Addressing moral injury in the military.

Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one's moral beliefs. There is a pressing need for further research to advance understanding of the nature of moral injury; its relationship to mental disorders such as posttraumatic stress disorder and depression; triggering events and underpinning mechanisms; and prevalence, prevention and treatment. In the meantime, military leaders have an immediate need for guidance on how moral injury should be addressed and, where possible, prevented. Such guidance should be theoretically sound, evidence-informed and ethically responsible. Further, the implementation of any practice change based on the guidance should contribute to the advancement of science through robust evaluation. This paper draws together current research on moral injury, best-practice approaches in the adjacent field of psychological resilience, and principles of effective implementation and evaluation. This research is combined with the military and veteran mental health expertise of the authors to provide guidance on the design, implementation and evaluation of moral injury interventions in the military. The paper discusses relevant training in military ethical practice, as well as the key roles leaders have in creating cohesive teams and having frank discussions about the moral and ethical challenges that military personnel face.

Deriving benefits from stressful events: the role of engagement in meaningful work and hardiness.

This research explored the relationship between the meaningfulness of work, personality hardiness, and deriving long-term benefits from a stressful event. U.S. soldiers participating in a peacekeeping mission to Bosnia completed measures assessing the meaning of their work and personality hardiness midway through a 1-year deployment (mid-deployment) and completed a measure of deriving benefits from the deployment 4-5 months after it was over (postdeployment). Structural equation modeling revealed that personality hardiness was associated with being engaged in meaningful work during the deployment, which was strongly associated with deriving benefits from the deployment months after it was over. Enriching experiences were also associated with deriving benefits from the deployment. Discussion focuses on the linkages between personality processes, meaningful work, and deriving benefits from a stressful experience.

Military psychologists and the Partnership for Peace program in Albania.

A team of two military psychologists (the authors) traveled to Albania to provide training to Albanian military sociologists in psychological issues associated with peacekeeping deployment in connection with the North Atlantic Treaty Organization's Partnership for Peace program. The training, based on research conducted by the authors, emphasize the typical problems faced by peacekeepers. The information presented was adjusted to better meet the particular needs of the Albanians. Topics of primary interest to the Albanians are discussed with an emphasis on the Albanian cultural context. General lessons for future Partnership for Peace training are also presented.

International survey of military mental health professionals.

This paper reports on data from a survey of international military mental health professionals. In a series of open-ended questions, respondents were asked to describe their country in terms of the field of military psychology, the role of mental health professionals on deployment, the degree to which the field of mental health is accepted in the military, and their contact with their international counterparts. The survey was mailed to 44 different countries from July 1995 through July 1996. The data are based on 30 individual responses from 23 different countries. Cultural differences included the role of psychologists in the military and on deployment, the degree of professional isolation, and specific services provided by psychologists. Cultural similarities included the ambivalent response to the mental health field by military leaders, the use of psychology as a prevention tool, and the degree of interest in international contact and exchange. The discussion focuses on three obstacles to the acceptance of the mental health field and possible avenues for greater exchange of information among military professionals working in psychology-related fields.

Stress and health during medical humanitarian assistance missions.

The present research examined stress and health among service members deployed on a medical humanitarian assistance mission to Kazakstan. Team members were surveyed before and during their deployment. Team members underestimated how much stress they would experience in terms of isolation and inability to help the local population. Team members also used less adaptive coping mechanisms than anticipated and showed elevations in alcohol and cigarette consumption. Despite these negative experiences, reports of depression and physical symptoms did not increase during the deployment. This may have been a function of team members being personally involved in important and relevant work during the humanitarian operation.

Dimensions of psychological stress in peacekeeping operations.

U.S. military forces are increasingly involved in a variety of multinational peacekeeping and humanitarian assistance missions. How well combat-trained units and soldiers adapt to these new roles will determine U.S. success in such operations, as well as the future health and readiness of the force. In preparing soldiers for such missions, it is critical that leaders and health care providers have a clear understanding of the nature of the stressors they are likely to encounter. This report summarizes findings from a longitudinal, descriptive case study of a U.S. Army medical unit performing a peacekeeping mission in the former Yugoslavia. The goal of the investigation was to identify key sources of stress and to delineate the effect of these stressors on the health, morale, and mental readiness of soldiers. Findings suggest a range of psychological stressors that varies somewhat across operational phases of a peacekeeping mission. Furthermore, the degree of stress experienced in various areas correlates significantly with depression, psychiatric symptoms, and low reported morale. The range of stressors is reduced and summarized in a conceptually derived model of five underlying dimensions of psychological stress salient to soldier adaptation in peacekeeping operations: isolation, ambiguity, powerlessness, boredom, and danger/threat. This model provides a useful heuristic for organizing thinking about stress in peacekeeping operations and leads to several recommendations for "countermeasures" that organizational leaders can take to maintain soldier psychological readiness during peacekeeping operations.