Structure and correlates of the Moral Injury Exposure and Symptom Scale for Civilians (MIESS-C) in a community sample with high trauma exposure

Background: Moral injury (MI) is a clinical phenomenon that can emerge in the aftermath of engaging in or witnessing an event that transgresses an individual’s deeply held moral beliefs. Research on MI assessments has yielded conflicting results regarding optimal structure, and there are very few comprehensive examinations of the clinical correlates of MI in diverse community samples.Objective: We examined psychometric properties of the Moral Injury Exposure and Symptoms Scale for Civilians (MIESS-C) and investigated clinical correlates of this measure. Method: In a community sample of N = 598 individuals (89.5% female; 67.1% African-American) with high rates of trauma exposure, we used exploratory and confirmatory analyses to adjudicate factor structure and investigated the bivariate and partialed relations between the MIESS-C scale and psychopathology indices such as PTSD, depression, anxiety and substance use.Results: A three-factor solution corresponding to MI caused by (1) self, (2) another person (‘other’), or (3) betrayal by a trusted person or institution best fits the data. Large, positive correlations with relevant indices of psychopathology (i.e. PTSD, depression, anxiety) support the convergent validity of the MIESS-C, although no evidence emerged for specific, unique links between forms of MIESS-C subscales and particular mental health concerns. Relatively small correlations with a comprehensive measure of lifetime trauma suggest this measure is not redundant with assessments of trauma exposure.Conclusions: Moral injury is of considerable clinical interest, but more work is needed to support meaningful clinical decision-making based on the MIESS-C.