{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T07:56:55Z","timestamp":1790495815060,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Moral injury among military personnel is characterized by profound psychological, relational, and existential distress arising from experiences that violate deeply held moral values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background and Purpose<\/jats:title>\n                    <jats:p>Moral injury may be accompanied by guilt, shame, social disconnection, and increased suicide risk, thereby threatening both individual well-being and military readiness. This qualitative meta-synthesis aimed to elucidate military personnel\u2019s experiences of moral injury and identify the factors contributing to its development, persistence, and recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted using five databases (PubMed, PsycINFO, Embase, CINAHL, and Web of Science). The search targeted qualitative studies published in English until August 2025. Study selection and methodological quality appraisal were independently conducted by multiple researchers. The findings were integrated using thematic synthesis, with Litz\u2019s model of moral injury used as the analytical framework to guide the development and interpretation of the themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 3,395 records identified, 19 studies were included in the meta-synthesis. A total of 5 main themes and 17 subthemes were identified: (1) contextual and vulnerability factors influencing moral injury, (2) potentially morally injurious events and moral conflict, (3) multidimensional presentation of moral injury symptoms, (4) the trajectory of moral disrepair and chronicity, and (5) existential path to recovery: moral reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Military moral injury involves disruption of moral meaning and may progress through moral conflict and disrepair toward moral reconstruction. Recovery does not necessarily require complete resolution of moral pain; rather, it may involve meaning-making, relational reconnection, and the integration of morally injurious experiences into a reconstructed identity. These findings highlight the need for clinical and organizational responses that address not only individual symptoms but also the relational, existential, and institutional contexts of moral injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag438","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:50:41Z","timestamp":1789127441000},"source":"Crossref","is-referenced-by-count":0,"title":["Experience and Contributing Factors of Moral Injury in Military Personnel"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7035-3619","authenticated-orcid":false,"given":"Riah","family":"Kim","sequence":"first","affiliation":[{"name":"Korea Armed Forces Nursing Academy , Daejeon,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9027-4897","authenticated-orcid":false,"given":"Junggeun","family":"Ahn","sequence":"additional","affiliation":[{"name":"College of Nursing, Jeju National University , Jeju,","place":["Republic of Korea"]},{"name":"Health and Nursing Research Institute, Jeju National University , Jeju,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5883-7557","authenticated-orcid":false,"given":"Jiu","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Nursing, Dongguk University-WISE , Gyeongju,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"2026092702564145300_usag438-B1","doi-asserted-by":"publisher","first-page":"3012","DOI":"10.1007\/s10943-021-01227-4","article-title":"Moral injury and the absurd: the suffering of moral paradox","volume":"60","author":"Fleming","year":"2021","journal-title":"J Relig Health"},{"key":"2026092702564145300_usag438-B2","first-page":"122","volume":"22"},{"key":"2026092702564145300_usag438-B3","doi-asserted-by":"publisher","first-page":"2567721","DOI":"10.1080\/20008066.2025.2567721","article-title":"Moral injury prevention and intervention","volume":"16","author":"Williamson","year":"2025","journal-title":"Eur J Psychotraumatol"},{"key":"2026092702564145300_usag438-B4","doi-asserted-by":"publisher","first-page":"387","DOI":"10.37898\/spiritualpc.1319074","article-title":"Guilt and shame because of violating beliefs: \u201cmoral injury.\u201d","volume":"8","author":"Tun\u00e7","year":"2023","journal-title":"Spiritual Psychol Couns"},{"key":"2026092702564145300_usag438-B5","doi-asserted-by":"publisher","first-page":"3904","DOI":"10.1007\/s10943-023-01885-6","article-title":"Examining the association between moral injury and suicidal behavior in military populations: a systematic review","volume":"62","author":"Jamieson","year":"2023","journal-title":"J Relig Health"},{"key":"2026092702564145300_usag438-B6","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1037\/gpr0000018","article-title":"The role of moral emotions in military trauma: Implications for the study and treatment of moral injury","volume":"18","author":"Farnsworth","year":"2014","journal-title":"Rev Gener Psychol"},{"key":"2026092702564145300_usag438-B7","doi-asserted-by":"publisher","first-page":"345","DOI":"10.12681\/cjp.35213","article-title":"Exploring enhanced military ethics and legal compliance through automated insights: an experiment on military decision-making in