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A Review of Research on Moral Injury and Suicide Risk

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Abstract

Purpose of Review

This review summarizes empirical studies investigating the associations between moral injury and suicide-related outcomes.

Recent Findings

A total of 47 studies met inclusion criteria and were reviewed. Samples included military, veteran, and civilian populations. Overall, more exposure to potentially morally injurious events (PMIE) and greater morally injurious symptom severity were both related to increased risk for suicide-related outcomes, including suicidal ideation and suicide attempt[s], and composite suicide-related variables. The strength of the association depended on the population, assessments used to measure moral injury and suicide-related outcomes, and covariates included in the model. Mediators and moderators of the association were identified including depression, posttraumatic stress, hopelessness, guilt, shame, social support, and resilience.   

Summary

Moral injury confers a unique risk for suicide-related outcomes even after accounting for formalized psychiatric diagnosis. Suicide prevention programs for military service members, veterans, and civilians working in high-stress environments may benefit from targeted interventions to address moral injury. While suicide-related outcomes have not been included in efficacy trials of moral injury interventions, mediators and moderators of the association between moral injury and suicide-related outcomes are potential targets for therapeutic change, including disclosure, self-forgiveness, and meaning-making.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

    * indicates articles included for review

    1. World Health Organization. Suicide worldwide in 2021: global health estimates. Internet 2021:Available from: https://www.who.int/health-topics/suicide#tab=tab_1

    2. Centers for Disease Control and Prevention. Suicide Rates by Age Group – United States, 2000–2021. Internet 2022:Available from: https://www.cdc.gov/mmwr/volumes/71/wr/mm7113a7.htm Theoretical and empirical studies on moral injury.

    3. Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, Maguen S. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009;29(8):695–706.

      Article  PubMed  Google Scholar 

    4. Shay J. Moral injury. Psychoanal. Psychology. 2014;31:182–91.

      Google Scholar 

    5. Ang JMS. Moral dilemmas and moral injury. Int J Appl Philos. 2017;2:189–205.

      Article  Google Scholar 

    6. Maguen S, Griffin BJ, Copeland LA, Perkins DF, Richardson CB, Finley EP, Vogt D. Trajectories of functioning in a population-based sample of veterans: contributions of moral injury, PTSD, and depression. Psychol Med. 2020;25:1–10.

      Google Scholar 

    7. •• Purcell N, Koenig CJ, Bosch J, Maguen S. Veterans’ perspectives on the psychosocial impact of killing in war. Couns Psychol. 2016;44(7):1062–99. Measuring moral injury.

    8. Bryan CJ, Bryan AO, Anestis MD, Anestis JC, Green BA, Etienne N, Morrow CE, Ray-Sannerud B. Measuring moral injury: psychometric properties of the moral injury events scale in two military samples. Assessment. 2016;23(5):557–70.

      Article  PubMed  Google Scholar 

    9. • Nash WP, Carper TLM, Mills MA, Au T, Goldsmith A, Litz BT. Psychometric evaluation of the Moral Injury Events Scale. Mil Med. 2013;178(6):646–52. Shared factors between moral injury and suicide risk.

    10. Hendin H, Haas AP. Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. Am J Psychiatry. 1991;148(5):586–91.

      Article  PubMed  CAS  Google Scholar 

    11. Bryan CJ, Ray-Sannerud B, Morrow CE, Etienne N. Guilt is more strongly associated with suicidal ideation among military personnel with direct combat exposure. J Affect Disord. 2013;148(1):37–41.

      Article  PubMed  Google Scholar 

    12. Bryan CJ, Morrow CE, Etienne N, Ray-Sannerud B. Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depress Anxiety. 2013;30(1):55–60.

      Article  PubMed  Google Scholar 

    13. Bryan CJ, Morrow CE, Anestis MD, Joiner TE. A preliminary test of the interpersonal-psychological theory of suicidal behavior in a military sample. Pers Individ Differ. 2010;48(3):347–50.

      Article  Google Scholar 

    14. •• Litz BT, Contractor AA, Rhodes C, Dondanville KA, Jordan AH, Resick PA, et al. Distinct trauma types in military service members seeking treatment for posttraumatic stress disorder. J Trauma Stress. 2018;31(2):286–95. Commonly used moral injury assessments and psychometric properties.

