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Background:  Moral injury emerges when someone perpetrates, fails to prevent, or witnesses acts that violate their own moral or ethical code. Nash et al. [(2013). Psychometric evaluation of the moral injury events scale.  Military Medicine ,  178 (6), 646–652] developed a short measure, the Moral Injury Events Scale (MIES) to facilitate the empirical study of moral injury in the military. Our study aimed to develop a civilian version of the measure (MIES–CV) and examine its psychometric properties in a sample of psychiatric inpatients . Methods:  In this cross-sectional study, the sample comprised 240 adult patients (71.7% female) with a mean age of 31.57 ( SD  = 11.69). The most common diagnoses in the sample were anxiety disorders (58.3%), depressive disorders (53.8%), and borderline personality disorder (39.6%). Participants were diagnosed using structured clinical interviews and filled out psychological questionnaires. Results:  Exploratory factor analysis suggested that Nash et al.’s model (Perceived Transgressions, Perceived Betrayals) represents the data well. This two-factor solution showed an excellent fit in the confirmatory factor analysis, as well. Meaningful associations were observed between moral injury and psychopathology dimensions, shame, reflective functioning, well-being, and resilience. The Perceived Betrayals factor was a significant predictor of bipolar disorders, PTSD, paranoid personality disorder, borderline personality disorder, and avoidant personality disorder. Conclusions:  Our study demonstrated that this broad version of the MIES is a valid measure of moral injury that can be applied to psychiatric patients.

european journal of psychotraumatology

Moral injury in psychiatric patients with personality and other clinical disorders: development, psychometric properties, and validity of the Moral Injury Events Scale–Civilian Version