extremis","volume":"8","author":"Lekea","year":"2023","journal-title":"Conatus J Philos"},{"key":"2026092702564145300_usag438-B8","doi-asserted-by":"publisher","first-page":"399","volume":"107","DOI":"10.2139\/ssrn.4115567"},{"key":"2026092702564145300_usag438-B9","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1177\/0095399711413711","article-title":"Martial virtue: civic humanism as a groundwork for American military ethics","volume":"43","author":"Hart","year":"2011","journal-title":"Adm Soc"},{"key":"2026092702564145300_usag438-B10","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1017\/S1816383125100829","article-title":"Upholding humanity: the role of redress in preventing and responding to civilian harm","volume":"108","author":"Moffett","year":"2026","journal-title":"Int Rev Red Cross"},{"key":"2026092702564145300_usag438-B11","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1162\/isec_a_00432","article-title":"Soldiers\u2019 dilemma: foreign military training and liberal norm conflict","volume":"46","author":"Joyce","year":"2022","journal-title":"Int Sec"},{"key":"2026092702564145300_usag438-B12","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1007\/s11896-025-09785-z","article-title":"\u201cIt\u2019s all just part of the job\u201d: an exploration of moral injury in police officers, sheriffs, and public safety communicators in Canada","volume":"41","author":"Smith-MacDonald","year":"2026","journal-title":"J Police Crim Psych"},{"key":"2026092702564145300_usag438-B13","author":"Allsbrook Roth","year":"2024"},{"key":"2026092702564145300_usag438-B14","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1192\/bjp.2018.55","article-title":"Occupational moral injury and mental health: systematic review and meta-analysis","volume":"212","author":"Williamson","year":"2018","journal-title":"Br J Psychiatry"},{"key":"2026092702564145300_usag438-B15","doi-asserted-by":"publisher","first-page":"923928","DOI":"10.3389\/fpsyt.2022.923928","article-title":"Defining and assessing the syndrome of moral injury: initial findings of the moral injury outcome scale consortium","volume":"13","author":"Litz","year":"2022","journal-title":"Front Psychiatry"},{"key":"2026092702564145300_usag438-B16","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1111\/inm.12792","article-title":"Military moral injury: a concept analysis","volume":"29","author":"Jamieson","year":"2020","journal-title":"Int J Ment Health Nurs"},{"key":"2026092702564145300_usag438-B17","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1080\/08995605.2025.2486242","article-title":"Exploring moral injury and reintegration challenges among post-9\/11 US veterans: a qualitative study","volume":"38","author":"Danson","year":"2026","journal-title":"Mil Psychol"},{"key":"2026092702564145300_usag438-B18","doi-asserted-by":"publisher","first-page":"100227","DOI":"10.1016\/j.metip.2026.100227","article-title":"Ethical considerations in qualitative health\/psychology research with military populations: Navigating power, vulnerability, and cultural complexity","volume":"14","author":"Heward","year":"2026","journal-title":"Methods Psychol"},{"key":"2026092702564145300_usag438-B19","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1007\/s10943-022-01542-4","article-title":"Complex moral injury: Shattered moral assumptions","volume":"61","author":"Fleming","year":"2022","journal-title":"J Relig Health"},{"key":"2026092702564145300_usag438-B20","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1016\/j.cpr.2009.07.003","article-title":"Moral injury and moral repair in war veterans: a preliminary model and intervention strategy","volume":"29","author":"Litz","year":"2009","journal-title":"Clin Psychol Rev"},{"key":"2026092702564145300_usag438-B21","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/1471-2288-8-45","article-title":"Methods for the thematic synthesis of qualitative research in systematic reviews","volume":"8","author":"Thomas","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"2026092702564145300_usag438-B22","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1002\/jts.22362","article-title":"Moral injury: an integrative review","volume":"32","author":"Griffin","year":"2019","journal-title":"J Trauma Stress"},{"key":"2026092702564145300_usag438-B23","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1002\/jclp.22134","article-title":"Moral injury, meaning making, and mental health in returning veterans","volume":"71","author":"Currier","year":"2015","journal-title":"J Clin Psychol"},{"key":"2026092702564145300_usag438-B24","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1002\/jclp.22471","article-title":"Impact of killing in war: a randomized, controlled pilot trial","volume":"73","author":"Maguen","year":"2017","journal-title":"J Clin Psychol"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag438\/71403944\/usag438.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag438\/71403944\/usag438.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T06:56:52Z","timestamp":1790492212000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag438\/8836723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,26]]},"references-count":24,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag438","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,26]]},"article-number":"usag438"}}