    15. Kovnick MO, Young Y, Tran N, Teerawichitchainan B, Tran TK, Korinek K. The impact of early life war exposure on mental health among older adults in Northern and Central Vietnam. J Health Soc Behav. 2021;62(4):526–44.

      Article  PubMed  PubMed Central  Google Scholar 

    16. Dennis PA, Dennis NM, Van Voorhees EE, Calhoun PS, Dennis MF, Beckham JC. Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans’ involvement in wartime atrocities. Anxiety Stress Coping. 2017;30(2):188–201.

      Article  PubMed  Google Scholar 

    17. Wisco BE, Marx BP, May CL, Martini B, Krystal JH, Southwick SM, Pietrzak RH. Moral injury in U.S. combat veterans: results from the national health and resilience in veterans study. Depress Anxiety. 2017;34(4):340–7.

      Article  Google Scholar 

    18. Williams CL, Berenbaum H. Acts of omission, altered worldviews, and psychological problems among military veterans. Psychol Trauma. 2019;11(4):391–5.

      Article  PubMed  Google Scholar 

    19. Corona CD, Van Orden KA, Wisco BE, Pietrzak RH. Meaning in life moderates the association between morally injurious experiences and suicide ideation among U.S. combat veterans: results from the National Health and Resilience in Veterans Study. Psychol Trauma. 2019;11(6):614–20.

      Article  PubMed  PubMed Central  Google Scholar 

    20. Bryan AO, Bryan CJ, Morrow CE, Etienne N, Ray-Sannerud B. Moral injury, suicidal ideation, and suicide attempts in a military sample. Traumatology. 2014;20(3):154–60.

      Article  Google Scholar 

    21. Frankfurt SB, Frazier P, Engdahl B. Indirect relations between transgressive acts and general combat exposure and moral injury. Mil Med. 2017;182(11):e1960–6.

      Article  Google Scholar 

    22. • Kelley ML, Chae JW, Bravo AJ, Milam AL, Agha E, Gaylord SA, Vinci C, Currier JM. Own soul’s warning: moral injury, suicidal ideation, and meaning in life. Psychol Trauma. 2021;13(7):740–8. Meaning in life is protective of self-related moral injury.

    23. Boscarino JA, Adams RE, Wingate TJ, Urosevich TG, Hoffman SN, Kirchner HL, Figley CR, Nash WP. Impact and risk of moral injury among deployed veterans: implications for veterans and mental health. Front Psychiatry. 2022;13:899084.

      Article  PubMed  PubMed Central  Google Scholar 

    24. Levi-Belz Y, Shemesh S, Zerach G. Moral injury and suicide ideation among combat veterans: The moderating role of self-disclosure. Crisis: The Journal of Crisis Intervention and Suicide Prevention. 2023;44(3):198–208.

    25. Bryan CJ, Bryan AO, Roberge E, Leifker FR, Rozek DC. Moral injury, posttraumatic stress disorder, and suicidal behavior among National Guard personnel. Psychol Trauma. 2018;10(1):36–45.

      Article  PubMed  Google Scholar 

    26. Maguen S, Luxton DD, Skopp NA, Gahm GA, Reger MA, Metzler TJ, Marmar CR. Killing in combat, mental health symptoms, and suicidal ideation in Iraq war veterans. J Anxiety Disord. 2011;25(4):563–7.

      Article  PubMed  Google Scholar 

    27. Cameron AY, Eaton E, Brake CA, Capone C. Moral injury as a unique predictor of suicidal ideation in a veteran sample with substance use disorder. Psychol Trauma. 2021;13(8):856–60.

      Article  PubMed  Google Scholar 

    28. • Levi-Belz Y, Dichter N, Zerach G. Moral injury and suicide ideation among Israeli combat veterans: the contribution of self-forgiveness and perceived social support. J Interpers Violence. 2022;37(1–2):NP1031–57. Reveals cultural differences of moral injury.

    29. Maguen S, Metzler TJ, Bosch J, Marmar CR, Knight SJ, Neylan TC. Killing in combat may be independently associated with suicidal ideation. Dep Anxiety. 2012;29:918–23.

      Article  Google Scholar 

    30. Tripp JC, McDevitt-Murphy ME, Henschel AV. Firing a weapon and killing in combat are associated with suicidal ideation in OEF/OIF veterans. Psychol Trauma. 2016;8(5):626–33.

