Examining the impact of risk and protective factors on post-9/11 U.S. Veterans’ moral injury latent profiles and transitions

Abstract: Objective: To identify moral injury (MI) latent profiles, transitions in MI profile membership over time, and predictors of MI profile transitions. This study represents the first attempt to characterize transitions in MI latent profile membership and examine associated risk and protective factors. Method: Latent transition analyses were conducted in a sample of 4,784 U.S. military veterans who responded to Waves 2 (W2) and 6 (W6) of the Veterans Metrics Initiative survey. The Moral Injury Events Scale and a variety of covariates were used in the analyses. Results: Three MI profiles were identified, low exposure/distress (80.2% sample membership at W2 and 72.9% at W6), moderate exposure/distress (14.0% at W2 and 20.0% at W6), and high exposure/distress (5.8% at W2 and 7.1% at W6). Higher PTSD and ACEs scores were associated with greater odds of transitioning from the low to the high exposure/distress profile, while higher scores on social support and a sense of purpose were associated with lesser odds of transitioning from the low to the high exposure/distress profile. Conclusions: The use of person-centered analytic techniques, especially those that can accommodate longitudinal data, is important for advancing the study of MI, especially in terms of identifying risk and protective factors that can guide treatment efforts. The study’s findings indicate the importance of considering malleable and nonmalleable risk and protective factors in understanding MI experiences and informing strategies to help those who are feeling MI-related distress.

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