The DOI matches its Crossref record; 63 of the 63 references it cites were found in a registry or an index.
Occupational moral injury and mental health: systematic review and meta-analysis
Open accessAbstract
Background: Many people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at risk for psychological difficulties (e.g. post-traumatic stress disorder (PTSD), depression, etc.). Aims: We aimed to assess the effect of moral injury on mental health outcomes. Method: We conducted a systematic review and meta-analysis to assess the association between work-related PMIEs and mental health disorders. Studies were independently assessed for methodological quality and potential moderator variables, including participant age, gender and PMIE factors, were also examined. Results: Thirteen studies were included, representing 6373 participants. PMIEs accounted for 9.4% of the variance in PTSD, 5.2% of the variance in depression and 2.0% of the variance in suicidality. PMIEs were associated with more symptoms of anxiety and behavioural problems (e.g. hostility), although this relationship was not consistently significant. Moderator analyses indicated that methodological factors (e.g. PMIE measurement tool), demographic characteristics and PMIE variables (e.g. military v.non-military context) did not affect the association between a PMIE and mental health outcomes. Conclusions: Most studies examined occupational PMIEs in military samples and additional studies investigating the effect of PMIEs on civilians are needed. Given the limited number of high-quality studies available, only tentative conclusions about the association between exposure to PMIEs and mental health disorders can be made. Declaration of interest: None.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Statistical Power Analysis for the Behavioral Sciences
Muller, K. (1989) · Technometrics · doi:10.1080/00401706.1989.10488618 · Cited by 99,167
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
Development and validation of brief measures of positive and negative affect: The PANAS scales.
Watson, D., Clark, L. A., & Tellegen, A. (1988) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.54.6.1063 · Cited by 32,433
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765
Operating characteristics of a rank correlation test for publication bias
Begg, C. B., & Mazumdar, M. (1994) · Biometrics · doi:10.2307/2533446 · Cited by 16,955
Lovibond, P. F., & Lovibond, S. H. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00075-u · Cited by 14,523
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799
Impact of Event Scale: A Measure of Subjective Stress
Horowitz, M., Wilner, N., & Alvarez, W. (1979) · Psychosomatic Medicine · doi:10.1097/00006842-197905000-00004 · Cited by 7,813
The brief resilience scale: Assessing the ability to bounce back
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008) · International Journal of Behavioral Medicine · doi:10.1080/10705500802222972 · Cited by 6,439
The development of a Clinician-Administered PTSD Scale
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995) · Journal of Traumatic Stress · doi:10.1002/jts.2490080106 · Cited by 5,024
Assessing heterogeneity in meta-analysis: Q statistic or I² index?
Huedo-Medina, T. B., Sánchez-Meca, J., Marín-Martínez, F., & Botella, J. (2006) · Psychological Methods · doi:10.1037/1082-989x.11.2.193 · Cited by 4,256
Assessment of suicidal intention: The Scale for Suicide Ideation.
Beck, A. T., Kovacs, M., & Weissman, A. (1979) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.47.2.343 · Cited by 3,419
Fixed-and random-effects models in meta-analysis.
Hedges, L. V., & Vevea, J. L. (1998) · Psychological Methods · doi:10.1037/1082-989x.3.4.486 · Cited by 2,977
Moral injury and moral repair in war veterans: A preliminary model and intervention strategy
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.07.003 · Cited by 2,738
Reprint—Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & and the PRISMA Group (2009) · Physical Therapy · doi:10.1093/ptj/89.9.873 · Cited by 2,486
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001) · Assessment · doi:10.1177/107319110100800409 · Cited by 2,276
Less is more: meta-analyses of sensitivity and attachment interventions in early childhood
Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F. (2003) · Psychological Bulletin · doi:10.1037/0033-2909.129.2.195 · Cited by 1,883
(2010) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2010.01108.x · Cited by 1,443
Writing meta-analytic reviews.
Rosenthal, R. (1995) · Psychological Bulletin · doi:10.1037/0033-2909.118.2.183 · Cited by 1,108
Impact of Event Scale--Revised
Weiss, D. S., & Marmar, C. R. (2016) · PsycTESTS Dataset · doi:10.1037/t12199-000 · Cited by 757
Field, A. P. (2001) · Psychological Methods · doi:10.1037/1082-989x.6.2.161 · Cited by 725
Psychometric Evaluation of the Moral Injury Events Scale
Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013) · Military Medicine · doi:10.7205/milmed-d-13-00017 · Cited by 606
King, L. A., King, D. W., Vogt, D. S., Knight, J., & Samper, R. E. (2006) · Military Psychology · doi:10.1207/s15327876mp1802_1 · Cited by 594
Lamiani, G., Borghi, L., & Argentero, P. (2017) · Journal of Health Psychology · doi:10.1177/1359105315595120 · Cited by 522
Beck Depression Inventory-II (BDI-II)
Bortnick, K. (2024) · Occupational Therapy Assessments for Older Adults · doi:10.4324/9781003525288-77 · Cited by 491
An exploration of the viability and usefulness of the construct of moral injury in war veterans.
