Demographic and Service-related Correlates of Moral Injury Symptoms in U.S. Military Populations

Introduction: Moral injury, the psychological distress from perceived transgressions of deeply held moral values, is distinct from moral distress and fear-based conditions such as PTSD. While combat exposure has received significant attention, less is known about how demographic and service-related factors shape vulnerability. This study examined these factors in relation to moral injury symptom severity among U.S. Veterans. Methods: Survey data from 2,949 Southern California Veterans were analyzed using hierarchical linear regression with Huber-White robust standard errors. Model 1 tested demographic factors (age, sex, ethnicity, race, marital status, education) with moral injury symptoms (using the Moral Injury Symptom Scale — Military Version — Short Form, which ranges from 10 to 100), while Model 2 added discharge status variables (reserve/guard status, branch, rank). Multicollinearity was assessed via variance inflation factors, with all values within acceptable thresholds. Results: Demographic factors explained 9% of variance in moral injury symptoms. Older age and higher education were protective, while female, Hispanic/Latino, and multiracial Veterans reported significantly higher symptom scores. Adding service variables increased explained variance to 11%. Reserve/guard status and commissioned officer rank were protective; army, marine corps, and navy Veterans reported higher symptoms than the air force, space force, and coast guard reference group. Discussion: Both demographic and service-related factors correspond with moral injury symptoms among Veterans. Given the large sample, findings should be interpreted with attention to effect size and practical relevance. Younger, less-educated, female, Hispanic/Latino, and multiracial Veterans, as well as those from the Army, Marine Corps, or Navy, warrant targeted outreach.