Civilian moral injury: associations with trauma type and high-frequency heart rate variability in two trauma-exposed community-based samples

• Type of Material: Article
• Authors: Emma C. Lathan, Emory University; Abigail Powers, Emory University; Anna Kottakis, Emory University; Allie Guelfo, Emory University; Greg J. Siegle, University of Pittsburgh School of Medicine; Jessica A. Turner, Georgia State University; Matthew D. Turner, Georgia State University; Vijwala Yakkanti, Emory University; Jahnvi Jain, University of Texas Health Science Center at Houston; Yara Mekawi, University of Louisville; Andrew P. Teer, Emory University; Joseph M. Currier, University of South Alabama; Negar Fani, Emory University
• Language: English
• Date: 2022-08-01
• Publisher: Cambridge University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1017%2FS003329172200215X
• Title of Journal or Parent Work: Psychological Medicine
• Volume: 53
• Issue: 11
• Start Page: 5136
• End Page: 5145
• Grant/Funding Information: This work was primarily supported by the National Institutes of Mental Health (MH101380 to NF) and the National Center for Complementary and Integrative Health (AT011267 to NF and GJS). Support was also received from the Emory Medical Care Foundation and American Psychological Association, Society for Clinical Neuropsychology.
• Keywords: sexual violence; Civilians; moral injury; heart rate variability; trauma exposure
• Research Categories: Health Sciences, Mental Health

Abstract

Background Moral injury exposure (MIE) and distress (MID) may indirectly affect the relationship between trauma exposure and alterations in autonomic regulation [assessed via high-frequency heart rate variability (hfHRV)] in civilians, but this has not been tested in prior research. We conducted two exploratory studies to examine trauma types' associations with MIE and MID among civilian medical patients (Study 1) and explore how these facets may indirectly affect the relationship between trauma type and hfHRV among civilians seeking mental health services (Study 2). Methods Participants recruited from a public hospital and/or community advertisements (Study 1, n = 72, 87.5% Black, 83.3% women; Study 2, n = 46, 71.7% Black, 97.8% women) completed measures assessing trauma type, MIE, and MID. In Study 1, trauma types that emerged as significant correlates of MIE and MID were entered into separate linear regression analyses. Trauma types identified were included as predictors in indirect effects models with MIE or MID as the mediator and resting hfHRV (assayed via electrocardiography) as the outcome. Results Childhood sexual abuse emerged as the only significant predictor of MIE, b = 0.38, p < 0.001; childhood sexual abuse, b = 0.26, p < 0.05, and adulthood sexual assault, b = 0.23, p < 0.05 were significant predictors of MID. Participants with greater MIE and MID demonstrated lower hfHRV. Adulthood sexual assault showed an indirect effect on hfHRV through MID, B = −0.10, s.e. = 0.06, 95%CI (−0.232 to −0.005). Conclusions Moral injury was uniquely associated with sexual violence and lower hfHRV in civilians. Data highlight moral injury as a pathway through which autonomic dysregulation may emerge and its salience for trauma treatment selection.