      Article  PubMed  Google Scholar 

    31. Williamson V, Murphy D, Stevelink SAM, et al. The impact of moral injury on the wellbeing of UK military veterans. BMC Psychol. 2021;9:73.

      Article  PubMed  PubMed Central  Google Scholar 

    32. Kline A, Weiner MD, Interian A, Shcherbakov A, St HL. Morbid thoughts and suicidal ideation in Iraq war veterans: the role of direct and indirect killing in combat. Depress Anxiety. 2016;33(6):473–82.

      Article  PubMed  Google Scholar 

    33. Hagerty SL, Williams LM. Moral injury, traumatic stress, and threats to core human needs in health-care workers: the COVID-19 pandemic as a dehumanizing experience. Clin Psychol Sci. 2022;10(6):1060–82.

      Article  Google Scholar 

    34. Bravo AJ, Kelley ML, Mason R, Ehlke S, Vinci C, Redman Ret LJC. Rumination as a mediator of the associations between moral injury and mental health problems in combat-wounded veterans. Traumatology. 2020;26(1):52–60.

      Article  PubMed  Google Scholar 

    35. Hoffman J, Liddell B, Bryant RA, Nickerson A. A latent profile analysis of moral injury appraisals in refugees. Eur J Psychotraumatol. 2019;10(1):1686805.

      Article  PubMed  PubMed Central  Google Scholar 

    36. Nieuwsma JA, Brancu M, Wortmann J, Smigelsky MA, King HA, VISN 6 MIRECC Workgroup, Meador KG. Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis. Clin Psychol Psychother. 2021;28(1):239–50.

      Article  PubMed  Google Scholar 

    37. • Nichter B, Norman SB, Maguen S, Pietrzak RH. Moral injury and suicidal behavior among US combat veterans: results from the 2019–2020 National Health and Resilience in Veterans Study. Depress Anxiety. 2021;38(6):606–14. Moral injury related to suicidal behavior beyond combat severity, PTSD, depression.

    38. Presseau C, Litz BT, Kline NK, Elsayed NM, Maurer D, Kelly K, et al. An epidemiological evaluation of trauma types in a cohort of deployed service members. Psychol Trauma. 2019;11(8):877–85.

      Article  PubMed  Google Scholar 

    39. Schwartz G, Halperin E, Levi-Belz Y. Moral injury and suicide ideation among combat veterans: the role of trauma-related shame and collective hatred. J Interpers Violence. 2022;37(15–16):NP13952–77.

      Article  PubMed  Google Scholar 

    40. • Shapiro MO, Houtsma C, Schafer KM, True G, Miller L, Anestis M. Moral injury and suicidal ideation among female national guard members: Indirect effects of perceived burdensomeness and thwarted belongingness. Traumatology 2022: Advance online publication. https://doi.org/10.1037/trm0000424. Current psychotherapeutic treatment approaches for moral injury, their efficacy, and moral injury case studies pertaining to suicide related outcomes.

    41. Thoresen S, Mehlum L. Traumatic stress and suicidal ideation in Norwegian male peacekeepers. J Nerv Ment Dis. 2008;196(11):814–21.

      Article  PubMed  Google Scholar 

    42. Sareen J, Cox BJ, Afifi TO, Stein MB, Belik SL, Meadows G, Asmundson GJ. Combat and peacekeeping operations in relation to prevalence of mental disorders and perceived need for mental health care: findings from a large representative sample of military personnel. Arch Gen Psychiatry. 2007;64(7):843–52.

      Article  PubMed  Google Scholar 

    43. McLean CP, Zang Y, Zandberg L, Bryan CJ, Gay N, Yarvis JS, et al. Predictors of suicidal ideation among active duty military personnel with posttraumatic stress disorder. J Affect Disord. 2017;208:392–8.

      Article  PubMed  Google Scholar 

    44. • Krauss SW, Zust J, Frankfurt S, Kumparatana P, Riviere LA, Hocut J, Sowden WJ, Adler AB. Distinguishing the effects of life threat, killing enemy combatants, and unjust war events in U.S. service members. J Trauma Stress. 2021;34(2):357–66. Studies examining the association between moral injury and suicidality.

    45. Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295(9):1023–32.

