Moral Injury and COVID-Related Stress Among Post-9/11 Veterans: Examining Longitudinal Associations

Although most U.S. military veterans make a successful transition from military service to civilian life, some may experience a heightened risk for having adverse mental health symptoms related to moral injury (MI), post-traumatic stress disorder (PTSD), depression, and anxiety. In addition, U.S. veterans may have faced an increased risk for experiencing more pronounced stress across multiple life domains during the COVID-19 pandemic. Limited research attention has been given to understanding how MI symptoms experienced by post-9/11 veterans prior to the COVID-19 pandemic (COVID) were related to their experiences of COVID-related stress. This study examined the impact of pre-COVID MI symptoms on veterans' COVID-related stress in various life domains. Participants included 3180 U.S. veterans who were involved in The Veterans Metric Initiative (TVMI) and the Veterans Engaging in Transition Studies (VETS). TVMI was a longitudinal study that occurred from 2016 to 2019. VETS, which began in 2020, was a continuation of TVMI and included a portion of the TVMI sample. Data from assessments of mental health variables from TVMI Wave 6 (spring 2019), COVID-related work, financial, social, and health stress from VETS Wave 7 (fall 2020), and relevant covariates from TVMI Wave 1 (fall 2016) were included in structural equation modelling analyses. Results demonstrated that MI predicted COVID-related work and financial stress, PTSD did not predict any of the four COVID-related stress domains, and depression and anxiety predicted all four COVID-related stress factors. The study's findings highlight the nuanced ways in which veterans' psychological experiences can impact their feelings of stress during a global pandemic.