Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers

“Moral injury has been defined as the “psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”¹ Since this definition was introduced in 2009, the subsequent decade of research focused almost exclusively on military veterans. Among military personnel, the killing of civilians or enemy combatants is frequently cited as an example of a potentially morally injurious experience,^2,3,4 though the range of phenomena that could be experienced as morally injurious is quite broad. Research with veterans has consistently found higher levels of moral injury to be related to greater psychiatric symptomatology on measures of posttraumatic stress disorder (PTSD), depression, alcohol and substance abuse, and suicidality.^5,6,7,8,9 Other research among veterans has demonstrated that the distinguishing features of moral injury (e.g., guilt, shame, feeling betrayed) are not just conceptually distinct from other psychiatric problems but are neurologically distinct from symptoms of PTSD.¹⁰ With the onset of the COVID-19 pandemic, numerous observers have suggested that moral injury as observed within veterans might be operative among healthcare workers (HCWs).”^{11,12,13,14,15,16,17}

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