Moral Injury and Suicidality Among Combat-Wounded Veterans: The Moderating Effects of Social Connectedness and Self-Compassion

Objective: Among combat veterans, moral injury (i.e., the guilt, shame, inability to forgive one's self and others, and social withdrawal associated with one's involvement in events that occurred during war or other missions) is associated with a host of negative mental health symptoms, including suicide. To better inform and tailor prevention and treatment efforts among veterans, the present study examined several potential risk (i.e.. overidentification and self-judgment) and protective (i.e.. self-kindness, mindfulness, common humanity, and social connectedness) variables that may moderate the association between moral injury and suicidality. Method: Participants were 189 combat wounded veterans (96.8% male; mean age = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability (a = 176, 93.1%) and many had received a Purple Heart (n = 163, 86.2%). Results: Within a series of moderation models, we found 3 statistically significant moderation effects. Specifically, the association between self-directed moral injury and suicidality strengthened at higher levels of overidentification, that is, a tendency to overidentify with one's failings and shortcomings. In addition, the association between other-directed moral injury and suicidality weakened at higher levels of mindfulness and social connectedness. Conclusions: These findings provide insight on risk and protective factors that strengthen (risk factor) or weaken (protective factor) the association between moral injury and suicidality in combat-wounded veterans. Taken together, mindfulness, social connectedness, and overidentification are relevant to understand the increased/ decreased vulnerability of veterans to exhibit suicidality when experiencing moral injury.