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

Area of Science:

• Psychology
• Occupational Health
• Trauma Studies

Background:

• Potentially morally injurious events (PMIE) can severely impact mental health, leading to moral injury (MI).
• High-risk professions are particularly vulnerable to PMIE exposure.
• Understanding the prevalence and impact of MI in these groups is crucial.

Purpose of the Study:

• To investigate the frequency of PMIE exposure and moral injury (MI) outcomes.
• To assess the prevalence of clinically meaningful MI using validated scales.
• To evaluate the psychometric properties of German versions of the MIOS and MIDS scales.

Main Methods:

• A large German-speaking sample (N=364) from high-risk occupations (legal, health care, military, security, social sector, press) participated.
• Participants completed the Moral Injury Outcome Scale (MIOS) and Moral Injury and Distress Scale (MIDS).
• Confirmatory factor analysis (CFA) and correlational analyses were used to assess scale validity and reliability.

Main Results:

• Approximately 75% of the sample reported experiencing at least one PMIE.
• 11.5% and 5.5% screened positive for clinically significant MI on the MIDS and MIOS, respectively.
• Both the MIOS and MIDS demonstrated good to excellent internal consistency and factorial validity.

Conclusions:

• Exposure to PMIE and subsequent moral injury (MI) is highly prevalent across diverse occupational fields in Germany.
• The German versions of the MIOS and MIDS are suitable for assessing MI outcomes and distress.
• Findings underscore the importance of addressing MI in occupational mental health strategies.