(PS11-B27) Factor Analysis of the Moral Injury Events Scale in Veterans Seeking Intensive Treatment

Many veterans report experiencing Moral Injury (MI) following exposure to combat or military sexual trauma (MST). MI can result from witnessing, partaking in, or failing to prevent an act that violates deeply held moral or ethical beliefs and expectations. MI may exacerbate PTSD symptoms and may be linked to barriers to seeking care, including shame, guilt, anger, and loss of trust in self or others. MI in veterans has also been linked with feelings of betrayal by the military institution or its members, which in turn is related to both poorer veteran mental health and worse treatment outcomes. Yet to be thoroughly investigated is the Moral Injury Events Scale (MIES). In studies of veterans recently separated from service, the MIES has been found to have a two-factor structure, which include perceived transgressions by self (PTBS) and by others (PTBO). Another study in active-duty personnel found a three-factor structure where betrayal-related items load onto a separate factor from PTBS and PTBO items. The factor structure of the MIES has not yet been examined in a sample of veterans with a range of service eras. As such, the present study intended to analyze the factor structure of the MIES with PTSD treatment-seeking veterans to determine whether further investigation of the betrayal subscale is supported.

Baseline MIES and PCL-5 scores were collected from veterans who completed 2- and 3-week (N=1037) intensive treatment programs (ITP). An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were conducted on the MIES. The EFA revealed that a three-factor structure (PTBS, PTBO, and betrayal) was more appropriate with acceptable eigenvalues of 3.19, 2.06, and 1.70 and fewer cross-loadings compared to the two-factor structure. The three-factor structure explained 46%, 30%, and 24% of the variance, respectively. Model fit was verified with the CFA, which indicated good model fit (CFI = 0.95, RMSEA = 0.01). Subsequently, a correlation was conducted to assess the relationship between betrayal endorsement and baseline PTSD symptom severity. The relationship was found to be significant (r(999) = 0.17, p<em><0.001).

Findings support a three-factor structure of the MIES in the current sample. Additionally, consistent with previous research, betrayal was significantly correlated with PTSD symptom severity. As such, future research on the betrayal subscale in this sample is supported and could investigate the impact of betrayal on intensive PTSD treatment outcomes. In doing so, we may better understand the role of betrayal and MI in veterans with PTSD and thus better address related barriers to treatment effectiveness.