Defining and Assessing the Syndrome of Moral Injury:Initial Findings of the Moral Injury Outcome Scale Consortium

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

Defining and Assessing the Syndrome of Moral Injury:Initial Findings of the Moral Injury Outcome Scale Consortium

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

The contribution of individual psychological resilience in determining the professional quality of life of Australian nurses.

Research Topic: The aim of this study was to determine the relative contribution of trait negative affect and individual psychological resilience in explaining the professional quality of life of nurses. Materials and Methods: One thousand, seven hundred and forty-three Australian nurses from the public, private, and aged care sectors completed an online Qualtrics survey. The survey collected demographic data as well as measures of depression, anxiety and stress, trait negative affect, resilience, and professional quality of life. Results: Significant positive relationships were observed between anxiety, depression and stress, trait negative affectivity, burnout, and secondary traumatic stress (compassion fatigue). Significant negative relationships were observed between each of the aforementioned variables and resilience and compassion satisfaction (CS). Results of mediated regression analysis indicated that resilience partially mediates the relationship between trait negative affect and CS. Conclusion: Results confirm the importance of both trait negative affect and resilience in explaining positive aspects of professional quality of life. Importantly, resilience was confirmed as a key variable impacting levels of CS and thus a potentially important variable to target in interventions aimed at improving nurse’s professional quality of life

Postpartum Bonding Difficulties And Adult Attachment Styles: The Mediating Role Of Postpartum Depression And Childbirth‐Related Ptsd

