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      The impact of trauma exposure and moral injury on UK military veterans: a qualitative study Translated title: El impacto de La exposición al trauma y daňo moral en los veteranos militares del reino unido:un estudio cualitativo Translated title: 创伤暴露和道德伤害对英国退伍军人的影响:一项定性研究

      research-article
      a , a , b , a , a , a , a
      European Journal of Psychotraumatology
      Taylor & Francis
      Moral injury, military veteran, trauma, PTSD, UK Armed Forces, morally injurious event, daño moral, trauma, militar, Reino Unido, veterano, salud mental, 道德伤害, 创伤, 军人, 英国, 退伍军人, 心理健康, • How the psychological consequences following morally injurious events compare to those encountered after a traumatic, but not a morally injurious event, remain poorly understood.• Qualitative telephone interviews were anonymously carried out with 30 UK military veterans.• Veterans’ cognitions and responses were found to differ following a morally injurious event compared to a traumatic, but not morally injurious event, which could have negative implications for daily functioning.

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          ABSTRACT

          Background: Exposure to a potentially morally injurious event (PMIE) has been found to be associated with a range of adverse mental health outcomes. However, how the psychological consequences following PMIEs compare to those encountered after a traumatic, but not a PMIE, remain poorly understood.

          Objective: The aim was to qualitatively explore UK military veterans’ responses to experiences of trauma and moral injury and the impact of such events on psychological wellbeing.

          Method: Thirty male veterans who reported exposure to traumatic and/or morally injurious events were recruited. Semi-structured qualitative interviews were conducted, and data were analysed using thematic analysis.

          Results: Six veterans described exposure to a non-morally injurious traumatic event, 15 reported experiencing a PMIE, and 9 described exposure to a ‘mixed’ event which was simultaneously morally injurious and traumatic. Veterans who encountered a PMIE described experiencing moral dissonance, or a clash between concurrently held sets of values (e.g. military values versus civilian values), which provoked considerable psychological distress. Veterans’ cognitions and responses were found to differ following a PMIE compared to a traumatic, but not PMIE, which could have negative implications for daily functioning. Several risk and protective factors for experiencing distress following a PMIE were described.

          Conclusions: This study provides some of the first evidence that events experienced by UK veterans can simultaneously be morally injurious and traumatic or life-threatening as well as highlighting the process by which moral injury may occur in UK veterans. These findings illustrate the need to examine effective pathways for prevention and intervention for veterans who have experienced a morally injurious event.

           

          Antecedentes: La exposición a un potencial evento moralmente perjudicial (PMIE por sus siglas en inglés) se ha asociado con un rango de resultados adversos en salud mental. Sin embargo, como las consecuencias psicológicas seguidas de PMIEs comparadas a aquellas encontradas después de un evento traumático, pero no un PMIE, permanece pobremente comprendido.

          Objetivo: El objetivo fue explorar cualitativamenbte las respuestas a experiencias de trauma y daño moral de veteranos militares del Reino Unido y el impacto de tales eventos en el bienestar psicológico.

          Método: Se reclutaron treinta veteranos varones que reportaron exposición a eventos traumáticos y/o moralmente perjudiciales. Se condujeron entrevistas cualitativas semiestructuradas, y los datos fueron analizados usando análisis temáticos.

          Resultados: Seis veteranos describieron exposición a eventos traumáticos no moralmente perjudiciales, quince reportaron haber experimentado un PMIE, y nueve describieron exposición a un evento ‘mixto’ el cual fue simultáneamente moralmente perjudicial y traumático. Los veteranos que encontraron una PMIE describieron experimentar disonancia moral, o un choque entre conjuntos de valores mantenidos simultáneamente (ej. Valores militares versus valores civiles), los cuales provocaron sufrimiento psicológico considerable. Se encontraron que las respuestas y cogniciones de los veteranos diferían después de un PMIE comparada con un evento traumático, pero no el PMIE, el cual podría tener implicancias negativas para el funcionamiento diario. Se describieron varios factores de riesgo y protectores por la experimentación de sufrimiento seguido a un PMIE.

