The prevalence and long-term effects of PTSD and moral injury in Swedish military veterans

Sofia Nilsson^1*Alicia Ohlsson¹Sofia Svensen¹Gerry Larsson^1,2

• ¹Swedish Defence University, Karlstad, Sweden
• ²Inland University College of Applied Sciences, Elverum, Hedmark, Norway

In the context of international military operations, officers and soldiers are exposed to a variety of service-related stressors, which may have long-lasting effects on their health and everyday function. This study explored: (1) the prevalence of indications of both Post-Traumatic Stress Disorder (PTSD) and moral injury (MI), (2) how these conditions related to each other, and (3) how they are related to a selection of background variables, in Swedish military veterans who have previously been deployed on operations. The study was a selfreport survey, and the data was analyzed using correlation and regression analyses to explore potential statistical relationships between variables of interest. Data was also analyzed using between-group analyses (t-tests) to examine differences between different groups. Resultsshow that a low proportion of the participants showed prevalence of indications of PTSD, which are comparable to earlier Swedish studies on previously deployed veterans. An even lower proportion was found to show indications of moral injury compared to the assessment of PTSD. However, apart from the small group that fulfilled the cutoff score criteria, a number of respondents reported milder symptoms of psychological and moral distress. The second aim concerned the relationship between indications of PTSD and indications of moral injury.The findings suggest that there is a considerable overlap between the two constructs. In addition, the results suggest that the risk of PTSD and MI is highest when an event is perceived as both very stressful (fear-based) and morally challenging. The MI symptom subcluster shame accounts for the largest variance in the PTSD indicator scale within the study sample. Health-and deployment-related background variables were identified that may be related to indications of moral injury. Regarding practical implications, the study results highlight the type(s) of stressful experience, as well as health-and deployment-related factors, that should be monitored post-deployment, and which may serve as significant risk factors in developing indications of moral injury.