Despite decades of research demonstrating the role of adult attachment styles and early motherâ infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirthâ related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeksâ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infantâ focused anxiety, mediated by postpartum depression but not childbirthâ related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirthâ related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirthâ related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.RESUMENA pesar de las décadas de investigación demostrando el papel de los estilos de afectividad adulta y la temprana unión afectiva madreâ infante en los comportamientos de crianza y la salud mental materna, estos conceptos han sido poco estudiados en conjunto. El presente estudio se propuso investigar la relación entre los estilos de afectividad y las específicas dificultades de unión afectiva de las madres. Adicionalmente, ya que la depresión posterior al parto y los síntomas de estrés postraumático relacionados con dar a luz han sido asociados con ambos conceptos, exploramos su posible efecto de mediación. 113 madres completaron, entre 4 y 12 semanas después del parto, un cuestionario demográfico, el Cuestionario del Estilo de Afectividad Adulta (AAQ), el Cuestionario de Unión Posterior al Parto (PBQ), el Cuestionario Modificado del Trastorno de Estrés Postraumático Perinatal (mPPQ), y la Escala de Edimburgo de Depresión Postnatal, usando un sistema de encuesta electrónico. Tal como se predijo, los estilos de afectividad inseguros fueron asociados con las dificultades de unión afectiva, donde la afectividad ansiosa/ambivalente se asoció con una mayor ansiedad enfocada en el infante, mediada por la depresión posterior al parto pero no así por los síntomas PTSD relacionados con dar a luz. En contraste, un mayor estilo de ocultar o evitar la afectividad se asoció con mayor rechazo e ira, mediado por PTSD relacionado con dar a luz pero no así por los síntomas de depresión. El presente estudio confirmó la asociación de diferentes estilos de afectividad con la unión afectiva así como también los papeles de mediación de síntomas PTSD relacionados con dar a luz y los de depresión posterior al parto. Futuras intervenciones sicológicas pudieran utilizar tal evidencia para dirigir intervenciones para trastornos de unión afectiva de acuerdo con diferencias individuales.Rà SUMà En dépit de dizaines d’années de recherches démontrant le rôle des styles de l’attachement adulte et du lien précoce mèreâ bébé dans les comportements de parentage et la santé mentale maternelle, ceuxâ ci ont rarement été étudiés ensemble. Cette étude s’est donné pour but dâ étudier la relation entre les styles d’attachement et les difficultés spécifier à se lier des mères. De plus puisque la dépression postpartum et les symptômes de stress postâ traumatique liés à l’accouchement ont été aussi liés à ces éléments, nous avons exploré leur effet de médiation possible. 113 mères à 4â 12 semaines postpartum ont rempli un questionnaire démographique, le Questionnaire de Style de l’Attachement Adulte, le Questionnaire de Lien Postpartum, le Questionnaire Modifié de Trouble de Stress Périnatal Postâ traumatique, et l’Echelle de Dépression Postnatale d’Edinbourg, en utilisant un système d’enquête en ligne. Comme on l’avait prédit, les styles d’attachement insécures étaient liés à des difficultés à se lier, alors que l’attachement anxieux/ambivalent était lié à une anxiété plus importante, centrée sur le bébé, médiées par la dépression postpartum mais pas par les symptômes liés au TSPT de l’accouchement. En revanche les styles