The longitudinal association between moral injury appraisals and psychological outcomes in refugees

• Published in: Psychological medicine 2022-09, Vol.52 (12), p.2352-2364
• Main Authors: Nickerson, Angela, Byrow, Yulisha, Hoffman, Joel, O'Donnell, Meaghan, Bryant, Richard A, Mastrogiovanni, Natalie, McMahon, Tadgh, Benson, Greg, Mau, Vicki, Liddell, Belinda J.
• Format: Article
• Language: English
• Subjects: Anger; Arousal; Cognitive ability; Cognitive appraisal; Critical incidents; Demography; Displaced persons; Emotions; Evaluation; Hyperarousal; Injuries; Investigations; Longitudinal studies; Mental depression; Mental health; Mental health services; Moral injury; Oppression; Original Article; Polls & surveys; Post traumatic stress disorder; Psychological development; Psychological problems; Refugees; Sadness; Shame; Social networks; Stress; Surveys; Symptoms; Trauma; Traumatic life events
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291720004262

BackgroundRefugees report a diverse array of psychological responses following persecution and displacement. Little is known, however, regarding the mechanisms that underlie differential psychological reactions in refugees. This study investigated the longitudinal impact of negative moral appraisals about one's own actions [i.e. moral injury-self (MI-self) appraisals] and others' actions [i.e. moral injury-other (MI-others) appraisals] on a variety of psychological symptoms over a period of 6 months.MethodsParticipants were 1085 Arabic, Farsi, Tamil, or English-speaking refugees who completed a survey at baseline and 6 months later either on-line or via pen-and-paper. The survey indexed demographic factors, exposure to potentially traumatic events (PTEs), exposure to ongoing stressors, MI-other appraisals, MI-self appraisals, re-experiencing and arousal symptoms, and feelings of sadness, anger and shame.ResultsFindings indicated that, after controlling for demographics, PTE exposure and ongoing stressors, MI-other appraisals predicted increased re-experiencing and hyperarousal symptoms, and feelings of sadness and shame. MI-self appraisals predicted decreased feelings of shame, and decreased re-experiencing symptoms. In contrast, psychological symptoms at baseline did not as strongly influence MI appraisals 6 months later.ConclusionsThese findings highlight the important role that cognitive appraisals of adverse events play in the longitudinal course of psychological symptoms. These results thus have important implications for the development of tailored psychological interventions to alleviate the mental health burden held by refugees.