{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:01:18Z","timestamp":1790802078428,"version":"4.1.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Dutch Veterans Institute","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]},{"name":"ARQ National Psychotrauma Centre","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The Clinical Interview for Moral Injury\u2014Military 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\u2009=\u20097) and military veterans (N\u2009=\u20098) at two Dutch trauma centers who conducted the CIMI-M were interviewed and completed questionnaires assessing the CIMI-M\u2019s feasibility, acceptability, and clinical utility. Interviews were analyzed using the General Inductive Approach for qualitative evaluation data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359553","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:01:32Z","timestamp":1790798492000},"page":"e0359553","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mapping moral injury: Development and feasibility of the Clinical Interview for Moral Injury\u2014military version (CIMI-M)"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9130-1443","authenticated-orcid":true,"given":"Mari\u00eblle L.","family":"de Goede","sequence":"first","affiliation":[{"name":"ARQ Centrum\u201845","place":["Diemen\/Oegstgeest, The Netherlands"]},{"name":"Utrecht University","place":["Utrecht, The Netherlands"],"department":["Department of Clinical Psychology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4125-4739","authenticated-orcid":true,"given":"Paul A.","family":"Boelen","sequence":"additional","affiliation":[{"name":"ARQ Centrum\u201845","place":["Diemen\/Oegstgeest, The Netherlands"]},{"name":"Utrecht University","place":["Utrecht, The Netherlands"],"department":["Department of Clinical Psychology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett T.","family":"Litz","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System","place":["Boston, Massachusetts, United States of America"]},{"name":"Boston University and Boston University School of Medicine","place":["Boston, Massachusetts, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. Jackie June","family":"ter Heide","sequence":"additional","affiliation":[{"name":"ARQ Centrum\u201845","place":["Diemen\/Oegstgeest, The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"8","key":"pone.0359553.ref001","doi-asserted-by":"crossref","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":"BT Litz","year":"2009","journal-title":"Clin Psychol Rev"},{"issue":"3","key":"pone.0359553.ref002","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1037\/trm0000287","article-title":"Moral injury and mental health: A systematic review and meta-analysis","volume":"27","author":"C 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handbook of psychological assessment","author":"M Hersen","year":"2004"},{"issue":"3","key":"pone.0359553.ref019","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1037\/pas0000486","article-title":"The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans","volume":"30","author":"FW Weathers","year":"2018","journal-title":"Psychol Assess"},{"issue":"4","key":"pone.0359553.ref020","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1176\/appi.focus.20150016","article-title":"An introduction to the cultural formulation interview","volume":"13","author":"NK Aggarwal","year":"2015","journal-title":"FOC"},{"key":"pone.0359553.ref021","doi-asserted-by":"crossref","first-page":"904659","DOI":"10.3389\/fpsyt.2022.904659","article-title":"Moral injury in trauma-exposed, treatment-seeking police officers and military veterans: Latent class analysis","volume":"13","author":"B Mensink","year":"2022","journal-title":"Front Psychiatry"},{"issue":"3","key":"pone.0359553.ref022","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1017\/S1352465802003065","article-title":"New developments in cognitive-behavioural case formulation. 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