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Cited by 57Posttraumatic Stress Disorder ResearchMigration, Health and TraumaTraumatic Brain Injury Research

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

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Levi-Belz, Yossi, Greene, Talya, Zerach, Gadi·2020·European Journal of Psychotraumatology
DOI 10.1080/20008198.2020.1736411PMC PMC7155211
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Abstract

Background: Moral Injury (MI) is one of the adverse consequences of combat. Following exposure to potentially morally injurious events (PMIEs)––events perceived as violations of deep moral beliefs by oneself or trusted individuals––a significant minority of veterans could develop posttraumatic stress disorder (PTSD) and depression.Objective: The current study represents the first attempt to apply a network analysis model to examine an exploratory empirical conceptualization of a network of PMIEs during military service, post-traumatic stress disorder (PTSD) symptom clusters, depression, and combat exposure among Israel Defence Forces veterans.Method: A volunteer sample of 191 Israeli combat veterans were recruited during 2017, and completed validated self-report questionnaires tapping PMIEs, PTSD, and depression in a cross-sectional design study. A regularized Gaussian graphical model was estimated.Results: Network analysis revealed strong bridge associations between the PTSD nodes and most of the PMIEs nodes. The nodes of PMIE-betrayal and PTSD negative alterations in cognitions and mood (NACM) symptom cluster were found to have a bridging function between other PMIEs and PTSD. Depression was found to be connected to most of the PMIEs and PTSD nodes.Conclusions: The study’s findings offer an overview of the complex relationships between PMIEs and PTSD clusters among Israeli veterans. PMIEs––notably, betrayal-based experiences––are related to PTSD clusters directly and through depressive symptoms. Some possible mechanisms for the links between PMIEs and PTSD and the clinical implications related to specific interventions are discussed.

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  • Moral injury is associated with posttraumatic stress disorder.

    “Findings from a broader trauma literature reveal that moral injury, which refers to a condition that may arise from witnessing, perpetrating, or failing to prevent acts that transgress their moral compass (Litz et al., 2009) is in turn associated with posttraumatic stress disorder (Currier et al., 2019; Levi-Belz et al., 2020).”

    From An examination of psychological distress and moral injury in journalists exposed to online harassment (2025) · cites this paper as Levi-Belz et al., 2020

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Authors
Levi-Belz, Y., Greene, T., & Zerach, G.
Affiliations
  • Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
  • University of Haifa (IL)
  • Ariel University (IL)
ORCID
Venue
European Journal of Psychotraumatology
Publisher
Informa UK Limited
Published
2020-03-20
Volume
11
Issue
1
Pages
1736411-1736411
ISSN
2000-8066 (ISSN-L)
DOI
10.1080/20008198.2020.1736411
PMC
PMC7155211
OpenAlex
W3013741402
Cited by
57
References
12
Citations by year
2026: 5 · 2025: 12 · 2024: 8 · 2023: 16 · 2022: 7 · 2021: 5 · 2020: 4
FWCI
3.19
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Psychotraumatology (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Figshare (cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
moral injury, potentially morally injurious events, post-traumatic stress disorder, depression, PTSD symptom clusters, combat exposure, betrayal, network analysis, military service

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