Drescher, K. D., Foy, D. W., Kelly, C., Leshner, A., Schutz, K., & Litz, B. (2011) · Traumatology · doi:10.1177/1534765610395615 · Cited by 488
Comprehensive handbook of psychological assessment
(2004) · Choice Reviews Online · doi:10.5860/choice.42-1239 · Cited by 479
State-Trait Anger Expression Inventory
Spielberger, C. (2021) · PsycTESTS Dataset · doi:10.1037/t29496-000 · Cited by 446
State‐Trait Anger Expression Inventory
Spielberger, C. D. (2010) · The Corsini Encyclopedia of Psychology · doi:10.1002/9780470479216.corpsy0942 · Cited by 442
Risk Factors Associated With Suicide in Current and Former US Military Personnel
LeardMann, C. A., Powell, T. M., Smith, T. C., Bell, M. R., Smith, B., Boyko, E. J., Hooper, T. I., Gackstetter, G. D., Ghamsary, M., & Hoge, C. W. (2013) · JAMA · doi:10.1001/jama.2013.65164 · Cited by 395
Moral distress experienced by nurses: A quantitative literature review
Oh, Y., & Gastmans, C. (2015) · Nursing Ethics · doi:10.1177/0969733013502803 · Cited by 387
Understanding and Addressing Moral Distress
Epstein, E., & Delgado, S. (2010) · OJIN: The Online Journal of Issues in Nursing · doi:10.3912/ojin.vol15no03man01 · Cited by 319
A Review of Research on Moral Injury in Combat Veterans
Frankfurt, S., & Frazier, P. (2016) · Military Psychology · doi:10.1037/mil0000132 · Cited by 305
Initial Psychometric Evaluation of the Moral Injury Questionnaire—Military Version
Currier, J. M., Holland, J. M., Drescher, K., & Foy, D. (2015) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1866 · Cited by 285
Bryan, C. J., Bryan, A. O., Anestis, M. D., Anestis, J. C., Green, B. A., Etienne, N., Morrow, C. E., & Ray-Sannerud, B. (2016) · Assessment · doi:10.1177/1073191115590855 · Cited by 279
Farnsworth, J. K., Drescher, K. D., Nieuwsma, J. A., Walser, R. B., & Currier, J. M. (2014) · Review of General Psychology · doi:10.1037/gpr0000018 · Cited by 232
Moral injury, suicidal ideation, and suicide attempts in a military sample.
Bryan, A. O., Bryan, C. J., Morrow, C. E., Etienne, N., & Ray-Sannerud, B. (2014) · Traumatology · doi:10.1037/h0099852 · Cited by 205
Weiss, D. S., Brunet, A., Best, S. R., Metzler, T. J., Liberman, A., Pole, N., Fagan, J. A., & Marmar, C. R. (2010) · Journal of Traumatic Stress · doi:10.1002/jts.20576 · Cited by 194
The Los Angeles Symptom Checklist: A Self Report Measure of Posttraumatic Stress Disorder
King, L. A., King, D. W., Leskin, G., & Foy, D. W. (1995) · Assessment · doi:10.1177/1073191195002001001 · Cited by 170
The impact of killing and injuring others on mental health symptoms among police officers
Komarovskaya, I., Maguen, S., McCaslin, S. E., Metzler, T. J., Madan, A., Brown, A. D., Galatzer-Levy, I. R., Henn-Haase, C., & Marmar, C. R. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.05.004 · Cited by 161
Crane, M. F., Phillips, J. K., & Karin, E. (2015) · Australian Veterinary Journal · doi:10.1111/avj.12366 · Cited by 133
Angerer, P., Siebert, U., Kothny, W., Mühlbauer, D., Mudra, H. G., & von Schacky, C. (2000) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(00)00944-x · Cited by 126
Dozois, D. J. A., & Covin, R. (2004) · Cited by 104
Testing the Short and Screener versions of the Social Adjustment Scale – Self‐report (SAS‐SR)
Gameroff, M. J., WICKRAMARATNE, P. J., & Weissman, M. M. (2011) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.358 · Cited by 84
The Trauma of Moral Injury: Beyond the Battlefield
Dombo, E. A., Gray, C., & Early, B. P. (2013) · Journal of Religion & Spirituality in Social Work Social Thought · doi:10.1080/15426432.2013.801732 · Cited by 83
Morally injurious experiences and meaning in Salvadorian teachers exposed to violence.
