Posttraumatic growth and depreciation among Ukrainians: a structural equation modelling approach.

Abstract

Background: War-related stressors can disrupt core beliefs and shape trauma outcomes, yet the distinct roles of moral processes in post-traumatic outcomes remain insufficiently understood.Objective: To examine how war-related stressors (WRS) and core-belief disruption (CBD) relate to posttraumatic stress disorder (PTSD) symptoms, moral injury (MI), moral sensitivity (MS), posttraumatic growth (PTG), and posttraumatic depreciation (PTD) among Ukrainian adults living under ongoing war.Method: A national sample of adults residing in Ukraine in 2025 (N = 6,340) was assessed for WRS, CBD, PTSD symptoms, MI, MS, PTG, and PTD. Scalar measurement invariance across gender and combat-exposure groups was established. Structural equation modelling was applied to test direct and indirect pathways from WRS and CBD to PTG and PTD through PTSD symptoms, MI, and MS.Results: WRS and CBD explained substantial variance in PTSD (R² = .69), MI (R² = .37), and MS (R² = .33). MI and MS showed divergent predictive patterns: MI uniquely predicted PTD (β ≈ .36) but not PTG (β ≈ .06), whereas MS predicted PTG (β ≈ .42) but not PTD (β ≈ .03). Indirect pathways indicated that WRS and CBD were associated with higher PTD primarily through PTSD and MI, while their associations with PTG were mainly mediated by MS, with a smaller contribution from PTSD. The model accounted for significant variance in PTG (R² = .35) and PTD (R² = .48).Conclusions: Moral injury and moral sensitivity represent distinct processes associated with depreciative and growth-related posttraumatic change. Under ongoing war conditions, moral sensitivity functions as an adaptive pathway linked to PTG, whereas moral injury functions as a risk pathway linked to PTD.