      Article  PubMed  CAS  Google Scholar 

    46. Parry KJ, Hicken BL, Chen W, Leng J, Allen S, Burningham Z. Impact of moral injury and posttraumatic stress disorder on health care utilization and suicidality in rural and urban veterans. J Trauma Stress. 2023;36(1):117–28.

    47. Zerach G, Levi-Belz Y. Intolerance of uncertainty moderates the association between potentially morally injurious events and suicide ideation and behavior among combat veterans. Journal of Traumatic Stress. 2019;32(3):424–36.

    48. Levi-Belz Y, Zerach G. Moral injury, suicide ideation, and behavior among combat veterans: The mediating roles of entrapment and depression. Psychiatry Res. 2018;269:508–16.

    49. Kelley ML, Bravo AJ, Davies RL, Hamrick HC, Vinci C, Redman JC. Moral injury and suicidality among combat wounded veterans: the moderating effects of social connectedness and self-compassion. Psychol Trauma. 2019;11(6):621–9.

      Article  PubMed  PubMed Central  Google Scholar 

    50. Currier JM, Smith PN, Kuhlman S. Assessing the unique role of religious coping in suicidal behavior among U.S. Iraq and Afghanistan veterans. Psych Relig Spirit. 2017;9(1):118–23.

      Google Scholar 

    51. Currier JM, Holland JM, Drescher K, Foy D. Initial psychometric evaluation of the Moral Injury Questionnaire-Military Version. Clin Psychol Psychother. 2015;22(1):54–63.

      Article  PubMed  Google Scholar 

    52. Battles AR, Bravo AJ, Kelley ML, White TD, Braitman AL, Hamrick HC. Moral injury and PTSD as mediators of the associations between morally injurious experiences and mental health and substance use. Traumatology. 2018;24(4):246–54.

    53. Hamrick HC, Ehlke SJ, Davies RL, Higgins JM, Naylor J, Kelley ML. Moral injury as a mediator of the associations between sexual harassment and Mental health symptoms and substance use among women veterans. J Interpers Violence. 2022;37(11–12):NP10007–35.

    54. Ames D, Erickson Z, Youssef NA, Arnold I, Adamson CS, Sones AC, Yin J, Haynes K, Volk F, Teng EJ, Oliver JP, Koenig HG. Moral Injury, religiosity, and suicide risk in U.S. veterans and active duty nilitary with PTSD symptoms. Mil Med. 2019;184(3-4):e271–8.

    55. •• Maguen S, Griffin BJ, Vogt D, Hoffmire CA, Blosnich JR, Bernhard PA, Akhtar FZ, Cypel YS, Schneiderman AI. Moral injury and peri- and post-military suicide attempts among post-9/11 veterans. Psychol Med:2022:1–10.

    56. •• Fani N, Currier JM, Turner MD, Guelfo A, Kloess M, Jain J, Mekawi Y, Kuzyk E, Hinrichs R, Bradley B, Powers A, Stevens JS, Michopoulos V, Turner JA. Moral injury in civilians: associations with trauma exposure, PTSD, and suicide behavior. Eur J Psychotraumatol. 2021;12(1):1965464. First study of moral injury and association of suicidal behaviors in U.S. civilians.

    57. Fontana A, Rosenheck R, Brett E. War zone traumas and posttraumatic stress disorder symptomatology. J Nerv Ment Dis. 1992;180(12):748–55.

      Article  PubMed  CAS  Google Scholar 

    58. Griffith J, Vaitkus M. Perspectives on suicide in the Army National Guard. Armed Forces Soc. 2013;39(4):628–53.

      Article  Google Scholar 

    59. • Richardson NM, Lamson AL, Smith M, Eagan SM, Zvonkovic AM, Jensen J. Defining Moral injury among military populations: a systematic review. J Trauma Stress. 2020;33(4):575–86. Most commonly used suicide assessments in articles reviewed in the current study.

    60. Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. 2001;8(4):443–54.

      Article  PubMed  CAS  Google Scholar 

    61. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979;47(2):343–52. Summary of studies examining association between moral injury and suicide-related outcomes cited in-text.

      Article  PubMed  CAS  Google Scholar 

    62. Currier JM, Holland JM, Malott J. Moral injury, meaning making, and mental health in returning veterans. J Clin Psychol. 2015;71(3):229–40.

      Article  PubMed  Google Scholar 

    63. Bryan AO, Theriault JL, Bryan CJ. Self-forgiveness, posttraumatic stress, and suicide attempts among military personnel and veterans. Traumatology. 2015;21:40–6.

