Connecting Moral Injury and PTSD among Military Veterans: The Role of Problem-Focused Thought Rumination & Social Support

The present study seeks to expound upon previous research indicating a connection between moral injury (MI), problem-focused thought rumination, PTSD, and social support among military veterans. Specifically, we examined the effect of MI factors (Atrocities of War, Psychological Consequences of War, and Leadership Failure/Betrayal) on PTSD via problem-focused thought rumination and whether social support would moderate these associations. The sample was composed of 282 current or former military veterans who had been deployed at least once for 90 days or more. Most participants were White (n = 199, 70.6%), male (n = 169, 59.9%), Christian (n = 197, 69.9%), married (n = 207, 73.4%), had served in the Army (n = 135, 48%), and reported an average age of 32.10 years (SD = 7.12). Results from mediation analyses indicated that problem-focused thoughts mediated the effect of each moral injury factor on PTSD symptoms. Specifically, higher levels of MI were associated with more problem-focused thought rumination, which in turn was associated with more severe PTSD symptoms. However, results of moderated mediation analyses were not statistically significant, such that differing levels of social support did not significantly moderate the association between MI factors and problem-focused thoughts. Research examining rumination as a mechanism linking MI and PTSD is still in its infancy and further research is needed to explore the complex interplay between these constructs and uncover how social support functions within this relationship. Study limitations and implications for clinical treatment of moral injury and PTSD are also discussed. Keywords: moral injury, PTSD, rumination, problem-focused thoughts, social support, veterans