MILE Study: Moral Injury and the Lived Experience

Abstract

Introduction
In the realm of the military experience, moral injury is often manifested as feelings of betrayal, shame, and guilt. The Moral Injury and the Lived Experience (MILE) Study, which I developed, led, and report on in this thesis, explored the following research questions (RQ):

RQ1: What are the experiences of Veterans in high stakes situations, such as combat, in relation to moral injury and what is the impact of these experiences and military service on Veterans’ beliefs in a just or moral world?

RQ2: What are the associations between potentially morally injurious experiences (PMIEs) and symptoms of depression, posttraumatic stress disorder (PTSD), and between PMIEs and engagement in health behaviours?

Prior to this project, the experiences leading to the emotional, spiritual, and psychological wounds, i.e., moral injuries, incurred during military service, had yet to be explored as a possible contributor to engagement in unhealthy lifestyle behaviours in post-9/11 American Veterans.

Methods
This project was a mixed-methods study; the research questions were evaluated quantitatively (n=16)—using validated assessments of morally injurious experiences, depression and PTSD symptoms, combat exposure, and engagement in health behaviours—as well as qualitatively (n=13) through analysis of participants’ written narratives. Spearman’s Rank correlation analysis and thematic narrative analysis were performed to identify if relationships might exist between PMIEs, mental health symptoms, and health behaviours both quantitatively and qualitatively.

Results
The overarching themes identified through the analysis of both the qualitative data and the quantitative data were:
1. Combat trauma and violence contradicting a service member’s moral expectations of war (RQ1).
2. Betrayals by military leadership and culture and the American public (RQ1).
3. Long-term consequences of experiencing PMIEs during military service were an impaired or destroyed capacity of trust and having hope for the future (RQ1).
4. Experiencing betrayals by military/political leaders was associated with both PTSD and depression symptoms (RQ2).
5. Betrayals and PMIEs associated with combat environments, may be associated with participants’ engagement in exercise, their dietary choices, and how they manage stress (RQ2).
Participants’ narratives provided additional context to the quantitative data around how experiencing PMIEs, especially betrayals by military leaders and trusted civilians can be associated with engaging in unhealthy lifestyle behaviours. Notably, poor stress management, being physically inactive and/or associating exercise with negative experiences and engaging in disordered eating behaviours were identified as being associated with PMIEs.

Conclusion
The most commonly reported PMIE in both the quantitative data and narratives was feeling betrayed, often by military leadership or trusted civilians. And, notable for this project’s aim and a new contribution to the moral injury literature, PMIEs, especially betrayals by military leadership and situations that resulted in participants feeling that their personal values were betrayed, may be associated with engagement in unhealthy lifestyle behaviours. Thirty-seven countries deployed forces, serve alongside the United States military in Iraq (Carney, 2011). Therefore, that experiencing PMIEs and that PMIEs may be associated with engaging in unhealthy lifestyle behaviours is relevant not only to the American Veterans studied in this project, but to Veterans of the wars in Iraq and Afghanistan across the globe.

Date of Award	25 Jun 2025
Original language	English
Awarding Institution	University of Bath
Supervisor	Jessica Francombe-Webb (Supervisor) & Emma Solomon-Moore (Supervisor)