An exploratory analysis of the association between moral injury and mental healthcare-seeking attitudes and behaviors in returning veterans of the Iraq and Afghanistan wars

Objectives This study examines the degree to which veterans who have experienced more “moral injury” are less likely to seek the mental healthcare services they may urgently need. Methods The sampling frame for this study included American veterans of the Iraq and/or Afghanistan wars aged 25-44. Participants were recruited into the study by posting a call for participants to social media platforms such as Facebook and LinkedIn. A web link was provided to direct them to an anonymous online survey. We then collected data assessing veterans’ combat experiences, healthcare-seeking attitudes and behaviors, and various sociodemographic data. No identifying information was collected, and an Institutional Review Board exemption was granted under DHHS Regulatory Category II by the George Washington University’s Office of Human Research Study. Results The results from the Inventory of Attitudes toward Seeking Mental Health Services (IASMHS) clearly showed that moral injury was associated with more negative mental health services-seeking attitudes in all measurable areas. Those respondents scoring higher on the Moral Injury Events Scale (MIES) were presumably less likely to acknowledge their psychological problems, more likely to have fear of anticipated stigma from loved ones if they were to seek mental health treatment, and less willing and able to seek out mental health treatment when needed. Conclusions It is probable that we will not be able to reach a significant number of veterans suffering from moral injury unless we dedicate further research in the area of developing effective techniques to recruit veterans suffering from moral injury into mental health treatment programs by taking their specific symptoms (independent of PTSD) into consideration. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study received no external funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB Exemption Granted under DHHS Regulatory Category II George Washington University Office of Human Research Study Number 031618 All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All participant data is currently being stored either online within Survey Monkey's secure servers, or on password-protected desktop computers secured within research team members' offices or private residences.