Experience and Contributing Factors of Moral Injury in Military Personnel.

Abstract

Introduction: Moral injury among military personnel is characterized by profound psychological, relational, and existential distress arising from experiences that violate deeply held moral values.

Background and purpose: Moral injury may be accompanied by guilt, shame, social disconnection, and increased suicide risk, thereby threatening both individual well-being and military readiness. This qualitative meta-synthesis aimed to elucidate military personnel's experiences of moral injury and identify the factors contributing to its development, persistence, and recovery.

Materials and methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted using five databases (PubMed, PsycINFO, Embase, CINAHL, and Web of Science). The search targeted qualitative studies published in English until August 2025. Study selection and methodological quality appraisal were independently conducted by multiple researchers. The findings were integrated using thematic synthesis, with Litz's model of moral injury used as the analytical framework to guide the development and interpretation of the themes.

Results: Of the 3,395 records identified, 19 studies were included in the meta-synthesis. A total of 5 main themes and 17 subthemes were identified: (1) contextual and vulnerability factors influencing moral injury, (2) potentially morally injurious events and moral conflict, (3) multidimensional presentation of moral injury symptoms, (4) the trajectory of moral disrepair and chronicity, and (5) existential path to recovery: moral reconstruction.

Conclusions: Military moral injury involves disruption of moral meaning and may progress through moral conflict and disrepair toward moral reconstruction. Recovery does not necessarily require complete resolution of moral pain; rather, it may involve meaning-making, relational reconnection, and the integration of morally injurious experiences into a reconstructed identity. These findings highlight the need for clinical and organizational responses that address not only individual symptoms but also the relational, existential, and institutional contexts of moral injury.