Moral injury among humanitarian aid personnel: a preliminary examination of associations with rumination and mental health

Abstract Given high rates of poor mental health among humanitarian aid workers, there has been a strong push for more research identifying risk and protective factors tied to poor mental health among this at-risk population. The present study examined moral injury (i.e., psychological, ethical, and/or spiritual conflict experienced when an individual’s basic sense of humanity is violated) as a new form of trauma that may place humanitarian aid workers at higher risk for poor mental health outcomes. Further, we tested a model examining rumination as a mechanism linking moral injury to mental health outcomes within this population. A total of 124 (67.2% cisgender women; 59.7% White; Mean age = 38.66, SD = 13.66) humanitarian aid personnel participated in a cross-sectional online survey study examining humanitarian aid experiences, moral injury, rumination, and mental health outcomes. Our preliminary findings suggest that humanitarian aid workers are susceptible to experiencing moral injury and that higher reports of moral injury were significantly associated with poorer mental health outcomes (e.g., depression, anxiety, suicidal ideation, sleep problems, memory issues). Furthermore, we found that ruminative thinking (particularly problem-focused thoughts and repetitive thoughts) indirectly linked moral injury to negative mental health outcomes among this population. Our preliminary study established the presence of at least moderate correlations between moral injury, rumination, and adverse mental health outcomes among humanitarian aid personnel. Considering complex humanitarian emergencies are becoming more commonplace, future longitudinal studies are most certainly needed in order to further understand and legitimize the threat that moral injury poses to humanitarian aid workers.