Health and Wellbeing Study of Serving and ex-Serving UK Armed Forces Personnel: Phase 4
Abstract: The study has been running since 2003 with the aim of investigating the impact of deployment to Iraq (Operation TELIC) and Afghanistan (Operation HERRICK) on the health and wellbeing of serving and ex-serving personnel.
Data have been collected over three previous phases - Phase 1 (2004/06), Phase 2 (2007/09), and Phase 3 (2014/16), with the most recent phase taking place over 2022/23. In addition to examining key mental health outcomes such as CMD, probable PTSD and alcohol misuse, this phase also collected new data on additional topics relevant to UK serving and ex-serving personnel including complex PTSD (C-PTSD), loneliness and caring responsibilities.
For Phase 4 (2022/23), we followed up participants who took part in the previous phase in 2014/16. 4104 participants completed the survey. 69% of the sample had deployed to Iraq and/or Afghanistan and 72% had left service.
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.