Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Kirkwood, Kenneth W.


Moral injury is a relatively new area of study within military mental health care, as such, prevalence estimates for both moral injury and exposure to potentially morally injurious events (PMIE; a moral injury precursor) are unknown for many of the world’s militaries. PMIE is commonly defined as the perpetrating, failing to prevent, witnessing, or learning about acts or events that transgress an individual’s deeply held moral belief(s). The primary purpose of this study was to estimate the prevalence of PMIE in a population of Canadian Armed Forces (CF) members who served in support of the recent mission to Afghanistan. How exposure to PMIE may affect these individuals’ self-reported rates positive mental health served as a secondary research question. To this end, a secondary data analysis was conducted using the results of the 2013 Canadian Forces Mental Health Survey, a cross-sectional survey of over 8,000 active-duty CF members conducted by Statistics Canada for the Department of National Defence and the CF.

Statistical analysis revealed that over 65% of CF members reported exposure to at least one event that would be considered a PMIE. The most commonly reported PMIE types included seeing ill or injured women and children that they were unable to help (48%), being unable to distinguish between combatants and non-combatants (44%), and finding themselves in a threatening situation where they were unable to respond due to the rules of engagement they were required to operate under (35%). Results of the second research question revealed that the positive mental health status of CF members overall differed slightly from the Canadian population as a whole. However, when CF members’ positive mental health statuses were compared according to PMIE exposure

status those exposed were found to be 37% less likely to be flourishing, and 138% more likely to be languishing when compared to those who were not exposed.

These findings provide support for both the presence of exposure to PMIE in CF members who were deployed in support of the mission to Afghanistan, and the detrimental effect that such exposure has on their mental health. The implications and limitations of these findings and potential directions for future research into moral injury and PMIE are also discussed.

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