Journal of emergencies, trauma, and shock · 2026
Moral Injury and Mental Health Consequences in Active-duty Soldiers: A Systematic Review and Meta-analysis of Cross-sectional Surveys.
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Sinha Madhubanti, Ranjan Jay Kumar, Singh Chandra Uday, Tripathi Mahesh A
Аннотация
INTRODUCTION: Moral injury (MI), defined as perceived betrayals or violations of one's moral values, causes psychological distress in active-duty soldiers (ADS), and it is associated with various mental health (MH) issues such as post-traumatic stress disorder (PTSD), anxiety, and depression. Although some quantitative reviews have examined the association between MI and MH outcomes in the military population, primarily among veterans, none of the studies focused specifically on ADS. This systematic review and meta-analysis were conducted to address the research gap.
METHODS: We reviewed published articles from six databases, namely, PubMed, Scopus, Web of Science, Taylor and Francis, and JSTOR up to July 29, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS: The retrieved articles underwent a systematic selection process using pre-specified inclusion and exclusion criteria, resulting in 12 potentially eligible studies. Seven cross-sectional studies examined the association between MI and PTSD, representing a total sample of 4,370 ADS. Pooled effect measures showed that MI and its dimensions, such as betrayal, transgression toward self, and transgression toward others, were positively correlated with PTSD. Similarly, MI and its domains were significantly positively associated with anxiety and depression in ADS.
CONCLUSION: The present findings should be interpreted with caution, as this review synthesis included a limited number of studies and was conducted mainly in Western countries. Future studies should address the cross-cultural component of MI to understand how MI manifests in non-Western military contexts, where cultural and religious values may shape moral reasoning differently.
METHODS: We reviewed published articles from six databases, namely, PubMed, Scopus, Web of Science, Taylor and Francis, and JSTOR up to July 29, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS: The retrieved articles underwent a systematic selection process using pre-specified inclusion and exclusion criteria, resulting in 12 potentially eligible studies. Seven cross-sectional studies examined the association between MI and PTSD, representing a total sample of 4,370 ADS. Pooled effect measures showed that MI and its dimensions, such as betrayal, transgression toward self, and transgression toward others, were positively correlated with PTSD. Similarly, MI and its domains were significantly positively associated with anxiety and depression in ADS.
CONCLUSION: The present findings should be interpreted with caution, as this review synthesis included a limited number of studies and was conducted mainly in Western countries. Future studies should address the cross-cultural component of MI to understand how MI manifests in non-Western military contexts, where cultural and religious values may shape moral reasoning differently.