Establishing Clinically Significant Change Benchmarks for the Moral Injury Outcome Scale in VA Behavioral Health
Brett T Litz1,2, Hannah E Walker1, Luke Rusowicz-Orazem2
1VA Boston Healthcare System, MA, USA.
Assessment
|April 24, 2026
Summary
This study established benchmarks for the Moral Injury Outcome Scale (MIOS) using VA data. A MIOS score change of 13 indicates significant improvement for Veterans receiving behavioral health treatment.
Area of Science:
- Psychiatry and Behavioral Health
- Clinical Psychology
- Health Services Research
Background:
- Moral injury is a growing concern among Veterans.
- Standardized outcome measures are needed for effective treatment.
- The Moral Injury Outcome Scale (MIOS) requires established benchmarks for clinical interpretation.
Purpose of the Study:
- To establish clinically significant change benchmarks for the MIOS.
- To define functional recovery thresholds for moral injury.
- To support the use of MIOS in measurement-based care for Veterans.
Main Methods:
- Analysis of 2,521 Veterans' electronic health records from VA behavioral health settings.
- Calculation of reliable change indices (RCIs) using the Jacobson and Truax method.
- Inclusion of a 361-Veteran episode-of-care cohort for detailed analysis.
Main Results:
- A MIOS change score of 13 points signifies clinically significant improvement.
- An endpoint score of ≤9 suggests functional recovery.
- 81% of Veterans remained unchanged, while 11.9% showed reliable improvement.
Conclusions:
- These findings provide the first benchmarks for clinically significant change on the MIOS.
- The MIOS is suitable for routine outcome monitoring and measurement-based care.
- Nearly half of the Veterans studied met criteria for probable moral injury.
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