Role of morality in the experience of guilt and shame within the armed forces.
OBJECTIVE
Despite advances in our understanding of mental health issues among military forces, a large proportion of military personnel continue to exhibit deployment-related psychological issues. Recent work has identified symptoms of guilt and shame related to moral injury as contributing significantly to combat-related mental health issues. This systematic scoping review explores the association between morality and symptoms of guilt and shame within military forces.


METHODS
A search of the literature pertaining to guilt, shame and morality within military samples was conducted.


RESULTS
Nineteen articles were selected for review. There is strong evidence linking exposure to and the perceived perpetration of moral transgressions with experiences of guilt and shame. Critically, symptoms of guilt and shame were related to adverse mental health outcomes, particularly the onset of post-traumatic stress disorder (PTSD). No studies have explored moral judgment in conjunction with assessments of guilt or moral injury.


CONCLUSIONS
These findings have important implications for the prevention and treatment of PTSD-related symptoms in military samples. By measuring moral judgment prior to deployment, it may be possible to predict the likelihood of incurring moral injuries and the development of associated symptoms. Early intervention programmes aimed at ameliorating guilt and shame are required to prevent the long-term development of deployment-related psychological distress.
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.|Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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Nazarov
Department of National Defence, Government of Canada, Ottawa, ON, Canada.|Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
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Jetly
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.|Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
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McNeely
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada.|Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Kiang
Department of Psychiatry, University of Western Ontario, London, ON, Canada.
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Lanius
Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.|Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.|Homewood Research Institute, Guelph, ON, Canada.
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McKinnon
D005260:Female; D006801:Humans; D008297:Male; D006167:Guilt; D007398:Interpersonal Relations; D008603:Mental Health / Q000706:statistics & numerical data; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data; D009014:Morals; D012720:Severity of Illness Index; D012752:Shame
guilt; military personnel; moral injury; morality; post-traumatic stress disorder; shame