Moral Injury and COVID‐Related Stress Among Post‐9/11 Veterans: Examining Longitudinal Associations

ABSTRACT Although most U.S. military veterans make a successful transition from military service to civilian life, some may experience a heightened risk for having adverse mental health symptoms related to moral injury (MI), post‐traumatic stress disorder (PTSD), depression, and anxiety. In addition, U.S. veterans may have faced an increased risk for experiencing more pronounced stress across multiple life domains during the COVID‐19 pandemic. Limited research attention has been given to understanding how MI symptoms experienced by post‐9/11 veterans prior to the COVID‐19 pandemic (COVID) were related to their experiences of COVID‐related stress. This study examined the impact of pre‐COVID MI symptoms on veterans' COVID‐related stress in various life domains. Participants included 3180 U.S. veterans who were involved in The Veterans Metric Initiative (TVMI) and the Veterans Engaging in Transition Studies (VETS). TVMI was a longitudinal study that occurred from 2016 to 2019. VETS, which began in 2020, was a continuation of TVMI and included a portion of the TVMI sample. Data from assessments of mental health variables from TVMI Wave 6 (spring 2019), COVID‐related work, financial, social, and health stress from VETS Wave 7 (fall 2020), and relevant covariates from TVMI Wave 1 (fall 2016) were included in structural equation modelling analyses. Results demonstrated that MI predicted COVID‐related work and financial stress, PTSD did not predict any of the four COVID‐related stress domains, and depression and anxiety predicted all four COVID‐related stress factors. The study's findings highlight the nuanced ways in which veterans' psychological experiences can impact their feelings of stress during a global pandemic.

• Publication year

  2025

• Venue

  Stress and Health

• Publication date

  2025-11-10

• Fields of study

  Medicine, Psychology

• Identifiers
  DOI 10.1002/smi.70121PMID 41214898PMCID 12603346
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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