A latent profile analysis of moral injury appraisals in refugees

<b>Background</b>: Refugees often exhibit reactions to traumatic events that may be conceptualized as moral injury (i.e. the impact of events that violate important moral values). There have been two types of moral injury appraisals found in refugees: transgressions by others and transgressions by oneself. <b>Objective</b>: To examine whether these types of moral injury appraisals co-occur or whether one form is usually predominant. Additionally, to investigate what types of events (trauma, living difficulties) and outcomes (PTSD, depression, anger, suicidality) were associated with each moral injury appraisal profile. <b>Method</b>: Participants included 221 refugees and asylum seekers residing in Australia. Data was collected online, and via pen and paper. A latent profile analysis was used to identify profiles of moral injury appraisals. <b>Results</b>: Results indicated a three-profile solution: Moral Injury-Other (MI-O; 37.8%), Moral Injury Other + Self (MI-OS; 35.2%), and no moral injury (No-MI; 26.9%). MI-O and MI-OS were predicted by both trauma experience and living difficulties. MI-O and MI-OS were also associated with greater psychopathology across all outcome variables compared to No-MI. MI-OS was also associated with greater anger and depression, compared to the MI-O profile. <b>Conclusions</b>: The association between the moral injury appraisal profiles and traumatic events, living difficulties and psychopathology, will have important clinical implications. • Three moral injury appraisal profiles were found in a diverse refugee sample• One profile appraised moral violations as committed by others• One profile appraised moral violation as committed by others and themselves• Both profiles were predicted by both greater trauma and living difficulties• Both profiles were associated with greater psychopathology.

<b>背景</b>：难民常对创伤事件出现可被界定为道德损伤（moral injury）的反应，即违背个体核心道德价值观的事件所带来的影响。现有研究在难民群体中已发现两类道德损伤评估类型：他人越轨行为与自我越轨行为。<b>研究目的</b>：探究这两类道德损伤评估类型是共同出现，还是通常以某一种为主导形式。此外，本研究旨在考察与每一类道德损伤评估亚型相关的事件类型（创伤事件、生活困境）及结局指标（创伤后应激障碍（Post-Traumatic Stress Disorder，PTSD）、抑郁、愤怒、自杀意念）。<b>研究方法</b>：本研究纳入221名居住于澳大利亚的难民与寻求庇护者。数据通过线上与纸笔两种方式采集。本研究采用潜在剖面分析（latent profile analysis）识别道德损伤评估亚型。<b>研究结果</b>：结果显示最优分类为三类亚型：仅他人导向道德损伤（Moral Injury-Other, MI-O；占比37.8%）、他人与自我导向道德损伤（Moral Injury Other + Self, MI-OS；占比35.2%），以及无道德损伤（No-MI；占比26.9%）。创伤经历与生活困境均可预测MI-O与MI-OS亚型。相较于无道德损伤亚型，MI-O与MI-OS亚型在所有结局指标上均表现出更严重的精神病理症状。相较于MI-O亚型，MI-OS亚型还伴随更显著的愤怒与抑郁水平。<b>研究结论</b>：道德损伤评估亚型与创伤事件、生活困境及精神病理症状之间的关联，具有重要的临床意义。• 在多样化的难民样本中发现三类道德损伤评估亚型• 一类亚型将道德违背归因于他人• 一类亚型将道德违背归因于他人与自身• 两类亚型均与更严重的创伤经历及生活困境相关• 两类亚型均与更严重的精神病理症状相关。