Mapping moral injury: Development and feasibility of the Clinical Interview for Moral Injury—military version (CIMI-M)
4 affiliations
- 1ARQ Centrum‘45, Diemen/Oegstgeest, The Netherlands
- 2Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- 3VA Boston Healthcare System, Boston, Massachusetts, United States of America
- 4Boston University and Boston University School of Medicine, Boston, Massachusetts, United States of America
Abstract
Objective: There is currently no clinical interview to assess exposure to potentially morally injurious experiences (PMIEs) and moral injury, the potential clinical outcome associated with PMIEs. To enable a person-centered assessment of PMIEs and moral injury in military veterans, we developed a structured, non-diagnostic clinical interview to support descriptive assessment, case conceptualization, and treatment planning, and conducted an initial evaluation of its feasibility, acceptability, and clinical utility. Method: The Clinical Interview for Moral Injury—Military Version (CIMI-M) was developed through an iterative, stakeholder-informed process. Questions from existing moral injury instruments were selected, adapted and supplemented to create an interview with a descriptive, theory-driven approach. Clinicians (N = 7) and military veterans (N = 8) at two Dutch trauma centers who conducted the CIMI-M were interviewed and completed questionnaires assessing the CIMI-M’s feasibility, acceptability, and clinical utility. Interviews were analyzed using the General Inductive Approach for qualitative evaluation data. Results: Mean evaluation scores were 7.63 for veterans and 8.41 for clinicians (10-point scale). Qualitative analysis of interview transcripts revealed that the CIMI-M helped veterans share their experiences, while clinicians found it valuable for fostering trust and planning treatment. Both groups agreed that the CIMI-M generated insightful content about PMIEs and moral injury. Based on feedback, several interview questions were revised or added. Conclusions: We found preliminary evidence that the CIMI-M is a feasible, acceptable, and clinically useful descriptive interview. It offers a potentially valuable treatment-planning tool that complements paper-and-pencil approaches that assess PMIEs and moral injury. Further evaluation, including in non-veteran populations, is needed.
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BibTeX
@article{goede2026mapping,
title = {{Mapping moral injury: Development and feasibility of the Clinical Interview for Moral Injury—military version (CIMI-M)}},
author = {Mariëlle L. de Goede and Paul A. Boelen and Brett T. Litz and F. Jackie June ter Heide},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0359553},
url = {https://doi.org/10.1371/journal.pone.0359553},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Mapping moral injury: Development and feasibility of the Clinical Interview for Moral Injury—military version (CIMI-M)
AU - Mariëlle L. de Goede
AU - Paul A. Boelen
AU - Brett T. Litz
AU - F. Jackie June ter Heide
PY - 2026
DA - 2026/09/30
JO - PLOS One
DO - 10.1371/journal.pone.0359553
UR - https://doi.org/10.1371/journal.pone.0359553
AB - Objective: There is currently no clinical interview to assess exposure to potentially morally injurious experiences (PMIEs) and moral injury, the potential clinical outcome associated with PMIEs. To enable a person-centered assessment of PMIEs and moral injury in military veterans, we developed a structured, non-diagnostic clinical interview to support descriptive assessment, case conceptualization, and treatment planning, and conducted an initial evaluation of its feasibility, acceptability, and clinical utility. Method: The Clinical Interview for Moral Injury—Military Version (CIMI-M) was developed through an iterative, stakeholder-informed process. Questions from existing moral injury instruments were selected, adapted and supplemented to create an interview with a descriptive, theory-driven approach. Clinicians (N = 7) and military veterans (N = 8) at two Dutch trauma centers who conducted the CIMI-M were interviewed and completed questionnaires assessing the CIMI-M’s feasibility, acceptability, and clinical utility. Interviews were analyzed using the General Inductive Approach for qualitative evaluation data. Results: Mean evaluation scores were 7.63 for veterans and 8.41 for clinicians (10-point scale). Qualitative analysis of interview transcripts revealed that the CIMI-M helped veterans share their experiences, while clinicians found it valuable for fostering trust and planning treatment. Both groups agreed that the CIMI-M generated insightful content about PMIEs and moral injury. Based on feedback, several interview questions were revised or added. Conclusions: We found preliminary evidence that the CIMI-M is a feasible, acceptable, and clinically useful descriptive interview. It offers a potentially valuable treatment-planning tool that complements paper-and-pencil approaches that assess PMIEs and moral injury. Further evaluation, including in non-veteran populations, is needed.
SN - 1932-6203
ER -