Cross-disciplinary insights on moral injury conceptualization and care: a qualitative study of expert perspectives

The term "moral injury" has been used to describe moral transgressions and their impact across populations. As a result of this broad application, interpretation of the construct and intervention strategies to address it have become increasingly nuanced and context-specific. This qualitative study explored how subject matter experts working in moral injury research and care across various populations view this complex phenomenon.

Virtual focus group discussions were conducted with 33 researchers, mental health clinicians, and spiritual-care practitioners. Discussions explored the conceptualization of moral injury to inform implications for identification and care. Focus groups were digitally recorded, professionally transcribed, and thematically analyzed using qualitative software.

Experts highlighted the context-specific nature of moral injury, where interpretations and applications often vary according to their disciplinary backgrounds and the diversity of populations they serve. Based on their insights and experiences, key themes central to the conceptualization of moral injury and resulting implications for identification and care emerged. Conceptualization of moral injury focused on the development (i.e., progression from moral identity formation and disruption to a maladaptive response to moral pain and distress) and presentation (i.e., distinct features differentiating moral injury from other psychosocial-spiritual constructs). Implications for identification and care centered on the practical value and limitations of broad construct application, diagnostic considerations (e.g., the potential benefits and challenges of pathologizing moral injury), and moral injury-specific intervention and care recommendations, highlighting tailored approaches for addressing the multidimensional nature of moral injury.

Despite its conceptual complexity, moral injury is a phenomenon that resonates across diverse populations, contributing to its growing recognition and application across professional disciplines. Findings from this study reveal context-specific interpretations and applications of the construct, while also identifying core elements essential for understanding moral injury and informing effective intervention strategies. Overall, findings highlight the evolving, interdisciplinary nature of moral injury and suggest opportunities for tailored and integrative care strategies.