d’attachement le plus évitant étaient liés à un plus grand rejet et à une colère plus importante, médiés par le TSPT lié à l’accouchement mais pas aux symptômes de dépression. Cette étude a confirmé le lien entre différents styles d’attachement et le lien affectif ainsi que les rôles de médiation du TSPT lié à l’accouchement et des symptômes de dépression postpartum. Les interventions psychologiques à venir pourraient utiliser ces résultats afin de cibler des intervention pour les troubles du lien affectif en fonctions des différences individuelles.ZUSAMMENFASSUNGAuch wenn in jahrzehntelanger Forschungsarbeit die Zusammenhänge von erwachsenen Bindungsstilen und frühem Mutterâ Kindâ Bonding mit dem Elternverhalten und der psychischen Gesundheit von Müttern demonstriert werden konnten, wurden diese Konstrukte selten gemeinsam untersucht. Ziel der vorliegenden Studie war es, den Zusammenhang zwischen Bindungsstilen und spezifischen Bindungsschwierigkeiten von Müttern zu untersuchen. Darüber hinaus wurden postpartale Depression und geburtsbedingte posttraumatische Stresssymptome bereits mit beiden Konstrukten in Verbindung gebracht, so dass wir zusätzlich diese potentiellen Mediationseffekte erforschten. 113 Mütter füllten 4â 12 Wochen nach der Geburt mithilfe eines Onlineâ Umfragesystems einen demografischen Fragebogen, den â Adult Attachment Style Questionnaireâ (AAQ), den â Postpartum Bonding Questionnaireâ (PBQ), den â Modified Perinatal Posttraumatic Stress Disorder Questionnaireâ (mPPQ) und die â Edinburgh Postnatal Depression Scaleâ (EPDS) aus. Wie vorhergesagt, wurden unsichere Bindungsstile mit Bindungsschwierigkeiten in Verbindung gebracht, wobei die ängstliche/ambivalente Bindung mit einer gröà eren, auf den Säugling bezogenen Angst assoziiert wurde, die durch postpartale Depression, aber nicht durch geburtsbedingte PTBSâ Symptome mediiert wurde. Im Gegensatz dazu wurde ein stärker vermeidender Bindungsstil mit gröà erer Ablehnung und Wut assoziiert und durch geburtsbedingte PTBS, aber nicht durch Depressionssymptome mediiert. Die aktuelle Studie bestätigte die Assoziation verschiedener Bindungsstile mit Bonding sowie die mediierenden Rollen von geburtsbedingter PTBS und postpartalen Depressionssymptomen. 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Ø¨Ø§Ù Ø§Ø¶Ø§Ù Ù Ø¥Ù Ù Ø°Ù Ù Ø Ø¨Ù Ø§ ا٠ا٠ا٠تئاب بعد ا٠٠٠ادة ٠ا٠اعراض ا٠٠تص٠ة با٠إج٠اد ا٠٠اح٠٠٠صد٠ة ا٠٠٠س٠ة ٠د ارتبطا ب٠ذ٠ا٠أ٠٠اط Ø Ù Ù Ø¯ ٠ا٠ت ا٠دراسة ا٠حا٠٠ة ببحث ا٠آثار ا٠٠س٠طة ا٠٠حت٠٠ة ٠٠ذ٠ا٠٠تغ٠رات. است٠٠٠113 ٠٠ا٠أ٠٠ات (4â 12 أسب٠ع بعد ا٠٠ضع) استب٠ا٠ا د٠٠٠غرا٠٠ا Ø Ù Ø§Ø³ØªØ¨Ù Ø§Ù Ø£Ù Ù Ø§Ø· ا٠تع٠٠ع٠د ا٠با٠غ٠٠(AAQ) Ø Ù Ø§Ø³ØªØ¨Ù Ø§Ù ØªÙ Ù Ù Ù Ø§Ù Ø§Ø±ØªØ¨Ø§Ø· بعد ا٠٠٠ادة (PBQ) Ø Ù Ø§Ù Ø§Ø³ØªØ¨Ù Ø§Ù Ø§Ù Ù Ø¹Ø¯Ù Ù Ø§Ø¶Ø·Ø±Ø§Ø¨ ا٠إج٠اد ا٠عصب٠٠٠صد٠ة ا٠٠اح٠ة ٠٠٠٠ادة (mPPQ) Ø Ù Ù Ù Ù Ø§Ø³ أد٠برة ٠ا٠تئاب ٠ا بعد ا٠٠٠ادة ((EPDSØ Ø¨Ø§Ø³ØªØ®Ø¯Ø§Ù Ø§Ø³ØªØ¨Ù Ø§Ù Ø¹Ù Ù Ø§Ù Ø¥Ù ØªØ±Ù Øª. ٠جاءت ا٠٠تائج ٠٠إطار ا٠ت٠٠عات Ø­Ù Ø« ارتبطت أ٠٠اط ا٠تع٠٠ا٠غ٠ر ا٠آ٠٠بصع٠بات ت٠٠٠٠ا٠ارتباط Ø Ø¨Ù Ù Ù Ø§ ارتبط ا٠تع٠٠ا٠٠٠٠â ا٠٠زد٠ج ب٠سبة أ٠بر ٠٠ا٠ت٠تر ا٠٠ر٠ز ع٠٠ا٠ط٠٠٠ت٠سط ٠ذ٠ا٠ع٠ا٠ة ا٠ا٠تئاب بعد ا٠٠٠ادة ٠٠٠٠٠٠س ا٠اعراض ا٠٠رتبطة با٠صد٠ات (PTSD). ٠ع٠٠ا٠٠٠٠ض Ù Ù Ø°Ù Ù Ø Ø§Ø±ØªØ¨Ø· أس٠٠ب ا٠تع٠٠ا٠تج٠ب٠با٠٠ز٠د ٠٠ا٠ر٠ض ٠ا٠غضب Ø Ù ØªÙ Ø³Ø· ٠ذ٠ا٠ع٠ا٠ة ا٠أعراض ا٠٠رتبطة با٠صد٠ات ٠٠٠٠٠٠س أعراض ا٠ا٠تئاب. ٠أ٠دت ا٠دراسة ا٠حا٠٠ة ع٠٠ارتباط أ٠٠اط ا٠تع٠٠ا٠٠خت٠٠ة بت٠٠٠٠ا٠ارتباط ٠٠ذ٠٠ا٠أد٠ار ا٠٠س٠طة ٠٠اضطرابات ا٠٠اح٠ة ٠٠صد٠ات ٠اعراض ا٠ا٠تئاب بعد ا٠٠٠ادة. ٠٠د تستخد٠ا٠تدخ٠ات ا٠٠٠سا٠٠ة ٠٠ا٠٠ست٠ب٠٠ذ٠ا٠اد٠٠٠است٠دا٠ا٠تدخ٠ات ا٠خاصة باضطرابات ت٠٠٠٠ا٠ارتباط ٠٠٠ا ٠٠اخت٠ا٠ات ا٠٠رد٠ة.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142928/1/imhj21695_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142928/2/imhj21695.pd