          Conclusiones: este estudio provee algunas de las primeras evidencias que los eventos experimentados por los veteranos del Reino Unido pueden ser simultáneamente moralmente perjudiciales y traumáticos o de amenaza vital así como tambien enfatizar el proceso por el cual el daño moral puede ocurrir en los veteranos del Reino Unido. Estos hallazgos enfatizan la necesidad de examinar las vías efectivas para la prevención e intervención a veteranos que han experimentado un evento moral perjudicial.

           

          背景: 已发现暴露于潜在道德伤害事件 (PMIE) 与一系列不良心理健康结果有关。但是, 对于经历PMIE相较于非PMIE创伤后的心理后果仍知之甚少。

          目标: 旨在定性探索英国退伍军人对创伤和道德伤害经历的反应以及此类事件对心理健康的影响。

          方法: 招募了30名报告遭受创伤和/或道德伤害事件的男性退伍军人。进行了半结构化定性访谈, 并使用主题分析对数据进行了分析。

          结果: 六名退伍军人描述了暴露于非道德损伤性创伤事件, 十五名报告经历了PMIE, 九名退伍军人描述了暴露于‘混合’事件,即同时发生了道德伤害及创伤。遭遇PMIE的退伍军人描述了道德失调, 或同时持有的多套价值观 (例如军事价值观与平民价值观) 之间的冲突, 这引起了极大的心理困扰。相较于非PMIE创伤, 经历PMIE后退伍军人的认知和反应不同, 可能会对日常功能产生负面影响。描述了PMIE后经历困扰的几种风险和保护因素。

          结论: 本研究提供了一些初步证据, 表明英国退伍军人经历的事件可能同时在道德上造成伤害和创伤或威胁生命, 并重点介绍了英国退伍军人可能发生道德伤害的过程。这些结果强调有必要考查对经历过道德伤害事件的退伍军人进行预防和干预的有效途径。

          关键词: 道德伤害;创伤;军人;英国;退伍军人;心理健康。

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          Moral injury and moral repair in war veterans: a preliminary model and intervention strategy.

          Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury). Although there has been some research on the consequences of unnecessary acts of violence in war zones, the lasting impact of morally injurious experience in war remains chiefly unaddressed. To stimulate a critical examination of moral injury, we review the available literature, define terms, and offer a working conceptual framework and a set of intervention strategies designed to repair moral injury.
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            This paper explores the most common methods of data collection used in qualitative research: interviews and focus groups. The paper examines each method in detail, focusing on how they work in practice, when their use is appropriate and what they can offer dentistry. Examples of empirical studies that have used interviews or focus groups are also provided.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2020
                9 January 2020
                : 11
                : 1
                : 1704554
                Affiliations
                [a ]King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London , London, UK
                [b ]Combat Stress, Research Department, Tyrwhitt House, Combat Stress , Leatherhead, Surrey, UK
                Author notes
                CONTACT Victoria Williamson Victoria.williamson@ 123456kcl.ac.uk Kings Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London , 10 Cutcombe Road, London, SE5 9RJ, UK
                Author information
                http://orcid.org/0000-0002-3110-9856
                http://orcid.org/0000-0002-9596-6603
                http://orcid.org/0000-0002-7655-7986
                http://orcid.org/0000-0003-4550-2971
                Article
                1704554
                10.1080/20008198.2019.1704554
                6968592
                32002137
                59273cf1-b721-4118-8541-60ce436aaa7d
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 July 2019
                : 26 November 2019
                : 05 December 2019
                Page count
                Tables: 2, References: 37, Pages: 11
                Funding
                Funded by: Forces in Mind Trust 10.13039/100012345
                Award ID: FiMT17/0920E
                This research was funded by the Forces in Mind Trust [FiMT17/0920E]. This paper represents independent research part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (SS). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
                Categories
                Basic Research Article

                Clinical Psychology & Psychiatry
                moral injury,military veteran,trauma,ptsd,uk armed forces,morally injurious event,daño moral,militar,reino unido,veterano,salud mental,道德伤害,创伤,军人,英国,退伍军人,心理健康,• how the psychological consequences following morally injurious events compare to those encountered after a traumatic, but not a morally injurious event, remain poorly understood.• qualitative telephone interviews were anonymously carried out with 30 uk military veterans.• veterans’ cognitions and responses were found to differ following a morally injurious event compared to a traumatic, but not morally injurious event, which could have negative implications for daily functioning.

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