Introduction

Cannabis use is highly common among military combat veterans, who are also inclined toward developing Cannabis Use Disorder (CUD). The present study examined the association between Moral Injury (MI), which may occur following combat-related acts that violate one’s deep moral beliefs, and CUD, as well as the mediating role of depression and the moderating role of perceived social support.

Methods

Participants were 215 Israel Defense Forces male combat veterans discharged from military service within the past five years, who reported using cannabis regularly (≥3 days weekly) during the past six months. Participants completed a set of validated self-report questionnaires assessing MI, CUD, depression and perceived social support.

Results

Results indicated that MI-perpetration by self and MI-betrayal were positively associated with CUD. Additionally, serial mediation analyses indicated that the associations between MI-self and betrayal and CUD were mediated by depression (direct effect: β = 0.13, p = 0.1, and β = 0.20, p = .04, respectively). Furthermore, moderation analyses indicated that the association between MI and CUD was significant only among participants with average or high levels of perceived social support (for support by a significant other: b = 0.13, p = .006 and b = 0.22, p < .001 for MI-self and betrayal, respectively; for support by family: b = 0.13, p = .009 for MI-betrayal; and for support by friends: b = 0.1, p = .044 for MI-self).

Conclusions

MI and its association with CUD should be addressed in clinical settings when working with combat veterans.

中文翻译：

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以色列退伍军人的道德伤害和大麻使用障碍：抑郁症和感知社会支持的作用

介绍

大麻使用在退伍军人中非常普遍，他们也倾向于患上大麻使用障碍 (CUD)。本研究调查了道德伤害 (MI) 与 CUD 之间的关联，后者可能发生在违反一个人深层道德信念的与战斗相关的行为之后，以及抑郁的中介作用和感知社会支持的调节作用。

方法

参与者是过去五年内退伍的 215 名以色列国防军男性退伍军人，他们报告说在过去六个月中经常使用大麻（每周≥3 天）。参与者完成了一套经过验证的自我报告问卷，评估 MI、CUD、抑郁和感知到的社会支持。

结果

结果表明，自我 MI 实施和 MI 背叛与 CUD 呈正相关。此外，连续中介分析表明 MI 自我与背叛和 CUD 之间的关联是由抑郁介导的（直接效应：分别为 β = 0.13，p  = 0.1 和 β = 0.20，p  = .04）。此外，适度分析表明 MI 和 CUD 之间的关联仅在具有平均或高水平感知社会支持的参与者中显着（对于显着他人的支持：b  = 0.13, p  = .006 和b  =  0. 22, p  < .001 对于 MI 自我和背叛，分别；对于家人的支持：b  = 0. 13， 对于 MI 背叛，p = .009；对于朋友的支持：b  = 0.1， 对于 MI-self ，p = .044）。

结论

与退伍军人一起工作时，应在临床环境中解决 MI 及其与 CUD 的关联。