Moral injury in Dutch treatment-seeking veterans: a latent profile analysis.

Background

Moral injury (MI) is a construct distinct from, yet related to, post-traumatic stress disorder (PTSD). To date, no study has assessed MI among Dutch treatment-seeking veterans using a validated measure.

Objective

This study aimed to (a) examine the factor structure and psychometric properties of the Dutch Expressions of Moral Injury Scale - Military Version (EMIS-M); (b) to identify profiles of PTSD and MI outcomes among treatment-seeking Dutch veterans, as well as their associations with comorbid psychopathology and family functioning.Method: Participants were 455 Dutch treatment-seeking veterans at four national psychotrauma centres. Data were drawn from pre-intake routine outcome monitoring assessments. We evaluated the internal consistency, temporal stability, and factor structure of the EMIS-M, and conducted latent profile analysis (LPA) to identify PTSD and MI profiles, followed by analyses of associated psychopathology and family functioning.

Results

The EMIS-M demonstrated acceptable psychometric properties. Confirmatory factor analysis (CFA) supported a two-factor structure (MI-self and MI-other), though fit indices suggested room for improvement. LPA revealed three profiles: 'Subclinical MI and PTSD' (n = 95, 20.9%), 'Moderate MI and PTSD' (n = 218, 47.9%), and 'High MI and PTSD' (n = 142, 31.2%). Higher levels of MI and PTSD were associated with greater comorbid psychopathology. Family functioning was significantly poorer in the Moderate and High profiles compared to the Subclinical profile.

Conclusions

Findings indicate that the Dutch EMIS-M is a psychometrically acceptable instrument for assessing MI among treatment-seeking veterans. MI frequently co-occurred with PTSD and was associated with greater psychopathology and poorer family functioning, underscoring the need for careful assessment of MI in veteran care.