The design and validation of the Moral Injury Scale in the UK adults exposed to morally or psychologically distressing experiences: MORIS

Victoria Williamson; Dominic Murphy; Daniel Leightley; Obioha C. Ukoumunne; Fatmanur Çimen; Neil Greenberg

doi:10.1016/j.ejtd.2026.100716

The design and validation of the Moral Injury Scale in the UK adults exposed to morally or psychologically distressing experiences: MORIS

Victoria Williamson
, Dominic Murphy
, Daniel Leightley
, Obioha C. Ukoumunne
, Fatmanur Çimen
, Neil Greenberg

Department of Psychology

National Addiction Centre
King's College London
Centre for Applied Military Health Research
University of Exeter
Elektronik Ve Haberlesme Bolumu

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives Studies have found that moral injury (MI) can be easily missed in clinical assessments and most measures of MI have been developed for and with US military samples. As MI is increasingly recognised in non-military samples, existing scales may not be appropriate to civilian experiences. Design To design and validate the Moral Injury Scale (MORIS), a self-report measure of exposure to potentially morally injurious events (PMIEs), moral injury-related distress, and associated risk and protective factors, in UK samples pre-screened for reporting morally or psychologically distressing experiences. Setting UK general population. Participants We administered an initial set of 47 items to 592 participants and conducted exploratory factor analysis. The reduced MORIS was then administered to an independent sample of 382 participants and confirmatory factor analysis was conducted. Primary outcome measures The validity and performance characteristics of the MORIS were assessed against validated measures of mental ill health. Receiver operating characteristic (ROC) curves were used to calculate a likely cut off score for detecting conditions that are associated with moral injury. Results Analysis yielded factors for assessing exposure to PMIEs; time since event; MI-related distress; and risk and protective factors. Good convergent validity was evidenced against the measure of MI and mental health symptoms. Confirmatory factor analysis demonstrated a good fit for the model. ROC analyses suggested that a score of ≥18 (ROC 0.83; 95% CI 0.77 - 0.90) on the MORIS Distress subscale may indicate elevated levels of moral injury-related distress within this sample; however, this finding should be considered exploratory at this stage. Conclusions This study provides preliminary evidence supporting the reliability, unidimensional factor structure, and convergent validity of the MORIS among UK adults reporting morally or psychologically distressing experiences. Data set information Please see data availability statement.

Original language	English
Article number	100716
Number of pages	11
Journal	European Journal of Trauma and Dissociation
Volume	10
Issue number	3
Early online date	27 Jun 2026
DOIs	https://doi.org/10.1016/j.ejtd.2026.100716
Publication status	E-pub ahead of print - 27 Jun 2026

Data Availability Statement

The data that support the findings of this study are available from the
corresponding author, [VW], upon reasonable request

Acknowledgements

Obioha Ukoumunne was supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula. The NIHR had no role in the study design, collection, management, analysis or interpretation of data, writing of the report, or the decision to submit the report for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Funding

This study was funded by the Forces in Mind Trust (NO AWARD NUMBER), a funding scheme run by the Forces in Mind Trust using an endowment awarded by the National Lottery Community Fund.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Clinical Psychology
Psychiatry and Mental health

Access to Document

10.1016/j.ejtd.2026.100716Licence: CC BY

Cite this

Williamson, V., Murphy, D., Leightley, D., Ukoumunne, O. C., Çimen, F., & Greenberg, N. (2026). The design and validation of the Moral Injury Scale in the UK adults exposed to morally or psychologically distressing experiences: MORIS. European Journal of Trauma and Dissociation, 10(3), Article 100716. Advance online publication. https://doi.org/10.1016/j.ejtd.2026.100716

