Despite a burgeoning of research on moral injury in the past decade, existing reviews have not explored the breadth of consequences and the multitude of pathways through which moral injury and potentially morally injurious experiences (PMIEs) influence mental and behavioural health outcomes. This study aimed to identify associations between moral injury on mental and behavioural health. Literature searches of psychological and medical databases were conducted through April 2020. Eligible studies measured moral injury or PMIEs, and health outcomes (e.g., depression, substance use and suicidality). Fifty-seven publications representing 49 separate samples were included. Studies examined the impact of moral injury on post-traumatic stress disorder (PTSD) (n = 43); depression (n = 32); anxiety (n = 15); suicide (n = 15); substance use (n = 14); and ‘other’ health outcomes, including pain, burnout, sleep disturbance and treatment-seeking behaviours (n = 11). The majority of studies found significant positive associations between moral injury-related constructs, mental health and behavioural health outcomes; however, the majority were also cross-sectional and focused on military samples. Proposed mediators included lack of social support, negative cognitions and meaning-making. Moderators included self-compassion, pre-deployment mental health education and mindfulness. Moral injury is associated with a variety of negative health outcomes. Research is needed to determine the mechanisms by which moral injury may influence these outcomes over time.

中文翻译：

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道德伤害、心理健康和行为健康结果：文献的系统评价

尽管在过去十年中对道德伤害的研究迅速发展，但现有的评论并没有探讨后果的广度以及道德伤害和潜在的道德伤害经历 (PMIE) 影响心理和行为健康结果的多种途径。本研究旨在确定道德伤害与心理和行为健康之间的关联。对心理和医学数据库的文献检索一直持续到 2020 年 4 月。符合条件的研究测量了道德伤害或 PMIE，以及健康结果（例如，抑郁症、药物滥用和自杀）。包括代表 49 个独立样本的 57 份出版物。研究检查了道德伤害对创伤后应激障碍 (PTSD) ( n  = 43) 的影响；抑郁症 ( n = 32); 焦虑（n  = 15）；自杀（n  = 15）；物质使用（n  = 14）；和“其他”健康结果，包括疼痛、倦怠、睡眠障碍和寻求治疗的行为（n = 11)。大多数研究发现与道德伤害相关的结构、心理健康和行为健康结果之间存在显着的正相关关系；然而，大多数也是横断面的，并侧重于军事样本。提出的中介因素包括缺乏社会支持、消极认知和意义建构。主持人包括自我同情、部署前的心理健康教育和正念。道德伤害与各种负面的健康结果有关。需要研究以确定道德伤害可能会随着时间的推移影响这些结果的机制。