{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:24:56Z","timestamp":1789439096790,"version":"build-2803163510"},"reference-count":92,"publisher":"SAGE Publications","issue":"11-12","license":[{"start":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T00:00:00Z","timestamp":1610409600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Interpers Violence"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>Moral injury is an array of symptoms theorized to develop in response to morally injurious events, defined as events that challenge one\u2019s core moral beliefs and expectations about the self, others, and world. Recent measures of moral injury have distinguished self-directed moral injury (e.g., moral injury symptoms that emerge following the perpetration of morally injurious events) from other-directed moral injury, the symptoms of which are believed to stem from one\u2019s response to actions that others have committed (e.g., within-rank violence, failures of leadership, and acts of betrayal committed by trusted others or institutions). Using a convenience sample of 154 primarily former military women, the present study examined if other-directed moral injury symptoms (e.g., anger, betrayal, and mistrust) associated with military experience would mediate the association between military sexual harassment and mental health and substance abuse symptoms. Results demonstrated that 85.8% ( n = 127) of the of this sample of women veterans reported experiencing sexual harassment during their military service. Using a single mediation model, we further demonstrated that other-directed moral injury mediated the association between sexual harassment experience and mental health symptoms. Given the percentage of women veterans who reported sexual harassment, these results suggest that additional training for military members, and particularly, military leaders, is necessary to begin to reduce sexual harassment. In addition, mental health providers who work with current and former military members should consider how other-directed moral injury may be associated with mental health symptoms among women veterans who have experienced sexual harassment while in the military.<\/jats:p>","DOI":"10.1177\/0886260520985485","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T21:40:51Z","timestamp":1610660451000},"page":"NP10007-NP10035","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Moral Injury as a Mediator of the Associations Between Sexual Harassment and Mental Health Symptoms and Substance Use Among Women Veterans"],"prefix":"10.1177","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8840-8734","authenticated-orcid":false,"given":"Hannah C.","family":"Hamrick","sequence":"first","affiliation":[{"name":"University of Arkansas, Fayetteville, AR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7288-2418","authenticated-orcid":false,"given":"Sarah J.","family":"Ehlke","sequence":"additional","affiliation":[{"name":"Oklahoma Tobacco Research Center, Oklahoma City, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Davies","sequence":"additional","affiliation":[{"name":"Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennise M.","family":"Higgins","sequence":"additional","affiliation":[{"name":"Old Dominion University, Norfolk, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Naylor","sequence":"additional","affiliation":[{"name":"Durham Veterans Affairs Medical Center, NC, USA"},{"name":"Duke University Medical Center, Durham, NC, USA"},{"name":"VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3643-0419","authenticated-orcid":false,"given":"Michelle L.","family":"Kelley","sequence":"additional","affiliation":[{"name":"Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA"},{"name":"Old Dominion University, Norfolk, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,1,12]]},"reference":[{"key":"bibr1-0886260520985485","author":"American Psychiatric Association.","year":"2013","journal-title":"The DSM-5 self-rated level 1 cross-cutting symptom measure-adult"},{"key":"bibr2-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usy148"},{"key":"bibr3-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.22773"},{"key":"bibr4-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.06.012"},{"key":"bibr5-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1111\/sltb.12464"},{"key":"bibr6-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1177\/1077801207305232"},{"key":"bibr7-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1037\/pas0000628"},{"key":"bibr8-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1007\/s12671-018-1047-4"},{"key":"bibr9-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000767"},{"key":"bibr10-0886260520985485","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301576"},{"key":"bibr11-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1177\/1073191115590855"},{"key":"bibr12-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1037\/tra0000290"},{"key":"bibr13-0886260520985485","doi-asserted-by":"publisher","DOI":"10.1891\/088667007780842810"},{"key":"bibr14-0886260520985485","unstructured":"Counseling and Treatment for Sexual Trauma. 38 U.S.C. 1720D. 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