Development and Preliminary Evaluation of the Moral Injury Assessment for Survivors of Abuse

Survivors of abuse (SoA) are exposed to violations of their trust and moral standards leading to the risk of experiencing significant psychological, spiritual, and behavioral suffering. However, little research has examined these experiences of moral injury (MI) in this population. Further, to our knowledge, there are no existing tools to measure MI in SoA. The Moral Injury Assessment for Survivors of Abuse was developed over multiple stages including literature review, focus groups with SoA, and consultations with clinical and research experts in relevant disciplines. The tool was piloted with 188 Canadian and American adult participants (M = 33.5 years old, standard deviation, SD = 9.2; 55% male-identified) and an exploratory factor analysis was conducted. Four distinct factors emerged that explained 60% of total variance: intergenerational transmission of trauma, emotional sequelae, self-blame, and betrayals. Further, the scale demonstrated strong internal reliability (total score: Cronbach’s α = .93), item-total correlations, and construct validity when compared to relevant measures of psychological distress. These findings present important preliminary insight into the unique experiences of MI within the SoA population and provide a foundation for future validation studies. Ultimately, it can potentially provide an additional tool for clinicians in developing tailored assessments and treatment plans for SoA.