The Changing Educators’ Work Environment in Contemporary Society

In this paper, we are going to address job satisfaction and perceived self-efficacy withinthe context of residential child-care. A joint report from the European Foundation for the Improvement on Living and Working Conditions and the European Agency for Safety and Health at Work revealed that managers in the field of health and education were the most concerned about the psychosocial risk of their employees, although concern is not automatically translated into tools to face the risk and to manage it. So, measuring and improving employees’ job satisfaction and self-efficacy can be an important means for organizations to prevent the outcomes of psychosocial risk, and supporting high quality performance of workers. But profound changes are affecting the nature of work at large, and specifically social educator’s in the field of residential care with minors. Globalization, radical technological and communication developments, as well as the pressure to frame care as a commodity, are quickly changing procedures and praxis at work, and even the meaning of job itself. All these changes are highly demanding for this category of professionals, as much as the fact that the organizational setting is vanishing as a resource to sustain their professional attitudes and behaviors. Under these circumstances, job satisfaction and self-efficacy can be hard to experience, and isolating their precursors is essential to develop healthy and effective work environments. This paper means to highlight the process of supporting self-efficacy and job satisfaction in the educational work in residential youth care that is still underrepresented in research. It presents data emerging from two studies, study 1 involving 268 educators and study 2 involving 472 educators belonging to different Italian residential child-care services. Study 1 consists of a quantitative study including the following measures: attachment style, job satisfaction, work-related self-efficacy, and length of service. Study 2 consist of a qualitative exploration deepening the sources of educators’ work-satisfaction. Quantitative data support the identification of attachment style and length of service as antecedents of work-related self-efficacy and job satisfaction. Qualitative data show the importance of relational issues in shaping the educators’ satisfaction at work

The associations between pathological narcissism, alexithymia and disordered eating attitudes among participants of pro-anorexic online communities

Abstract Purpose This study investigated the relationships between pathological narcissism, alexithymia, and disordered eating attitudes among participants of pro-anorexic online communities. Specifically, we explored the possible moderating role of alexithymia in the relationships between narcissistic vulnerability and disordered eating attitudes. Methods Participants included 97 Israeli female young adults who are active participants in pro-anorexic online communities. These participants completed a battery of self-reported questionnaires: The Pathological Narcissism Inventory (PNI); The Eating Attitudes Test-26 (EAT-26); and The Toronto Alexithymia Scale (TAS-20). Results Narcissistic grandiosity, vulnerability, and alexithymia were positively related to disordered eating attitudes. Alexithymia moderated the relationships between narcissistic vulnerability and the total score of disordered eating attitudes. Furthermore, alexithymia moderated the relationships between both narcissistic vulnerability and grandiosity and the oral control subscale of EAT-26. Conclusions These findings highlight the interaction between the pathological narcissism and the fundamental trait of alexithymia that might put individuals at risk for disordered eating

The interpersonal implications of PTSD and complex PTSD: The role of disturbances in self-organization

BACKGROUND: In the aftermath of trauma not only the primary traumatized survivors' mental health is affected but often also their significant others. The current study explores the specific associations of ICD-11 symptoms of posttraumatic stress disorder (PTSD) and disturbances in self organization (DSO) for secondary traumatic stress and dyadic adjustment among both spouses. METHODS: Male Israeli veterans and their wives (N = 216) were assessed 30 years after the war. Primary PTSD/DSO symptoms of the veterans and secondary posttraumatic stress symptoms (secondary PTSS)/DSO of the wives were assessed. Actor Partner Independence Modelling (APIM) evaluated the differential effects of PTSD and DSO for trauma transmission and dyadic adjustment. RESULTS: While veterans' primary PTSD only related to secondary PTSS of the wives, the veterans' DSO predicted the wives' secondary PTSS as well as DSO. Moreover, the APIM revealed that the primary and secondary DSO of both partners were associated with dyadic adjustment while their PTSD symptoms were not. LIMITATIONS: The cross-sectional data did not allow to identify directional or causal effects and DSO symptoms were not assessed with an ICD-specific instrument as such scales did not exist at the time of data collection. CONCLUSIONS: ICD-11 DSO symptoms seem to drive the transmission of posttraumatic stress among spouses to a more significant extent than PTSD symptoms. As DSO are also strongly implicated in decreased dyadic adjustment, they are valuable targets for couple therapy after one spouse experienced severe trauma, both in order to prevent interpersonal trauma transfer as well as to enhance dyadic adjustment