Moral Injury and Religious Coping as Serial Mediators Between Childhood Sexual Abuse and Depressive Symptoms Among Survivors in the USA.

Moral injury, a persistent distress arising from experiences that shatter one's sense of goodness in oneself, others, or higher powers, is consistently linked to trauma yet remains underexplored among childhood sexual abuse (CSA) survivors. Additionally, while positive and negative religious coping often serve as protective and risk factors for adverse mental health outcomes, respectively, no research to these authors' knowledge has examined their relationship to moral injury. The present study investigated how CSA severity, moral injury, and religious coping influence depressive symptoms among survivors of CSA. Adult CSA survivors (N = 376) were recruited via Prolific (56.91% female; Mage = 38.60) and completed validated measures of CSA, moral injury, religious coping, and depressive symptoms. Structural equation modeling was utilized to test the hypothesis that religious coping and moral injury would serially mediate the relationship between CSA severity and depressive symptoms. CSA severity predicted increased positive religious coping and negative religious coping, negative religious coping predicted increased moral injury, and positive religious coping predicted decreased moral injury. Moral injury, in turn, significantly predicted depressive symptoms. The indirect paths through negative religious coping were significant, but the pathways through positive religious coping were not. To our knowledge, this study provides the first empirical evidence of relationships among CSA, religious coping, moral injury, and depressive symptoms. These findings extend moral injury assessment beyond military and healthcare contexts and highlight the need for interventions that address moral and spiritual distress among CSA survivors.