MOESM1 of A group randomized control trial to test the efficacy of the Road to Mental Readiness (R2MR) program among Canadian military recruits

Additional file 1: Table S1 Assessing R2MR efficacy at the 1st follow up among the fidelity (Group 1) and no fidelity check groups (Group 2). Table S2 Assessing R2MR efficacy at the 2st follow up among the fidelity (Group 1) and no fidelity check groups (Group 2). Table S3 Assessing R2MR efficacy at the 1st follow up among different divisions. Table S4 Assessing R2MR efficacy at the 2st follow up among different divisions. Table S5 Intraclass Correlation Coefficients (ICC, k) for T1 variables

sj-pdf-1-asm-10.1177_10731911211044198 – Supplemental material for Psychometric Evaluation of the Moral Injury Events Scale in Two Canadian Armed Forces Samples

Supplemental material, sj-pdf-1-asm-10.1177_10731911211044198 for Psychometric Evaluation of the Moral Injury Events Scale in Two Canadian Armed Forces Samples by Rachel A. Plouffe, Bethany Easterbrook, Aihua Liu, Margaret C. McKinnon, J. Don Richardson and Anthony Nazarov in Assessment</p

Moral reasoning in women with posttraumatic stress disorder related to childhood abuse

Preliminary evidence suggests that relative to healthy controls, patients with posttraumatic stress disorder (PTSD) show deficits on several inter-related social cognitive tasks, including theory of mind, and emotion comprehension. Systematic investigations examining other aspects of social cognition, including moral reasoning, have not been conducted in PTSD stemming from childhood trauma. To conduct a comprehensive assessment of moral reasoning performance in individuals with PTSD stemming from childhood abuse. Moral reasoning performance was assessed in 28 women with PTSD related to prolonged childhood trauma and 19 matched healthy controls. Performance was assessed using 12 modified moral dilemmas and was queried in three domains: utilitarian/deontological sacrificial dilemmas (personal and impersonal), social order vs. compassion, and altruism vs. self-interest. Participants were asked whether a proposed action was morally acceptable or unacceptable and whether or not they would perform this action under the circumstances described. Women with PTSD were less likely to carry out utilitarian actions in personal, sacrificial moral dilemmas, a choice driven primarily by consequential intrapersonal disapproval. Increased concern regarding intrapersonal disapproval was related to higher symptoms of guilt in the PTSD group. Patients with PTSD demonstrated less altruistic moral reasoning, primarily associated with decreased empathic role-taking for beneficiaries. Women with PTSD due to childhood trauma show alterations in moral reasoning marked by decreased utilitarian judgment and decreased altruism. Childhood trauma may continue to impact moral choices made into adulthood. Moral judgment processing was found to be altered in women with PTSD related to chronic childhood trauma. In comparison to healthy women, women with PTSD were less likely to approve utilitarian actions when required to assume their agency in dilemmas involving the infliction of direct physical harm. Decreased likelihood of utilitarian action approval by the PTSD sample was driven by significantly enhanced endorsement of guilt and shame as consequences of such actions. Endorsement of guilt and shame in moral dilemmas was related to increased severity of current clinical symptoms of guilt.</p

Additional file 1 of “You can’t un-ring the bell”: a mixed methods approach to understanding veteran and family perspectives of recovery from military-related posttraumatic stress disorder

Additional file 1. Interview guide – Veterans

Additional file 2 of “You can’t un-ring the bell”: a mixed methods approach to understanding veteran and family perspectives of recovery from military-related posttraumatic stress disorder

Additional file 2. Interview guide – partners

Data_Sheet_1_The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress: a longitudinal study of Canadian health care workers during the COVID-19 pandemic.docx

IntroductionThe COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs’ perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.MethodsA total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress.ResultsAssociations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.DiscussionTo ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment.</p

Optimizing military mental health and stress resilience training through the lens of trainee preferences: A conjoint analysis approach

Effective mental health and stress resilience (MHSR) training is essential in military populations given their exposure to operational stressors. The scarcity of empirical evidence supporting the benefits of these programs emphasizes the need for research dedicated to program optimization. This paper aims to identify the relative importance of MHSR training attributes preferred by military members. Conjoint analysis (CA), an experimental method used to prioritize end-user preferences for product feature development, was conducted using an online survey with 567 Canadian Armed Forces (CAF) personnel. Participants made a series of choices between hypothetical MHSR training options that were systematically varied across seven training attributes. Each training attribute consisted of 3–4 variations in the nature of the attribute or its intensity. Participants also completed questions on health beliefs, mental health and previous MHSR training experiences, and demographics, to assess whether preferences varied by individual characteristics. CA demonstrated that instructor type, leadership buy-in, degree of skills practice, and content relevance/applicability were attributes of highest and relatively equal importance. This was followed by degree of accessible supplemental content. Lowest importance was placed on degree of behavioral nudging and demographic similarity between the trainee and trainer. Sociodemographic factors were not associated with MHSR training preferences. Programs that incorporate expert-led instruction, demonstrate leadership buy-in, embed practical applications within simulated stress environments, and provide a digitally-accessible platform to augment training may be well-received among military members. Understanding and accommodating personal preferences when designing MHSR training programs may increase relevance, foster acceptance and trust, and support sustained engagement.</p

Exposure to moral stressors and associated outcomes in healthcare workers: prevalence, correlates, and impact on job attrition

Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs’ self-reported job attrition intentions. Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed. Results: Moral stressors with the highest reported frequency and distress ratings included patient care requirements that exceeded the capacity HCWs felt safe/comfortable managing, reported lack of resource availability, and belief that administration was not addressing issues that compromised patient care. Participants who considered leaving their jobs (44%; N = 517) demonstrated greater moral distress and injury scores. Logistic regression highlighted burnout (AOR = 1.59; p p p = .022) as significant predictors of the intention to leave one’s job. Conclusion: While it is impossible to fully eliminate moral stressors from healthcare, especially during exceptional and critical scenarios like a global pandemic, it is crucial to recognize the detrimental impacts on HCWs. This underscores the urgent need for additional research to identify protective factors that can mitigate the impact of these stressors. This study explored the nature of moral stressors encountered by health care workers, along with impacts on moral injury and intentions to leave their jobs.Morally distressing encounters were common, with the most prevalent and distressing experiences being organizational or team-based in nature.Findings revealed that severity of moral injury, particularly related to trust violation or betrayal, was a key factor influencing healthcare workers’ intentions to leave their jobs. This study explored the nature of moral stressors encountered by health care workers, along with impacts on moral injury and intentions to leave their jobs. Morally distressing encounters were common, with the most prevalent and distressing experiences being organizational or team-based in nature. Findings revealed that severity of moral injury, particularly related to trust violation or betrayal, was a key factor influencing healthcare workers’ intentions to leave their jobs.</p

The effects of child encounters during military deployments on the well-being of military personnel: a systematic review

Background: Military members report higher instances of trauma exposure and subsequent posttraumatic stress disorder (PTSD) relative to civilians. Encounters with children in war and conflict settings may have particularly unsettling consequences. However, the nature of these consequences has yet to be systematically examined. Objective: This systematic review sought to identify and document deployment-related encounters with children and associated outcomes reported by military personnel, as well as identify any current training programs, policies, or procedures in place regarding encountering children during deployment. Method: A total of 17 studies with 86 independent samples were included. Analyses were based primarily on qualitative data. Results: Based on the review, 77 military personnel samples documented their experiences encountering children during deployment. Most commonly, child encounters included armed children, porters/human shields, suicide bombers, and ambiguous interactions. Outcomes from encountering children during deployment were diverse, occurring both during the encounter, and described by many as persisting years following the exposure. Consequences of encounters as described by military personnel included: hesitation to complete mission objectives, mental health concerns, moral struggles, social isolation, and sleep disturbances. Of the 86 included reports, only nine provided information regarding training at any stage (pre-, during, or post-deployment) in relation to encountering children. Much of the available information underscored the lack of training, with six reports highlighting the lack of pre-deployment training and five reports describing the lack of policies, including rules of engagement, as they relate to encountering children during deployment. Only two reports described post-deployment procedures made available to military personnel following exposure to children while on deployment. Conclusions: Results from this review will be used to identify available research, develop and support training initiatives, and increase awareness regarding implications of encountering children during deployment. We further provide recommendations regarding research needs, policy implementation, and current training gaps. A systematic review that identified and documented deployment-related encounters with children and associated outcomes reported by military personnel, as well as identified current training programs, policies, or procedures in place regarding encountering children during deployment.The review found child encounters included armed children, porters/human shields, suicide bombers and ambiguous interactions with consequences, described by military personnel, of mental health concerns, moral struggles (e.g. loss of faith), sleep disturbances, social isolation, and inability to work.Available data showcased a lack of training, lack of policies, and lack of post-deployment interventions. A systematic review that identified and documented deployment-related encounters with children and associated outcomes reported by military personnel, as well as identified current training programs, policies, or procedures in place regarding encountering children during deployment. The review found child encounters included armed children, porters/human shields, suicide bombers and ambiguous interactions with consequences, described by military personnel, of mental health concerns, moral struggles (e.g. loss of faith), sleep disturbances, social isolation, and inability to work. Available data showcased a lack of training, lack of policies, and lack of post-deployment interventions.</p

Data_Sheet_1_Defining and Assessing the Syndrome of Moral Injury: Initial Findings of the Moral Injury Outcome Scale Consortium.docx

Potentially morally injurious events (PMIEs) entail acts of commission (e.g., cruelty, proscribed or prescribed violence) or omission (e.g., high stakes failure to protect others) and bearing witness (e.g., to grave inhumanity, to the gruesome aftermath of violence), or being the victim of others' acts of commission (e.g., high stakes trust violations) or omission (e.g., being the victim of grave individual or systemic failures to protect) that transgress deeply held beliefs and expectations about right and wrong. Although there is a proliferation of interest in moral injury (the outcome associated with exposure to PMIEs), there has been no operational definition of the putative syndrome and no standard assessment scheme or measure, which has hampered research and care in this area. We describe an international effort to define the syndrome of moral injury and develop and validate the Moral Injury Outcome Scale (MIOS) in three stages. To ensure content validity, in Stage I, we conducted interviews with service members, Veterans, and clinicians/Chaplains in each country, inquiring about the lasting impact of PMIEs. Qualitative analysis yielded six operational definitions of domains of impact of PMIEs and components within domains that establish the parameters of the moral injury syndrome. From the domain definitions, we derived an initial pool of scale items. Stage II entailed scale refinement using factor analytic methods, cross-national invariance testing, and internal consistency reliability analyses of an initial 34-item MIOS. A 14-item MIOS was invariant and reliable across countries and had two factors: Shame-Related (SR) and Trust-Violation-Related (TVR) Outcomes. In Stage III, MIOS total and subscale scores had strong convergent validity, and PMIE-endorsers had substantially higher MIOS scores vs. non-endorsers. We discuss and contextualize the results and describe research that is needed to substantiate these inaugural findings to further explore the validity of the MIOS and moral injury, in particular to examine discriminant and incremental validity.</p