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Measuring Moral Injury Outcome and Distress in High-Risk Populations in Germany: A Validation Study
Philipp Herzog1, Simon Stenkamp1, Sonya B Norman2
1RPTU University Kaiserslautern-Landau, Germany.
Assessment
|June 19, 2026
Summary
Exposure to potentially morally injurious events (PMIE) is common in high-risk professions. Many individuals experience PMIE, with a notable percentage showing signs of moral injury (MI) distress, indicating a need for effective assessment tools.
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.