Moral Injury and Mental Health Consequences in Active-duty Soldiers: A Systematic Review and Meta-analysis of Cross-sectional Surveys.
- 1Department of Psychology, Faculty of Social Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
- 2School of Behavioural Sciences and Forensic Investigations, Rashtriya Raksha University, Gandhinagar, Gujarat, India.
Abstract
Introduction
Moral injury (MI), defined as perceived betrayals or violations of one's moral values, causes psychological distress in active-duty soldiers (ADS), and it is associated with various mental health (MH) issues such as post-traumatic stress disorder (PTSD), anxiety, and depression. Although some quantitative reviews have examined the association between MI and MH outcomes in the military population, primarily among veterans, none of the studies focused specifically on ADS. This systematic review and meta-analysis were conducted to address the research gap.Methods
We reviewed published articles from six databases, namely, PubMed, Scopus, Web of Science, Taylor and Francis, and JSTOR up to July 29, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results
The retrieved articles underwent a systematic selection process using pre-specified inclusion and exclusion criteria, resulting in 12 potentially eligible studies. Seven cross-sectional studies examined the association between MI and PTSD, representing a total sample of 4,370 ADS. Pooled effect measures showed that MI and its dimensions, such as betrayal, transgression toward self, and transgression toward others, were positively correlated with PTSD. Similarly, MI and its domains were significantly positively associated with anxiety and depression in ADS.Conclusion
The present findings should be interpreted with caution, as this review synthesis included a limited number of studies and was conducted mainly in Western countries. Future studies should address the cross-cultural component of MI to understand how MI manifests in non-Western military contexts, where cultural and religious values may shape moral reasoning differently.
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BibTeX
@article{sinha2026moral,
title = {{Moral Injury and Mental Health Consequences in Active-duty Soldiers: A Systematic Review and Meta-analysis of Cross-sectional Surveys.}},
author = {Madhubanti Sinha and Jay Kumar Ranjan and Chandra Uday Singh and Mahesh A Tripathi},
journal = {Journal of emergencies, trauma, and shock},
year = {2026},
month = jul,
doi = {10.4103/jets.jets_207_25},
url = {https://europepmc.org/article/MED/42852135},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Moral Injury and Mental Health Consequences in Active-duty Soldiers: A Systematic Review and Meta-analysis of Cross-sectional Surveys.
AU - Madhubanti Sinha
AU - Jay Kumar Ranjan
AU - Chandra Uday Singh
AU - Mahesh A Tripathi
PY - 2026
DA - 2026/07/01
JO - Journal of emergencies, trauma, and shock
DO - 10.4103/jets.jets_207_25
UR - https://europepmc.org/article/MED/42852135
AB - Introduction Moral injury (MI), defined as perceived betrayals or violations of one's moral values, causes psychological distress in active-duty soldiers (ADS), and it is associated with various mental health (MH) issues such as post-traumatic stress disorder (PTSD), anxiety, and depression. Although some quantitative reviews have examined the association between MI and MH outcomes in the military population, primarily among veterans, none of the studies focused specifically on ADS. This systematic review and meta-analysis were conducted to address the research gap.Methods We reviewed published articles from six databases, namely, PubMed, Scopus, Web of Science, Taylor and Francis, and JSTOR up to July 29, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results The retrieved articles underwent a systematic selection process using pre-specified inclusion and exclusion criteria, resulting in 12 potentially eligible studies. Seven cross-sectional studies examined the association between MI and PTSD, representing a total sample of 4,370 ADS. Pooled effect measures showed that MI and its dimensions, such as betrayal, transgression toward self, and transgression toward others, were positively correlated with PTSD. Similarly, MI and its domains were significantly positively associated with anxiety and depression in ADS.Conclusion The present findings should be interpreted with caution, as this review synthesis included a limited number of studies and was conducted mainly in Western countries. Future studies should address the cross-cultural component of MI to understand how MI manifests in non-Western military contexts, where cultural and religious values may shape moral reasoning differently.
SN - 0974-2700
SN - 0974-519X
ER -