Assessment of moral injury and PTSD in active-duty personnel and veterans in Ukraine: a scoping review
| Date | 10 January 2025 |
| Pages | 81-98 |
| DOI | https://doi.org/10.1108/JCRPP-01-2024-0005 |
| Published date | 10 January 2025 |
| Author | Nino Tabeshadze,Gerry Larsson,Alicia Ohlsson,Sofia Nilsson |
Assessment of moral injury and PTSD in
active-duty personnel and veterans in
Ukraine: a scoping review
Nino Tabeshadze, Gerry Larsson, Alicia Ohlsson and Sofia Nilsson
Abstract
Purpose –This studyisa scopingliterature review of research into post-traumaticstress disorder (PTSD)
and moral injury(MI) in active-duty military personnel and veteransin Ukraine. This study aims to explore
the existing researchregarding the relationship between PTSDand MI in Ukrainian military personnel to
identifythe need for future research in a vulnerable socialgroup that is exposed to a high level of conflict.
Design/methodology/approach –This scoping review includes the results of peer-reviewed articles
from online databases (PubMed,Science Direct, PsycArticles, Military Database,Sociological Abstract,
Psychology Database, PTSD Pubs, Web of Science), which were searched for publications in English,
Ukrainianand Russian. The data obtained was organized using PreferredReporting Items for Systematic
Reviews extension for scoping reviews and Meta-Analyses, the Critical Appraisal Skills Programme
QualitativeStudies Checklist and Joanna Briggs Institute CriticalAppraisal Checklist. Data was analyzed
and categorizedusing an inductive thematicanalysis.
Findings –Accordingto the thematic analysis, the followingthemes were identified in a Ukrainianmilitary
context: sources of PTSD, sources of moralinjury, symptoms of PTSD, symptoms of moral injury and
treating and preventionmechanisms. All studies included in the scopingreview (32) report on PTSD and/
or MI in military groupsin Ukraine. They find the gap in research and in numerouscomprehensive studies
problematicand underline the need for more effective rehabilitationprograms.
Practical implications –A scoping reviewwas conducted to thematically map the researchin the area,
identify any knowledgegaps deficit about PTSD and MI in Military personnelin Ukraine and contribute to
furtherdevelopment of effective rehabilitationprograms.
Originality/value –The sparsity of the existing literature highlights the need for further research into
enhancing themental health services provided to militarypersonnel. In addition, there is a growing need
to further explore trauma exposure and potentially morally injurious events related to PTSD and MI, in
particular.Such a review has not yet been carriedout, which adds value to the current paper.
Keywords Treatment, Ukraine, Military, PTSD, Coping, Symptoms,Moral injury
Paper type Literature review
Introduction
Veterans and active-duty military personnel are exposed to various stressful and traumatic
experiences during their participation in military operations. Military personnel, being at the
forefront of armed conflict, are often believed to be at higher risk of experiencing psychiatric
symptoms due to increased combat exposure leading to psychological distress (van der Wal
et al., 2019). Exposure to war, combat and trauma serves as a primary cause of deteriorated
mental health, post-traumatic stress disorder (PTSD) and moral injury (MI) among military
personnel. PTSD is a stress response characterized by a collection of symptoms including
hyperarousal, avoidance and numbing of responsiveness, experiencing negative thoughts
and reexperiencing traumatic events(s). It is a stress responsefollowing exposure to a
distressing event that involved actual or potentially serious injury to oneself or another
Nino Tabeshadze, Gerry
Larsson, Alicia Ohlsson and
Sofia Nilsson are all based
at the Department of
Leadership and Command
and Control, Swedish
National Defence University
–Karlstad,Karlstad,
Sweden.
Received 30 January 2024
Revised 10 October 2024
10 December 2024
Accepted 11 December 2024
Funding: This study was
funded by the Swedish
Defence University and the
Swedish Armed Forces.
DOI 10.1108/JCRPP-01-2024-0005 VOL. 11 NO. 12025, pp. 81-98, ©Emerald Publishing Limited, ISSN 2056-3841 jJOURNAL OF CRIMINOLOGICAL RESEARCH , POLICY AND PRACTICE jPAGE 81
(American Psychiatric Association, 2013). MI, which often overlaps with PTSD, is the
distressing psychological, behavioral, social and sometimesspiritual aftermath of exposure to
such events. It is suggested that MI occurs in response to carrying out,or witnessing,
behaviors that go against an individual’s values and moral beliefs (Maguen and Norman,
2022). The present war in Ukraine is an example of an ongoing traumatic andharmful event
that has detrimental effect on well-being. War challenges mental health care institutionsin
Ukraine. Even before the full-scale war, approximately 30% of Ukrainians suffered from a
mental health disorder (World Bank Group, 2017). In 2019, the prevalence of depressive
disorders in Ukraine exceeded average data for the European Union –5.2% versus 4.6%,
respectively (Institute for Health Metrics and Evaluation, 2019). This d ata reflects the aftermath
of the 2014–2021 military conflict in Ukraine where 4,400 Ukrainian military personnel were
killed and about 14,000 were wounded (Office of the United Nations High Commissioner
2014–2021).
Rehabilitation programs are crucial for military units exposed to traumatic experiences.
Treatment includes medical, and sociopsychological measures aimed at restoring the
functional state of the body, normalization of emotional, moral and motivationalspheres,
and the achievement of optimal levels of sociopsychological adaptation (Mitina and
Orlovska, 2020). However, the development of adequate rehabilitation is problematic
without understanding the effects of PTSD and MI on active-duty combatants and veterans.
A scoping review was conducted to thematically map the research in the area, and to
identify any knowledge gaps about PTSD and MI in military personnel in Ukraine. The
following research questions were formulated according to the population/problem/patient,
exposure, outcome framework for qualitative research for evidence-based practice: What is
known from the literature about PTSD and MI in active-duty military units and veterans
serving in Ukraine? What can be concluded from the literature about the requirements for
post-deployment mental health,rehabilitation and prevention programs?
Based on these questions, a scoping review protocol was drafted to select articles that
were relevant to answering the research questions. A thematic analysis was used to
identify, explore and report themes identified within the literature, and to explore how the
concepts of PTSD and MI have beendiscussed across various studies.
Method
The research used inductive thematic analysis, which entails deriving meaning and
identifying themes from data without existing preconceptions. The analysis was performed
in several stages, which will bedescribed below.
Stage 1
The protocol used in this researchwas drafted using the scoping review extension of
Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols, which was
slightly revised by the authors to meet the specific research question aims of this project.
For report planning, the PRISMA checklistfor qualitative research was used.
Stage 2
The inclusion criteria were as follows: peer-reviewed articles published between 2013 and
2023, articles written in the following languages: English, Ukrainian and Russian, empirical
research articles using qualitative or quantitative methods, or mixed-method studies with a
focus on PTSD and MI in Ukrainian military personnel. Research could come from different
fields of study including humanities, social sciences, medicineand psychology.
Exclusion criteria included articles written for nonacademic purposes (journalistic entries
and popular blog posts), non-peer reviewed works, research focusing on exacerbated
PAGE 82 jJOURNAL OF CRIMINOLOGICAL RESEARCH, POLICY AND PRACTICE jVOL. 11 NO. 12025
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