Moral Injury and Spiritual Struggles in Military Veterans: A Latent Profile Analysis.

War-related traumas can lead to emotional, relational, and spiritual suffering. Drawing on two community samples of war zone veterans from diverse military eras (Study 1, N = 616 and Study 2, N = 300), the purpose of this study was to examine patterns of constellations between outcomes related to moral injury (MI) and common ways in which veterans may struggle with religion or spirituality, defined as divine, morality, meaning, interpersonal, and doubt. Results from latent profile analyses revealed three distinct classes across the samples, based on psychometrically validated instruments: (a) no MI-related outcomes or spiritual struggles (nondistressed group; Study 1 = 72.7%, Study 2 = 75.0%); (b) MI-related outcomes and equivalent or lower degrees of spiritual struggles relative to MI-related outcomes (psychological MI group; Study 1 = 19.2%, Study 2 = 17.0%); and (c) MI-related outcomes and salient struggles with religious faith or spirituality, both within their own profiles and compared to other groups (spiritual MI group; 8.1% and 8.0% in the two samples). When we compared severity of spiritual struggles within MI groups, turmoil with God or a higher power emerged as a defining feature of the spiritual MI group in both samples. In addition, secondary analyses revealed membership in this third group was linked with greater importance of religion or spirituality before military service, χ2 (1, N = 616 and 300) = 4.468-8.273. Overall, although more research is needed, these findings highlight the possible utility of differentiating between psychological and spiritual subtypes of MI according to war zone veterans' religious or spiritual backgrounds.