Screening for Moral Injury: The Moral Injury Symptom Scale - Military Version Short Form

• Published in: Military medicine Vol. 183; no. 11-12; pp. e659 - e665
• Main Authors: Koenig, Harold G, Ames, Donna, Youssef, Nagy A, Oliver, John P, Volk, Fred, Teng, Ellen J, Haynes, Kerry, Erickson, Zachary D, Arnold, Irina, O'Garo, Keisha, Pearce, Michelle
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2018
• Subjects: Adult; Anxiety; Clinical medicine; Factor Analysis, Statistical; Faith; Female; Humans; Male; Mass Screening - methods; Mass Screening - standards; Medical screening; Mental depression; Middle Aged; Moral injury; Post traumatic stress disorder; Psychometrics - instrumentation; Psychometrics - methods; Psychometrics - standards; Quantitative psychology; R&D; Religion; Reproducibility of Results; Research & development; Review boards; Spirituality; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - psychology; Suicides & suicide attempts; Surveys and Questionnaires; Syndrome; Trauma; United States; United States Department of Veterans Affairs - organization & administration; United States Department of Veterans Affairs - statistics & numerical data; Validity; Veterans; United States; United States > US; Los Angeles California
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usy017

To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD. A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two. In the first half (n = 214), exploratory factor analysis identified the highest loading item on each of the 10 MISS scales (guilt, shame, moral concerns, loss of meaning, difficulty forgiving, loss of trust, self-condemnation, religious struggle, and loss of religious faith) to form the 10-item MISS-M-SF; confirmatory factor analysis was then performed to replicate results in the second half of the sample (n = 213). Internal reliability, test-retest reliability, and convergent, discriminant, and concurrent validity were examined in the overall sample. The study was approved by the institutional review boards and the Research & Development (R&D) Committees at Veterans Administration medical centers in Durham, Los Angeles, Augusta, Houston, and San Antonio, and the Liberty University and Duke University Medical Center institutional review boards. The 10-item MISS-M-SF had a median of 50 and a range of 12-91 (possible range 10-100). Over 70% scored a 9 or 10 (highest possible) on at least one item. Cronbach's alpha was 0.73 (95% CI 0.69-0.76), and test-retest reliability was 0.87 (95% CI 0.79-0.92). Convergent validity with the 45-item MISS-M was r = 0.92. Discriminant validity was demonstrated by relatively weak correlations with social, religious, and physical health constructs (r = 0.21-0.35), and concurrent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms (r = 0.54-0.58). The MISS-M-SF is a reliable and valid measure of MI symptoms that can be used to screen for MI and monitor response to treatment in veterans and active duty military with PTSD.