Currier, J. M., Holland, J. M., Rojas-Flores, L., Herrera, S., & Foy, D. W. (2013) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0034092 · Cited by 83
Psychometric properties of the Civilian version of the Mississippi PTSD scale
Lauterbach, D., Vrana, S. R., King, D. W., & King, L. A. (1997) · Journal of Traumatic Stress · doi:10.1023/a:1024801607043 · Cited by 78
Suicidal Behaviors Questionnaire
Linehan, M. M. (1981) · PsycTESTS Dataset · doi:10.1037/t24083-000 · Cited by 78
Backholm, K., & Idås, T. (2015) · Journal of Traumatic Stress · doi:10.1002/jts.22001 · Cited by 69
Griffith, J. E. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00104.x · Cited by 66
Hunt, M. R. (2008) · Developing World Bioethics · doi:10.1111/j.1471-8847.2006.00153.x · Cited by 62
Ethics in Humanitarian Aid Work: Learning From the Narratives of Humanitarian Health Workers
Schwartz, L. J., Sinding, C., Hunt, M. R., Elit, L. M., Redwood-Campbell, L. J., Adelson, N., Luther, L., Ranford, J., & de Laat, S. (2010) · AJOB Primary Research · doi:10.1080/21507716.2010.505898 · Cited by 62
Dennis, P. A., Dennis, N. M., Voorhees, E. E. V., Calhoun, P. S., Dennis, M. F., & Beckham, J. C. (2016) · Anxiety Stress & Coping · doi:10.1080/10615806.2016.1230669 · Cited by 60
Ferrajão, P. C., & Oliveira, R. A. (2014) · Traumatology An International Journal · doi:10.1037/trm0000016 · Cited by 54
Psychometric Characteristics of the MMPI-2 Cook-Medley Hostility Scale
Han, K., Weed, N. C., Calhoun, R. F., & Butcher, J. N. (1995) · Journal of Personality Assessment · doi:10.1207/s15327752jpa6503_15 · Cited by 49
The Causes, Course, and Consequences of Anger Problems in Veterans Returning to Civilian Life
Worthen, M., & Ahern, J. (2013) · Journal of Loss and Trauma · doi:10.1080/15325024.2013.788945 · Cited by 48
Unethical Battlefield Conduct Reported by Soldiers Serving in the Iraq War
Wilk, J. E., Bliese, P. D., Thomas, J. L., Wood, M. D., McGurk, D., Castro, C. A., & Hoge, C. W. (2013) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e318288d302 · Cited by 31
Ritov, G., & Barnetz, Z. (2013) · International Journal of Social Psychiatry · doi:10.1177/0020764013502469 · Cited by 25
Firing a weapon and killing in combat are associated with suicidal ideation in OEF/OIF veterans.
Tripp, J. C., McDevitt‐Murphy, M. E., & Henschel, A. V. (2015) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000085 · Cited by 25
Suicidal Behaviors QuestionnairePreprint
Wilson, L. (2018) · OSF Preprints (OSF Preprints) · Cited by 15
Interpersonal Support Evaluation List (ISEL)
Cohen, & Hoberman (2020) · Psychology Press eBooks · doi:10.4324/9781003076391-157 · Cited by 13
Research works printed but not linked: 10
- Derogatis, 1993, BSI Brief Symptom Inventory: Administration, Scoring, and Procedure Manual
- Moyo, 2015, Pastoral care in the healing of moral injury: a case of the Zimbabwe National Liberation War Veterans, HTS Teol Stud/Theol Stud, 71, 1
- 10.1002/bsl.2370010308 · doi:10.1002/bsl.2370010308
- Viechtbauer, 2010, Conducting meta-analyses in R with the meta for package, J Stat Softw, 6, 1
- Beck, 1990, Manual for the beck anxiety inventory, Psychological Corporation
- 2013, Diagnostic and Statistical Manual of Mental Disorders
- 10.1002/jts.2490100313 · doi:10.1002/jts.2490100313
- Lovibond S , Lovibond P. Depression anxiety and stress scale. Manual for the Depression and Anxiety Stress Scales. DASS Publications, 1995. · doi:10.1037/t03473-000
- 10.1201/b13455 · doi:10.1201/b13455
- 10.1037/0022-006X.47.2.343 · doi:10.1037/0022-006x.47.2.343 · Paper page
Cited by
Managing mental health challenges faced by healthcare workers during covid-19 pandemic
Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020) · BMJ · doi:10.1136/bmj.m1211 · Cited by 2,135
Self-citationSøvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., & Münter, L. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.679397 · Cited by 973
Moral injury in healthcare professionals: A scoping review and discussion
Čartolovni, A., Stolt, M., Scott, P. A., & Suhonen, R. (2021) · Nursing Ethics · doi:10.1177/0969733020966776 · Cited by 454
COVID-19 and experiences of moral injury in front-line key workers
Williamson, V., Murphy, D., & Greenberg, N. (2020) · Occupational Medicine · doi:10.1093/occmed/kqaa052 · Cited by 365
Self-citationBereavement Support on the Frontline of COVID-19: Recommendations for Hospital Clinicians
Selman, L. E., Chao, D., Sowden, R., Marshall, S., Chamberlain, C., & Koffman, J. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.04.024 · Cited by 261
Metadata
- Authors
- Williamson, V., Stevelink, S. A. M., & Greenberg, N.
- Venue
- The British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2018-05-22
- Volume
- 212
- Issue
- 6
- Pages
- 339-346
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2803326482
- Cited by
- 375
- References
- 63
- FWCI
- 5.22
- Type
- journal article
- Language
- en
- Open access
- bronze
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.