Moral injury appraisals and PTSD symptoms in treatment-seeking refugees: a latent profile analysis

Objective: Refugees flee from countries due to war, violence, or persecution and are often exposed to potentially traumatic events (PTEs). Furthermore, they might encounter situations where they are compelled to act contrary to their moral codes or witness others acting morally wrong. Consequently, they are at risk to not only develop symptoms of posttraumatic stress disorder (PTSD), but also moral injury (MI). To date, MI in traumatized refugees has received limited research attention. The present study sought to identify classes of MI appraisals and PTSD symptoms among refugees exposed to PTEs and to investigate differences between these classes in terms of demographics, general psychopathology, and depression. Method: For this study, 136 treatment-seeking refugees completed questionnaires on demographics, self-directed and other-directed MI appraisals, PTSD symptoms, general psychopathology, and depression. Latent profile analysis was conducted to identify classes and regression analyses to explore differences between classes in terms of age, gender, general psychopathology, and depression. Results: The following three classes were identified: a ‘below average MI and below average PTSD class’ (39%), an ‘average MI-self, below average MI-other and low PTSD class’ (10%) and an ‘above average MI and above average PTSD class’ (50%). Classes differed in terms of general psychopathology and depression but not age and gender. Conclusions: We identified three classes, each displaying distinct manifestations of MI appraisals and PTSD symptoms. This highlights the importance of assessing and recognizing MI appraisals within treatment-seeking refugees, enabling customized treatment interventions for both MI and PTSD.