title: The Invisible Wound: Moral Injury and Its Impact on the Health of Operation Enduring Freedom/Operation Iraqi Freedom Veterans.
abstract: Many veterans are now returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) deployments with physical and mental health problems. However, there are few studies that examine the impact of moral injury on both physical and mental well-being. This study examines the impact of moral injury on self-reported general physical health, general mental health, post-traumatic stress disorder symptoms, and depression symptoms. Cross-sectional data were collected at as part of a pilot study at the New Jersey Veteran Affairs. 100 OEF/OIF veterans recruited at the New Jersey Veteran Affairs completed the paper questionnaire. We found that moral injury and combat experiences positively predicted post-traumatic stress disorder scores. Seeing the aftermath of battle and moral injury were negatively associated with mental well-being and positively associated with depression. Physical health status was negatively associated with depression. Spirituality and moral injury were negatively associated with physical health, whereas age was positively associated with physical health. Moral injury plays an important role in both physical and mental health outcomes for OEF/OIF veterans, but it is often not addressed in health care. These results underline the need for an approach to veterans' health care that includes discussion of existential and moral issues since they may impact health outcomes for many service members.
authors.affiliation: Department of Veterans Affairs, Center for Health and Wellness, 385 Tremont Avenue, Building 17 MS11C, East Orange, NJ 07018.
authors.forename: Grace W
authors.initials: GW
authors.lastname: Yan
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D009014:Morals; D009515:New Jersey; D010865:Pilot Projects; D029181:Spirituality; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology*