The prevalence and long-term effects of PTSD and moral injury in Swedish military veterans.

Introduction: In the context of international military operations, officers and soldiers are exposed to various service-related stressors that may have long-lasting effects on their health and daily functioning. This study explored (1) the prevalence of symptoms indicative of both post-traumatic stress disorder (PTSD) and moral injury (MI), (2) the relationship between these conditions, and (3) the relationship between these conditions and a selection of background variables in Swedish military veterans who have previously been deployed in operations. Methods: The study was a self-report survey. Of 6000 individuals invited to participate, 1940 completed the questionnaire, resulting in a response rate of 32%. Data was analyzed using correlation and regression analyses to explore potential statistical relationships between variables of interest. Additionally, the data were also analyzed using between-group analyses ( Results: The results indicate that a low proportion of participants showed a prevalence of indications of PTSD, which are comparable to previous Swedish studies on deployed veterans. An even smaller proportion was found to show indications of moral injury when compared to the assessment of PTSD. However, besides the small group that fulfilled the cutoff score criteria, a number of respondents reported milder symptoms of both psychological and moral distress. The second goal of the study was to examine the relationship between indications of PTSD and indications of moral injury. The findings suggest that there is a considerable overlap between the two constructs. In addition, the results suggest that the risk of PTSD and MI is highest when an event is perceived as both highly stressful (fear-based) and morally challenging. The MI symptom subcluster shame accounts for the largest variance in the PTSD indicator scale within the study sample. Health- and deployment-related background variables were identified that may be related to indications of moral injury. Discussion: The study results highlight the type(s) of stressful experience and the health- and deployment-related factors that should be monitored post-deployment, which may serve as risk factors in developing indications of moral injury. The higher prevalence of indication of PTSD and MI in the past month, despite receiving various forms of support upon returning from deployment, highlights the need for MI-specific treatment.