2 - (SYM 100) Moral Injury, Mental Health Symptoms, and Family Functioning Among Men and Women Veterans

Moral standards serve an adaptive function by defining appropriate actions to maintain roles within social communities, including families. Moral injury (MI) refers to distress resulting from interpersonal violations in which one’s deeply held moral beliefs are transgressed through actions one perpetrates, is directly betrayed by, or witnesses. Military service may heighten risk for moral injury and associated consequences for psychological health and family functioning.

Drawing from a longitudinal study of military veterans who completed six surveys, a subsample of 1673 veterans (51% women) were administered a measure of military related MI. Controlling for other trauma exposures, we conducted separate linear repeated measures mixed models to examine gender differences in how MI (self, betrayal, witnessed) moderates within timepoint associations between mental health symptoms (i.e., PTSD, depression) and family functioning (i.e., intimate relationship, parental). We found several significant three-way interactions for self and betrayal MI, indicating that associations between symptoms and family functioning varied with the severity of MI and by gender.

            Associations between women’s mental health symptoms and worse intimate relationship functioning were the strongest at the highest levels of self MI (high: d = .23 PTSD; d = .39 depression; low: d = .20 PTSD; d = .30 depression). Associations between men’s PTSD and worse intimate relationship functioning were only observed at the lowest levels of self MI (low: d = .23). Associations between men’s depression symptoms and worse relationship functioning were strongest at the lowest levels of self MI (high: d = .32; low: d = .65).

Associations between depression symptoms and worse intimate relationship functioning were strongest at the lowest levels of betrayal MI for both women (high: d = .35; low: d = .37 women) and men (high: d = .32; low: d = .64). For women only, associations between PTSD symptoms and worse parental functioning were strongest at the lowest levels of betrayal MI (high: d = .20; low: d = .59).

            Results suggest that associations between mental health symptoms and worse family functioning tend to be stronger when MI is low, particularly among men. When MI is high, the effect of mental health symptoms on family functioning dissipates. Cognitive-behavioral interventions may better promote mental health and positive family functioning if they address individual experiences with MI.