      Article  Google Scholar 

    64. Kopacz MS, Currier JM, Drescher KD, Pigeon WR. Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD. J Inj Violence Res. 2016;8(1):6–14.

      PubMed  PubMed Central  Google Scholar 

    65. Smigelsky MA, Jardin C, Nieuwsma JA, Brancu M, Meador KG, Molloy KG, VA Mid-Atlantic MIRECC Workgroup, Elbogen EB. Religion, spirituality, and suicide risk in Iraq and Afghanistan era veterans. Depress Anxiety. 2020;37(8):728–37.

      Article  PubMed  Google Scholar 

    66. Raines AM, Currier J, McManus ES, Walton JL, Uddo M, Franklin CL. Spiritual struggles and suicide in veterans seeking PTSD treatment. Psychol Trauma. 2017;9(6):746–9.

      Article  PubMed  Google Scholar 

    67. Joiner T. Why people die by suicide. Cambridge, MA, US: Harvard University Press; 2005.

      Google Scholar 

    68. Houtsma C, Khazem LR, Green BA, Anestis MD. Isolating effects of moral injury and low post-deployment support within the U.S. military. Psychiatry Res. 2017;247:194–9.

      Article  PubMed  Google Scholar 

    69. Martin RL, Houtsma C, Bryan ABO, Bryan CJ, Green BA, Anestis MD. The impact of aggression on the relationship between betrayal and belongingness among U.S. military personnel. Mil Psychol. 2017;29(4):271–82.

      Article  Google Scholar 

    70. Gray MJ, Schorr Y, Nash W, Lebowitz L, Amidon A, Lansing A, Maglione M, Lang AJ, Litz BT. Adaptive disclosure: an open trial of a novel exposure-based intervention for service members and combat-related psychological stress injuries. Behav Ther. 2012;43:407–15.

      Article  PubMed  Google Scholar 

    71. • Litz BT, Rusowicz-Orazem L, Grunthal B, Gray M, Nash W, Lang A. Adaptive disclosure, a combat-specific PTSD treatment versus cognitive-processing therapy in deployed marines and sailors: a randomized controlled non-inferiority trial. Psychiatr Res. 2020;297:113761. First study comparing efficacy of moral injury specific treatment to evidence-based treatment for PTSD.

    72. Maguen S, Burkman K, Madden E, Dinh J, Bosch J, Keyser J, Neylan TC. Impact of killing in war: a randomized, controlled pilot trial. J Clin Psychol. 2017;73:997–1012.

      Article  PubMed  Google Scholar 

    73. Harris J, Usset T, Voecks C, Thuras P, Currier J, Erbes C. Spiritually integrated care for PTSD: a randomized controlled trial of “Building Spiritual Strength.” Psychiatry Res. 2018;267:420–8.

      Article  PubMed  Google Scholar 

    74. Norman SB, Wilkins KC, Myers US, Allard CB. Trauma informed guilt reduction therapy with combat veterans. Cogn Behav Pract. 2014;21:78–88.

      Article  PubMed  PubMed Central  Google Scholar 

    75. Farnsworth JK, Drescher KD, Evans W, Walser RD. A functional approach to understanding and treating military-related moral injury. J Contextual Behav Sci. 2017;6:391–7.

      Article  Google Scholar 

    76. Cenkner DP, Yeomans PD, Antal CJ, Scott JC. A pilot study of a moral injury group intervention co-facilitated by a chaplain and psychologist. J Trauma Stress. 2021;34:367–74.

      Article  PubMed  Google Scholar 

    77. Evans WR, Russell LH, Hall-Clark BN, Fina BA, Brown LA, Foa EB, Peterson AL. Consortium to alleviate PTSD. Moral injury and moral healing in prolonged exposure for combat-related PTSD: A case study. Cogn Behav Pract. 2021;28:210–23.

      Article  Google Scholar 

    78. Held P, Klassen BJ, Brennan MB, Zalta AK. Using prolonged exposure and cognitive processing therapy to treat veterans with moral injury-based PTSD: two case examples. Cogn Behav Pract. 2018;25:377–90.

      Article  PubMed  Google Scholar 

    79. Murray H, Ehlers A. Cognitive therapy for moral injury in post-traumatic stress disorder. Cogn Behav Therap. 2021;14(e8):1–19.

