This article provides firsthand accounts of the combat experiences of Ukrainian soldiers, emphasizing the psychological toll of their exposure to morally injurious events during modern combat operations. Case studies illustrate the various contexts in which moral injuries might occur involving both military members and civilians. Other psychological issues that co-occur with moral issues as a result of combat exposures are presented including traumatic stress, profound grief, and various threats to individual identity. The authors include an analysis of the utility of the recent American Psychiatric Association's (APA) revision of DSM-5-TR that now includes moral issues and how this conceptualization captures the experiences of soldiers fighting in the Russia-Ukraine War. The case studies presented reveal that there remain important experiences and responses that are not fully captured by the new APA conceptualization of moral injury, such as existential ethical crisis, survivor guilt, disruption of one's role or identity, and the failure of others to uphold societal norms and expectations. Various approaches to facilitate recovery from moral injury are discussed. These approaches include the use of debriefings, remembrance memorials and structured therapeutic interventions. These approaches are intended to facilitate the soldier's recovery from moral injury by providing immediate emotional relief, and by facilitating the soldier's cognitive awareness of how morally injurious events can change and shape individual and collective identity. This study highlights the unique challenges faced by military personnel in modern, high-intensity warfare, and the need for early and targeted mental health interventions, including building resilience and promoting psycho-social well-being.
Synyahovskyy et al. (Sat,) studied this question.