Morally Injurious Events, Moral Injury, and Suicidality among Recent-Era Veterans: The Moderating Effects of Rumination and Mindfulness

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Abstract
The present study used mediation analysis to examine the associations among morally injurious events (MIEs), moral injury, and suicidality in a sample of 285 Operation Enduring Freedom and Operation Iraqi Freedom veterans. Additionally, moderated mediation analysis was used to examine rumination and mindfulness as potential moderators of the MIE, moral injury, suicidality associations. Participants were largely male (n = 174, 61.1%), White (n = 197, 69.1%), and reported a mean age of 32.01 years (SD = 6.90 years). The most represented branch of the military was the Army (n = 136, 47.7%), followed by the Navy (n = 87, 30.5%) and participants on average reported completing 3.05 (SD = 1.38) deployments in support of OIF and 3.15 (SD = 1.42) deployments in support of OEF. Moral injury mediated the association between MIEs and suicidality, such that higher levels of exposure to potential MIEs were associated with higher levels of moral injury; which in turn was associated with higher suicidality. Our moderated mediation models revealed that this indirect effect was attenuated among individuals with higher mindfulness (i.e., the nonjudging of experience and acting with awareness dimensions of mindfulness) and strengthened among those who reported higher rumination. Results point to the potential utility of mindfulness-based therapies among service members who serve in combat and who report moral injury.

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