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abstract = "Objectives Studies have found that moral injury (MI) can be easily missed in clinical assessments and most measures of MI have been developed for and with US military samples. As MI is increasingly recognised in non-military samples, existing scales may not be appropriate to civilian experiences. Design To design and validate the Moral Injury Scale (MORIS), a self-report measure of exposure to potentially morally injurious events (PMIEs), moral injury-related distress, and associated risk and protective factors, in UK samples pre-screened for reporting morally or psychologically distressing experiences. Setting UK general population. Participants We administered an initial set of 47 items to 592 participants and conducted exploratory factor analysis. The reduced MORIS was then administered to an independent sample of 382 participants and confirmatory factor analysis was conducted. Primary outcome measures The validity and performance characteristics of the MORIS were assessed against validated measures of mental ill health. Receiver operating characteristic (ROC) curves were used to calculate a likely cut off score for detecting conditions that are associated with moral injury. Results Analysis yielded factors for assessing exposure to PMIEs; time since event; MI-related distress; and risk and protective factors. Good convergent validity was evidenced against the measure of MI and mental health symptoms. Confirmatory factor analysis demonstrated a good fit for the model. ROC analyses suggested that a score of ≥18 (ROC 0.83; 95\% CI 0.77 - 0.90) on the MORIS Distress subscale may indicate elevated levels of moral injury-related distress within this sample; however, this finding should be considered exploratory at this stage. Conclusions This study provides preliminary evidence supporting the reliability, unidimensional factor structure, and convergent validity of the MORIS among UK adults reporting morally or psychologically distressing experiences. Data set information Please see data availability statement.",

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N2 - Objectives Studies have found that moral injury (MI) can be easily missed in clinical assessments and most measures of MI have been developed for and with US military samples. As MI is increasingly recognised in non-military samples, existing scales may not be appropriate to civilian experiences. Design To design and validate the Moral Injury Scale (MORIS), a self-report measure of exposure to potentially morally injurious events (PMIEs), moral injury-related distress, and associated risk and protective factors, in UK samples pre-screened for reporting morally or psychologically distressing experiences. Setting UK general population. Participants We administered an initial set of 47 items to 592 participants and conducted exploratory factor analysis. The reduced MORIS was then administered to an independent sample of 382 participants and confirmatory factor analysis was conducted. Primary outcome measures The validity and performance characteristics of the MORIS were assessed against validated measures of mental ill health. Receiver operating characteristic (ROC) curves were used to calculate a likely cut off score for detecting conditions that are associated with moral injury. Results Analysis yielded factors for assessing exposure to PMIEs; time since event; MI-related distress; and risk and protective factors. Good convergent validity was evidenced against the measure of MI and mental health symptoms. Confirmatory factor analysis demonstrated a good fit for the model. ROC analyses suggested that a score of ≥18 (ROC 0.83; 95% CI 0.77 - 0.90) on the MORIS Distress subscale may indicate elevated levels of moral injury-related distress within this sample; however, this finding should be considered exploratory at this stage. Conclusions This study provides preliminary evidence supporting the reliability, unidimensional factor structure, and convergent validity of the MORIS among UK adults reporting morally or psychologically distressing experiences. Data set information Please see data availability statement.

AB - Objectives Studies have found that moral injury (MI) can be easily missed in clinical assessments and most measures of MI have been developed for and with US military samples. As MI is increasingly recognised in non-military samples, existing scales may not be appropriate to civilian experiences. Design To design and validate the Moral Injury Scale (MORIS), a self-report measure of exposure to potentially morally injurious events (PMIEs), moral injury-related distress, and associated risk and protective factors, in UK samples pre-screened for reporting morally or psychologically distressing experiences. Setting UK general population. Participants We administered an initial set of 47 items to 592 participants and conducted exploratory factor analysis. The reduced MORIS was then administered to an independent sample of 382 participants and confirmatory factor analysis was conducted. Primary outcome measures The validity and performance characteristics of the MORIS were assessed against validated measures of mental ill health. Receiver operating characteristic (ROC) curves were used to calculate a likely cut off score for detecting conditions that are associated with moral injury. Results Analysis yielded factors for assessing exposure to PMIEs; time since event; MI-related distress; and risk and protective factors. Good convergent validity was evidenced against the measure of MI and mental health symptoms. Confirmatory factor analysis demonstrated a good fit for the model. ROC analyses suggested that a score of ≥18 (ROC 0.83; 95% CI 0.77 - 0.90) on the MORIS Distress subscale may indicate elevated levels of moral injury-related distress within this sample; however, this finding should be considered exploratory at this stage. Conclusions This study provides preliminary evidence supporting the reliability, unidimensional factor structure, and convergent validity of the MORIS among UK adults reporting morally or psychologically distressing experiences. Data set information Please see data availability statement.

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The design and validation of the Moral Injury Scale in the UK adults exposed to morally or psychologically distressing experiences: MORIS

Abstract

Data Availability Statement

Acknowledgements

Funding

UN SDGs

ASJC Scopus subject areas

Access to Document

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