      Google Scholar 

    80. Pearce M, Haynes K, Rivera N, Koenig H. Spiritually-integrated cognitive processing therapy: a new treatment for moral injury in the setting of PTSD. Glob Adv Health Med. 2018;7:1–7.

      Article  Google Scholar 

    81. Antal CJ, Yeomans PD, East R, Hickey DW, Kalkstein S, Brown KM, Kaminstein DS. Transforming veteran identity through community engagement: a chaplain–psychologist collaboration to address moral injury. J Humanist Psychol. 2019;59:168–87.

      Google Scholar 

    82. • Borges LM. A service member’s experience of Acceptance and Commitment Therapy for Moral Injury (ACT-MI) via telehealth: “learning to accept my pain and injury by reconnecting with my values and starting to live a meaningful life.” J Contextual Behav Sci. 2019;13:134–40. Suicide risk factors.

    83. Bryan CJ, Rudd MD. Advances in the assessment of suicide risk. J Clin Psychol. 2006;62(2):185–200.

      Article  PubMed  Google Scholar 

    84. • Smith NB, Mota NP, Tsai J, Monteith LL, Harpaz-Rotem I, Southwick SM, Pietrzak RH. Nature and determinants of suicidal ideation among US veterans: results from the National Health and Resilience in Veterans Study. J Affect Disord. 2017;212:98–105. Additional studies examining association between moral injury and suicide-related outcomes that were included in table, but not cited in-text. Studies examining the association between moral injury and suicidal ideation.

    85. Currier JM, Holland JM, Drescher KD, Foy D. Initial psychometric properties of the Moral Injury Questionnaire-Military Version. Clin Psychol Psychother. 2015;22(5):54–63.

      Article  PubMed  Google Scholar 

    86. *Kang HK, Natelson BH, Mahan CM, Lee KY, Murphy FM. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. Am J Epidemiol. 2003;158(3):231–8.

      Google Scholar 

    87. *Schnurr PP, Lunney CA, Sengupta A. Risk factors for suicidal ideation in OEF/OIF veterans: a pilot study. Suicide Life Threat Behav. 2005;35(6):664–75.

      Google Scholar 

    88. *Steenkamp MM, Litz BT, Hoge CW, Marmar CR. Psychotherapy for military-related PTSD: a review of randomized clinical trials. JAMA. 2015;314(9):489–500.

      Article  PubMed  CAS  Google Scholar 

    89. *Nock MK, Dempsey CL, Aliaga PA, Brent DA, Heeringa SG, Kessler RC, Stein MB, Ursano RJ, Colpe LJ. Psychological autopsy study comparing suicide decedents, suicide ideators, and propensity score matched controls: results from the Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Mol Psychiatry. 2017;22(11):1425–34.

      Google Scholar 

    90. *Schreiber M, Bell RS, Walker J, Rempel J, Silver A, Ursano RJ. Predictors of suicide in US Army soldiers: a case-control study of 60 suicides and 120 matched controls. Suicide Life Threat Behav. 2012;42(5):567–82.

      Google Scholar 

    91. *Koenig HG, Boucher NA, Oliver R, Youssef NA, Mooney SR, Currier JM, Pearce M, Kvale JN. Moral injury, religiosity, and suicide risk in veterans with posttraumatic stress disorder. J Nerv Ment Dis. 2021;209(6):422–8.

      Google Scholar 

    92. • *Kelley ML, Braitman AL, White TD, Ehlke SJ. Sex differences in mental health symptoms and substance use and their association with moral injury in veterans. Psych Trauma. 2019;11(3):337–44. Studies examining the association between moral injury and suicide attempts.

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    1. San Francisco VA Health Care System, San Francisco, CA, USA

      A. J. Khan PhD & S. Maguen PhD

    2. Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA

      A. J. Khan PhD & S. Maguen PhD

    3. Center for Mental Health Care & Outcomes Research, Central Arkansas VA Healthcare System, Little Rock, USA

      B. J. Griffin PhD

    4. Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, USA

      B. J. Griffin PhD

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    Khan, A.J., Griffin, B.J. & Maguen, S. A Review of Research on Moral Injury and Suicide Risk. Curr Treat Options Psych 10, 259–287 (2023). https://doi.org/10.1007/s40501-023-00293-7

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