Measuring Civilian Moral Injury: Adaptation and Validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian)

Moral injury (MI) research has been expanded to populations beyond the military in recent years. A key barrier to further research into MI in civilian populations is the lack of valid, reliable measures of the construct appropriate for general civilian use. This paper addresses this barrier by adapting two existing military measures, and exploring their psychometrics in a general civilian sample: The Moral Injury Events Scale (MIES-Civilian) and Expressions of Moral Injury Scale-Military (EMIS-Civilian). A sample of civilian women (n = 192) and men (n = 88) completed the above measures, and additional scales designed to capture theoretically-supported primary and secondary markers of MI (guilt, shame, anger; depression, post-traumatic stress symptoms, anxiety). Confirmatory factor analysis found that the factor structure of the MIES-C and EMIS-C replicated well within our civilian sample. Discriminant validity was indicated through significant negative correlation with wellbeing. Both measures correlated as predicted with each other and measures of MI markers at the total score level. Correlations of individual subscales with each of these measures were more varied, shedding light on differential relationships between type of MI event and clinical outcomes, and suggesting some conceptual differences in how MI is experienced in general civilian populations. Results suggest that civilian populations are also susceptible to MI, but that existing measures may have problems capturing this effectively. While the MIES-C and EMIS-C are supported for civilian use, further scale construction efforts for this population are warranted.