Moral Injury Appraisals in Young People from Refugee Backgrounds in Melbourne, Australia

Objective: While moral injury can influence psychological outcomes experienced by adult refugees, no research to date has examined moral injury among young refugees. This study aimed to investigate the associations between moral injury and mental health in young people with refugee backgrounds. Method: Participants were 85 young refugees (58.80% female), aged on average 20.78 years (SD = 2.29, range = 16-25 years), living in Melbourne Australia. This community sample completed measures of moral injury appraisals, traumatic stress, resilience, and mental health using an online survey. Results: Moral injury appraisals significantly correlated with poorer mental health. Regression analyses demonstrated that moral injury predicted differences on externalizing symptoms but not internalizing or PTSD symptoms. Further, the relationship between traumatic stress and externalizing symptoms was mediated by moral injury appraisals. Similarly, the relationship between postmigration living difficulties and internalizing symptoms was mediated by moral injury appraisals. Conclusions: Findings indicated young people with refugee backgrounds also experience moral injury appraisals and these are associated with poor mental health. Further research is needed to understand the factors associated with psychological outcomes experienced by young refugees and to guide clinical assessments and novel interventions for this population. Clinical Impact Statement This study was the first to explore whether young people with refugee backgrounds exhibit reactions to traumatic events that violate important moral values (termed "moral injury"). We surveyed young refugees aged 16 to 25 years from diverse backgrounds living in Australia. Our findings showed that like adults, young refugees also experience moral injury, and these are associated with poor mental health. These findings are important for therapists conducting clinical assessments and providing mental health support.