# The role of measurement in moral injury care: latent profiles on the moral injury and distress scale

## TL;DR

This study identifies three distinct levels of moral injury symptoms in veterans and first responders using a psychological scale.

## Contribution

The study introduces a method to classify moral injury symptom profiles using latent profile analysis on the MIDS scale.

## Key findings

- Three distinct moral injury symptom profiles were identified: minimal, moderate, and severe.
- Most participants (74.7%) had minimal symptoms, while 5.1% had severe symptoms.
- Those with moderate or severe symptoms were more likely to be younger, less educated, and Hispanic.

## Abstract

Although studies of moral injury proliferated over the past decade, few studies have examined common moral injury symptom presentations.

Data were analyzed from a population-based sample (N = 645) of combat veterans, healthcare workers, and first responders. All participants endorsed exposure to a potentially morally injurious event (PMIE) and completed the Moral Injury and Distress Scale (MIDS).

Latent profile analysis revealed three distinct symptom profiles based on MIDS items assessing psychological, emotional, social, and spiritual symptoms of moral injury. The majority of participants (74.7%, n = 482) reported minimal moral injury symptoms. Approximately one in five participants (20.2%, n = 130) endorsed moderate levels of moral injury symptoms, and one in twenty (5.1%, n = 33) reported severe moral injury symptoms. All participants with the severe profile screened positive for probable moral injury on the MIDS (score ≥ 27); however, 9.1% had scores within normal limits on measures of posttraumatic stress and depression. After adjusting for demographics, those with moderate or severe moral injury symptoms were more likely than those with minimal moral injury symptoms to be younger, have fewer years of education, and identify as Hispanic.

These findings support the use of the MIDS in measurement-based care to identify distinct clinical presentations of moral injury, including those with moderate to severe presentations that warrant further evaluation and potentially treatment.