Adverse Childhood Experiences, Military Adversities, and Adult Health Outcomes Among Female Veterans in the UK
Abstract: Adverse childhood experiences (ACEs) are well-documented risk factors for poor outcomes in adulthood, including worse physical and mental health. A higher prevalence of ACEs has been reported in military populations compared with the general population. Although there is a body of literature exploring childhood adversities in military populations, research focusing on the female Veteran population in the United Kingdom is limited. Data were collected through a cross-sectional, self-report survey. The survey was completed by female army Veterans recruited via a female military association. The response rate was approximately 45%, and the efective sample for this study consisted of 750 female UK army Veterans. Participant histories of ACEs, military adversities, and current mental and physical health difculties were assessed. The most frequently reported ACEs were emotional abuse, physical abuse, and feeling unloved by family. Experiencing childhood adversities was most strongly associated with mental health difculties such as posttraumatic stress disorder and military adversities such as emotional bullying, sexual harassment, and sexual assault during military service. This study provides insight into the prevalence rates of ACEs in a largely under-researched population and into the relationship between military adversities and adult health outcomes. Further research is needed to better understand the unique needs of female Veterans in the United Kingdom and how they compare with those of their male counterparts and women in the UK general population.
Abstract: Background: Exposure to potentially morally injurious events (PMIEs) during military service can lead to moral injury (MI) outcomes and posttraumatic stress symptoms (PTSS). This longitudinal study examined the relationships between PMIE exposure, MI outcomes, and PTSS among Israeli combat veterans, and the potential protective role of dispositional forgiveness in these associations. Method: Participants were 169 Israeli combat veterans who participated in a six-year longitudinal study with four measurement points (T1: 12 months before enlistment, T2: Six months following enlistment- pre-deployment, T3: 18 months following enlistment- post-deployment, and T4: 28 months following discharge). Participants’ characteristics were assessed via semi-structured interviews (T1) and validated self-report measures (T2-T4) between 2019-2024. Results: Approximately 36% of participants reported exposure to PMIEs during service, with 13% exceeding the clinical threshold for probable PTSD at T4. PMIE-Betrayal at T3 was positively associated with MI outcomes of shame and trust violation at T4. The indirect effect of PMIEs on PTSS through MI outcome-Shame depended on forgiveness levels. Among veterans with low forgiveness, higher exposure to PMIE-Betrayal was associated with increased MI shame, which was linked to more severe PTSS. Conversely, for those with high forgiveness, exposure to PMIE-Self and Other was associated with decreased MI shame and subsequently reduced PTSS. Conclusion: Dispositional forgiveness moderates the relationship between PMIE exposure and MI outcomes, particularly shame, which mediates the development of PTSS. These findings highlight forgiveness as a potential target for intervention in treating moral injury and preventing PTSS among combat veterans.