Beliefs about Confidentiality and Attitudes toward Disclosure of Moral Injuries among Military Personnel

Military personnel often face situations that challenge their moral beliefs, which, in some instances, leads to moral injury – profound psychological, social, and spiritual impairments caused by actions or events that violate deeply held moral values. The legal and ethical complexities of these events may cause individuals with moral injury to hesitate in seeking mental health treatment due to fears of confidentiality breaches and the potential legal and career repercussions for disclosing their traumatic experiences. In a hypothetical vignette-based experiment, we investigated the impact of potentially morally injurious events (PMIEs) on the likelihood of mental health treatment-seeking and trauma detail disclosure, compared to conventional posttraumatic stress disorder (PTSD) trauma. Canadian Armed Forces Veterans (n = 335) were presented with vignettes that varied in the type of trauma (PMIE vs. PTSD), military release status of the depicted persona (active vs. released), and the degree of confidentiality assurance during treatment-seeking (fully assured vs. ambiguous). We measured the likelihood of help-seeking, willingness to disclose trauma details, and perceptions of legal and career harm. Participants were less likely to seek help and disclose trauma in PMIE scenarios, especially when still in service and confidentiality was uncertain. PMIEs were also associated with higher perceived legal and career harm. Greater perceptions of legal and career harm severity predicted hesitation to disclose trauma details to mental health professionals. Results demonstrate that perceptions and policies surrounding confidentiality should be re-evaluated to facilitate help-seeking among Veterans and still-serving military personnel, particularly those experiencing moral injury.