Mental health symptoms in Public Safety Personnel: Examining the effects of adverse childhood experiences and moral injury

BACKGROUND: Adverse Childhood Experiences (ACEs) increase risk for negative mental health outcomes in adulthood; however, the mechanisms through which ACEs exert their influence on adult mental health are poorly understood. This is particularly true for Public Safety Personnel (PSP; e.g., police, firefighters, paramedics, etc.), a group with unique vulnerability to negative psychiatric sequalae given their chronic exposure to potentially traumatic, work-related events. OBJECTIVES: To examine the role of moral injury (MI) and emotion regulation in the relation between ACEs and adult mental health symptoms in adulthood. PARTICIPANTS AND SETTING: Participants (N = 294) included a community sample of Canadian and American PSP members aged 22 to 65. METHODS: The current study uses cross-sectional data collection via retrospective self-report questionnaires administered between November, 2018 and November, 2019 to assess level of ACEs (ACE-Q), emotion regulation difficulties (DERS) and symptoms of post-traumatic stress (PCL-5), dissociation (MDI), depression, stress, and anxiety (DASS-21). Additionally, participants completed the Moral Injury Assessment for Public Safety Personnel, the first measure of MI developed specifically for PSP. RESULTS: Path analysis revealed that ACEs significantly predicted adverse mental health symptoms in adulthood; this effect was mediated by symptoms of MI and moderated by difficulties with emotion regulation. CONCLUSIONS: This study is the first to identify MI as a mechanism involved in the relation between ACEs and adult psychopathology and highlights the protective role of emotion regulation skills. These findings can inform the development of future research and clinical interventions in PSP populations.