Mapping moral injury: Development and feasibility of the Clinical Interview for Moral Injury-military version...

There is currently no clinical interview to assess exposure to potentially morally injurious experiences (PMIEs) and moral injury, the potential clinical outcome associated with PMIEs. To enable a person-centered assessment of PMIEs and moral injury in military veterans, we developed a structured, non-diagnostic clinical interview to support descriptive assessment, case conceptualization, and treatment planning, and conducted an initial evaluation of its feasibility, acceptability, and clinical utility.

The Clinical Interview for Moral Injury-Military Version (CIMI-M) was developed through an iterative, stakeholder-informed process. Questions from existing moral injury instruments were selected, adapted and supplemented to create an interview with a descriptive, theory-driven approach. Clinicians (N = 7) and military veterans (N = 8) at two Dutch trauma centers who conducted the CIMI-M were interviewed and completed questionnaires assessing the CIMI-M's feasibility, acceptability, and clinical utility. Interviews were analyzed using the General Inductive Approach for qualitative evaluation data.

Mean evaluation scores were 7.63 for veterans and 8.41 for clinicians (10-point scale). Qualitative analysis of interview transcripts revealed that the CIMI-M helped veterans share their experiences, while clinicians found it valuable for fostering trust and planning treatment. Both groups agreed that the CIMI-M generated insightful content about PMIEs and moral injury. Based on feedback, several interview questions were revised or added.

We found preliminary evidence that the CIMI-M is a feasible, acceptable, and clinically useful descriptive interview. It offers a potentially valuable treatment-planning tool that complements paper-and-pencil approaches that assess PMIEs and moral injury. Further evaluation, including in non-veteran populations, is needed.