Understanding post-9/11 U.S. veterans’ perspectives on moral injury: An exploratory study.

OBJECTIVE: Research on moral injury (MI) continues to grow despite a lack of consensus definition, and qualitative, exploratory studies can enable further construct clarification. This study sought to understand how post-9/11 veterans perceive MI and how these perceptions impact their responses to existing measures of MI. METHOD: Twelve veterans completed a cognitive interview utilizing the Moral Injury Questionnaire-Military Version and the Expressions of Moral Injury Scale-Military Version. Using thematic analysis, qualitative data were coded and analyzed for their connection or divergence to existing theoretical frameworks of MI. RESULTS: Veterans' narratives focused on themes of institutional betrayal, collective betrayal, and discharge as a betrayal-based potentially morally injurious experience. Some veterans did not perceive experiences to be morally injurious if they happened outside of combat. Other veterans perceived the construct as too narrow in scope to account for what they considered morally injurious. CONCLUSION: Further construct clarification is needed to determine betrayal's role in MI. Definitions and conceptualizations of MI may need to expand to be inclusive of experiences of betrayal that do not come from high-stakes situations or explicitly distinguish MI from other constructs such as institutional betrayal. Veterans' perceptions that MI is primarily based in combat experiences has significant implications for adequately capturing and assessing MI. (PsycInfo Database Record (c) 2026 APA, all rights reserved).