Measuring Moral Injury Outcome and Distress in High-Risk Populations in Germany: A Validation Study

Exposure to potentially morally injurious events (PMIE) poses a threat to one's moral beliefs that can lead to prolonged and impairing mental health outcomes related to moral injury (MI). In a large German-speaking sample (N = 364, 48.9% female) of high-risk populations (legal, health care, military, security, social sector, press), we administered the Moral Injury Outcome Scale (MIOS) and Moral Injury and Distress Scale (MIDS) to investigate the frequency of PMIE exposure and MI outcome and distress. About three-quarters of the sample endorsed having experienced a PMIE, while 11.5% and 5.5.% screened positive for clinically meaningful MI on the MIDS and MIOS, respectively. Both the MIOS and the MIDS demonstrated good to excellent internal consistency. The CFA provided further evidence for their factorial validity; correlations supported aspects of convergent and discriminant validity. Exposure to PMIE and MI is a highly prevalent phenomenon across different occupational fields in Germany. The German versions of both scales seem suitable for assessing MI outcome and distress.