Loading
Moral Injury / Depression / Stress Disorders, Post Traumatic · Journal article
European Journal of Psychotraumatology · July 31, 2026
Reinforces what was already believed, rather than introducing something new.
This systematic review of 15 quantitative studies confirms that PMIE subtypes are associated with distinct patterns of psychological distress, with betrayal-related PMIEs showing the most consistent and prominent associations with PTSD, depression, and anxiety. Commission-related events linked to suicidality; omission-type findings were more variable. The evidence supports differentiating PMIE subtypes in clinical assessment and research.
Systematic review of quantitative studies. Military, healthcare, veteran, and civilian samples; 15 studies met inclusion criteria. Intervention: PMIE subtypes (betrayal-type, commission-type, omission-type). n = 15.
Betrayal-type PMIEs frequently associated with PTSD, depression, and anxiety across included studies Commission-type events associated with PTSD, depression, and suicidality, although findings varied across samples and analytic approaches Omission-type exposures showed variable associations; several studies reported significant links with PTSD, depression, anxiety, or suicidality
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should consider PMIE subtypes separately during assessment and case formulation, as betrayal-type exposures show particularly consistent associations with major psychological distress outcomes. Differentiation may inform targeted intervention strategies and risk stratification.
Systematic review of 15 quantitative studies synthesizes evidence that PMIE subtypes associate with distinct psychological outcomes, with betrayal-type PMIEs showing consistent associations with PTSD, depression, and anxiety across samples.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should consider PMIE subtypes separately during assessment and case formulation, as betrayal-type exposures show particularly consistent associations with major psychological distress outcomes. Differentiation may inform targeted intervention strategies and risk stratification.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background: Potentially morally injurious events (PMIEs) are experiences that violate deeply held moral values through one's own transgressive actions (commission), failing to prevent or witnessing wrongdoing (omission), or betrayal by a trusted person. PMIE exposure has been linked to psychological distress, but it is unclear whether different PMIE subtypes confer distinct patterns of risk. This systematic review examined associations between specific PMIE subtypes and key psychological outcomes.Methods: Multiple databases were searched for quantitative studies that assessed PMIE subtypes in relation to PTSD or complex PTSD, depression, anxiety, alcohol misuse, and suicidal ideation or self-injurious behaviour. Fifteen studies published in the last seven years (total N ≈ 21,700) in military, healthcare, veteran, and civilian samples met inclusion criteria. A Population-Exposure-Outcome framework guided data extraction, and findings were synthesised narratively by outcome and subtype.Results: Betrayal-type PMIEs were frequently associated with PTSD, depression, and anxiety across included studies. Commission-type events were associated with several outcomes, including PTSD, depression, and suicidality, although findings varied across samples and analytic approaches. Omission-type exposures showed more variable associations overall, although several studies reported significant links with PTSD, depression, anxiety, or suicidality.Conclusions: PMIE subtypes showed overlapping but potentially different patterns of associations with psychological distress. Across the available literature, betrayal-related PMIEs emerge as the most prominent and consistent correlate of PTSD, depression, and anxiety, while commission-related events were also linked with distress, particularly suicidality, and omission-related findings were less consistent. These findings support considering PMIE subtypes separately in assessment and future research.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.