Harold G Koenig1,2,3, Donna Ames4,5, Nagy A Youssef6, John P Oliver3, Fred Volk7, Ellen J Teng8, Kerry Haynes9, Zachary D Erickson10, Irina Arnold10, Keisha O'Garo11, Michelle Pearce12. 1. Departments of Medicine and Psychiatry, Duke University Medical Center, 201 Trent Drive, Durham, NC. 2. Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia. 3. Department of Pastoral Care, Durham Veterans Affairs Medical Center, 508 Fulton St, Durham, NC. 4. Mental Health Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA. 5. David Geffen School of Medicine, University of California, 760 Westwood Plaza, Los Angeles, CA. 6. Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Charlie Norwood VA Medical Center, 1 Freedom Way, Augusta, GA. 7. Department of Counselor Education and Family Studies, School of Behavioral Sciences, Liberty University, 1971 University Blvd, Lynchburg, VA. 8. Baylor College of Medicine and Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX. 9. South Texas Veterans Healthcare System, 4318 Woodcock Dr #120, San Antonio, TX. 10. Research Service, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA. 11. Department of Psychiatry, Duke University Medical Center, 201 Trent Drive, Durham, NC. 12. Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD.
Abstract
Introduction: To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD. Methods: A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two. In the first half (n = 214), exploratory factor analysis identified the highest loading item on each of the 10 MISS scales (guilt, shame, moral concerns, loss of meaning, difficulty forgiving, loss of trust, self-condemnation, religious struggle, and loss of religious faith) to form the 10-item MISS-M-SF; confirmatory factor analysis was then performed to replicate results in the second half of the sample (n = 213). Internal reliability, test-retest reliability, and convergent, discriminant, and concurrent validity were examined in the overall sample. The study was approved by the institutional review boards and the Research & Development (R&D) Committees at Veterans Administration medical centers in Durham, Los Angeles, Augusta, Houston, and San Antonio, and the Liberty University and Duke University Medical Center institutional review boards. Findings: The 10-item MISS-M-SF had a median of 50 and a range of 12-91 (possible range 10-100). Over 70% scored a 9 or 10 (highest possible) on at least one item. Cronbach's alpha was 0.73 (95% CI 0.69-0.76), and test-retest reliability was 0.87 (95% CI 0.79-0.92). Convergent validity with the 45-item MISS-M was r = 0.92. Discriminant validity was demonstrated by relatively weak correlations with social, religious, and physical health constructs (r = 0.21-0.35), and concurrent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms (r = 0.54-0.58). Discussion: The MISS-M-SF is a reliable and valid measure of MI symptoms that can be used to screen for MI and monitor response to treatment in veterans and active duty military with PTSD.
RCT Entities:
Introduction: To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD. Methods: A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two. In the first half (n = 214), exploratory factor analysis identified the highest loading item on each of the 10 MISS scales (guilt, shame, moral concerns, loss of meaning, difficulty forgiving, loss of trust, self-condemnation, religious struggle, and loss of religious faith) to form the 10-item MISS-M-SF; confirmatory factor analysis was then performed to replicate results in the second half of the sample (n = 213). Internal reliability, test-retest reliability, and convergent, discriminant, and concurrent validity were examined in the overall sample. The study was approved by the institutional review boards and the Research & Development (R&D) Committees at Veterans Administration medical centers in Durham, Los Angeles, Augusta, Houston, and San Antonio, and the Liberty University and Duke University Medical Center institutional review boards. Findings: The 10-item MISS-M-SF had a median of 50 and a range of 12-91 (possible range 10-100). Over 70% scored a 9 or 10 (highest possible) on at least one item. Cronbach's alpha was 0.73 (95% CI 0.69-0.76), and test-retest reliability was 0.87 (95% CI 0.79-0.92). Convergent validity with the 45-item MISS-M was r = 0.92. Discriminant validity was demonstrated by relatively weak correlations with social, religious, and physical health constructs (r = 0.21-0.35), and concurrent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms (r = 0.54-0.58). Discussion: The MISS-M-SF is a reliable and valid measure of MI symptoms that can be used to screen for MI and monitor response to treatment in veterans and active duty military with PTSD.
Authors: Ryan P Chesnut; Cameron B Richardson; Nicole R Morgan; Julia A Bleser; Kimberly J Mccarthy; Daniel F Perkins Journal: J Relig Health Date: 2022-07-05
Authors: Donna Ames; Zachary Erickson; Chelsea Geise; Suchi Tiwari; Sergii Sakhno; Alexander C Sones; Chaplain Geoffrey Tyrrell; Chaplain Robert B Mackay; Chaplain William Steele; Therese Van Hoof; Heidi Weinreich; Harold G Koenig Journal: J Relig Health Date: 2021-06-20
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