Consortium in the first phase of measure development, we present a small subset of preliminary results from semistructured interviews and questionnaires conducted with care providers (N = 26) at three of the 10 study sites. The themes derived from these initial preliminary clinician interviews suggest that exposure to potentially morally injurious events is associated with broad psychological/behavioral, social, and spiritual/existential impacts. The early findings also suggest that the outcomes associated with acts of commission or omission and events involving others' transgressions may overlap. These results will be combined with data derived from other clinicians, service members, and veterans to generate the MIOS.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Definiendo y midiendo el daño moral: fundamentos, diseño y resultados preliminares de la escala consorcio de consecuencias del daño moral DEFINIENDO Y MIDIENDO EL DAÑO MORAL En el documento actual, describimos en primer lugar los fundamentos y la metodología empleados por un consorcio internacional de investigación, la Escala Consorcio de consecuencias del daño moral (MIOS en sus siglas en inglés), cuyo objetivo es desarrollar y validar una medida de daño moral con contenido válido y como consecuencias multidimensionales. El Consorcio MIOS está compuesto por investigadores y clínicos que trabajan con miembros del servicio militar activos y veteranos en los Estados Unidos, el Reino Unido, los Países Bajos, Australia y Canadá. Describimos el proceso de desarrollo psicométrico multifase que está llevando a cabo el Consorcio, que recopilará datos fenomenológicos de miembros del servicio, veteranos y clínicos para poner en práctica subdominios de impacto y generar contenido para una nueva medida de daño moral. En segundo lugar, para ilustrar la metodología empleada por el Consorcio en la primera fase de desarrollo de la medida, presentamos un pequeño subconjunto de resultados preliminares de entrevistas semiestructuradas y cuestionarios realizados con proveedores de atención (N = 26) en tres de los 10 sitios de estudio. Los temas derivados de estas primeras entrevistas clínicas preliminares sugieren que la exposición a eventos potencialmente dañinos moralmente está asociada con amplios impactos psicológicos / conductuales, sociales y espirituales / existenciales. Los primeros hallazgos también sugieren que los resultados asociados con actos de comisión u omisión y eventos que involucran las transgresiones de otros pueden superponerse. Estos resultados se combinarán con datos derivados de otros clínicos, miembros del servicio y veteranos para generar el MIOS.

Sexual Dysfunction in Male Canadian Armed Forces Members and Veterans Seeking Mental Health Treatment.

INTRODUCTION: There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage. MATERIALS AND METHODS: Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction. RESULTS: Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05-1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse. CONCLUSIONS: Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.

Sexual Functioning Among a Cohort of Treatment-Seeking Canadian Military Personnel and Veterans With Psychiatric Conditions.

OBJECTIVE: The aim of this study was to assess potential predictors of sexual dysfunction and dissatisfaction in a sample of 99 current and former Canadian Forces members attending the Parkwood Hospital Operational Stress Injury Clinic for mental health treatment. METHODS: Respondents completed a number of questionnaires assessing sexual functioning, post-traumatic stress disorder symptom severity, health-related quality of life, and self-perceived masculinity traits. RESULTS: Regression analyses revealed that role limitations because of physical problems predicted erectile functioning (ß = 0.107, p = 0.075), whereas vitality predicted orgasmic functioning (ß = 0.044, p = 0.032). Hypermasculinity was the strongest predictor of sexual desire (ß = 0.466, p = 0.036), and sexual satisfaction was significantly predicted by bodily pain (ß = 0.036, p = 0.019). Preliminary analyses revealed a significant mediating effect of bodily pain on the relationship between post-traumatic stress disorder symptom severity. CONCLUSIONS: Results suggest a nuanced interplay between physical health and mental health factors regarding sexual functioning in treatment-seeking military personnel and veterans; however, further research is needed to better delineate the relationship between the 2.

The effects of children's exposure to domestic violence: a meta-analysis and critique.

A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Zr = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.

Somatic symptoms and health-related quality of life among treatment-seeking Canadian Forces personnel with PTSD.

This study examined the association between somatic complaints and health-related quality of life (HR-QoL) in treatment-seeking Canadian military personnel with military-related Posttraumatic Stress Disorder (PTSD). Current and former Canadian Forces (CF) members attending the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario (N=291) were administered self-report questionnaires assessing number and severity of somatic complaints, PTSD and depressive symptom severity, and mental and physical health-related quality of life (HR-QoL) prior to commencing treatment. Regression analyses were used to identify the role of somatic complaints on physical and mental HR-QoL, after controlling for PTSD symptom cluster and depressive symptom severity. Somatic symptom severity accounted for only a small amount of the variance in mental HR-QoL after accounting for PTSD symptom cluster and depressive symptom severity, but accounted for a larger proportion of the variance in physical HR-QoL after accounting for PTSD cluster and depressive symptom severity. Understanding the role of somatization in the symptom-presentation of military personnel with PTSD may provide additional avenues for treatment with this population.

Examining the association between psychiatric illness and suicidal ideation in a sample of treatment-seeking Canadian peacekeeping and combat veterans with posttraumatic stress disorder PTSD.

OBJECTIVE: Our study examines the association between suicidal ideation and and self-reported symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) in a sample of treatment-seeking Canadian combat and peacekeeping veterans; and identifies potential predictors of suicidal ideation. METHODS: Actively serving Canadian Forces and Royal Canadian Mounted Police members and veterans seeking treatment at the Parkwood Hospital Operational Stress Injury Clinic (n = 250) completed measures including the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, the Alcohol Use Disorder Identification Test, and the PTSD Checklist-Military Version (PCL-M) between January 2002 and December 2010. Regression analyses were used to determine the respective impact of PTSD, and self-reported symptoms of MDD, GAD, AUD, and anxiety on suicidal ideation. RESULTS: Most people met PCL-M screening criteria for PTSD (73.6%, n = 184), while 70.8% (n = 177) screened positively for a probable major depressive episode. PTSD symptom was significantly associated with suicidal ideation (ß = 0.412, P < 0.001). After controlling for self-reported depressive symptom severity, AUD severity, and generalized anxiety, PTSD severity was no longer significantly associated with suicidal ideation (ß = 0.043, P = 0.58). CONCLUSIONS: Although PTSD alone is associated with suicidal ideation, after controlling for common comorbid psychiatric illnesses, self-reported depressive symptom severity emerged as the most significant predictor of suicidal ideation. These findings support the importance of screening for comorbidities, particularly an MDD, as potentially modifiable conditions that are strongly related to suicidal ideation in military personnel's endorsing criteria for PTSD.