Symptoms of Moral Injury from a Psychological Perspective: A Systematic Review

OpenAlex İngilizce

Moral injury is a condition associated with severe negative outcomes such as self-harm, suicide attempts, post-traumatic stress disorder (PTSD), substance abuse, and depression. Although research on moral injury has increased in recent years, studies in the Turkish literature remain limited, and no systematic review on this topic has been identified. This gap leads to insufficient recognition of moral injury in clinical settings, often resulting in its confusion with PTSD, which can complicate treatment processes for affected individuals. This systematic review aims to clarify the manifestations and symptoms of moral injury. A comprehensive search was conducted in Web of Science, Science Direct, and Taylor & Francis databases using relevant keywords, focusing on English-language studies. Peer-reviewed articles addressing moral injury symptoms, available as open or early access, were included, while books, theses, reviews, case reports, conference papers, and non-English publications were excluded. The 59 included studies revealed that moral injury impacts not only psychological but also emotional, cognitive, behavioral, social, spiritual, and physical domains. These effects were categorized and analyzed. The studies primarily focused on various occupational groups, particularly veterans, and offer significant recommendations for mental health professionals to develop holistic treatment plans. It is emphasized that researchers should conduct culturally sensitive studies, develop culturally appropriate scales to measure moral injury, and explore how it is understood and manifested. The predominance of studies on specific groups highlights the need for public health research on diverse populations.