Moral injury: assessing forensic secure care and a psychometric tool

Steen, Scott ORCID: 0000-0002-6712-2761 (2022). Moral injury: assessing forensic secure care and a psychometric tool. University of Birmingham. Clin.Psy.D.

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Abstract

This thesis is submitted in partial fulfilment of a Clinical Psychology Doctorate and includes a literature review, empirical paper, and press release. The topic considers Moral Injury (MI): a type of trauma characterised by shame, guilt, and inner anguish that follows a violation of moral beliefs through transgressive acts.

The literature review includes a meta-analysis of the psychometric properties of the Moral Injury Event Scale (MIES). A systematic search found 42 records up to April-2022 reporting reliability data using Cronbach's Alpha. The findings support the tool as internally consistent based on pooled estimates at Full-scale and Sub-scale levels. There was high heterogeneity and inconsistencies across studies, although the estimates remained above acceptable levels throughout moderator analyses. While it's not possible to categorise the tool as psychometrically sound due to the limited reliability and validity properties in these findings, it does support the tool as internally consistent across contexts.

MI was considered relevant for a forensic secure care context due to the moral challenges and transgressive acts experienced by this population. The empirical paper presents a cross-sectional psychometric study assessing MI prevalence and its clinical associations within a UK secure care population (n=38). The results indicate that MI scores were moderate-to-high and associated with trauma, guilt, and poorer quality-of-life, but not shame or self-compassion. This study supports MI assessments within secure care settings and recommends that services and professionals should consider the moral aspects of traumatic experiences to enhance their intervention and rehabilitation strategies.

Type of Work:

Thesis (Doctorates > Clin.Psy.D.)

Award Type:

Doctorates > Clin.Psy.D.

Supervisor(s):