The Influence of Potentially Morally Injurious Experiences on the Stigma of Seeking Professional Mental Health Care Among Service Members and Veterans

Background: Moral injury, or the engagement in or witnessing of an act that violates a person’s moral code, has undergone increased research in the past decade, especially as it applies to service members and Veterans. Moral injury stems from exposure to potentially morally injurious experiences (PMIEs), which have been associated with many psychosocial concerns, but there is still limited literature on the prevalence rates of and potential risk factors for PMIEs. Additionally, there is limited knowledge of the rates of mental health treatment seeking by service members and Veterans for PMIEs, as well as how these influence stigma and attitudes towards help seeking. Methods: Participants (n = 730) were post-9/11 era service members and Veterans recruited from a Qualtrics Panel and social media platforms to complete a survey that included informed consent, validity items, demographic and military history information, moral injury measures, stigma and attitudes towards help seeking scale, and several mental health screeners. Descriptive statistics were used to examine the prevalence rates of PMIEs and associated mental health treatment seeking rates. Through structural equation modeling, I examined factors associated with the types of PMIEs in the MIES, perceived transgressions by self or others and betrayals by others, in and outside the military. Additionally, structural equation modeling was employed to determine if PMIEs and screening positive for various types of mental health disorders interacted with stigma to influence the established model of public stigma, self-stigma, and attitudes towards help seeking. Results: While over three-quarters of the participants endorsed at least one PMIE and the average score on the Moral Injury Events Scale was 35.17 (SD = 12.98), fewer than half of all participants reported seeking mental health care for concerns related to PMIEs. Among those who did seek treatment, the most common treatment source was military behavioral health providers. Combat experience and military sexual trauma were significantly correlated with both types of PMIEs whereas serving as a warrant officer was significantly correlated with betrayals by others, in and outside the military. There was a significant indirect effect of public stigma on attitudes towards help seeking through self-stigma as well as a direct effect of perceived transgressions by self or others on self-stigma. No significant interactions were found between PMIEs or screening positive for mental health disorders and public or self-stigma on attitudes towards help seeking. Discussion: The current study contributed prevalence rates of PMIEs among post-9/11 era service members and Veterans, as well as associated mental health treatment seeking rates associated with PMIEs. Additionally, while higher endorsement of perceived transgressions is associated with higher levels of self-stigma, there were no interactions between PMIEs and stigma on predicting attitudes towards help seeking. Future research should include the development of improved measurement tools for PMIEs, continued exploration of unique barriers to seeking care for concerns related to PMIEs, and treatments to address the associated psychosocial concerns for PMIEs, especially as conceptualization of moral injury develops further