Prevalence and contributing factors towards moral injury within a homeless population

Abstract

The first chapter is a systematic review of the associations between moral injury (MI) and social support (SS) across any population. The databases PsycINFO, MEDLINE, Web of Science, CINAHL, and Cochrane Library, were used to conduct literature searches. 13 studies were found and thematically fell into two groups for analysis, the social support group, and the social disconnection group. The analysis utilised two synthesis methods, summary of effects and narrative synthesis. The summary of effects showed that SS was negatively associated with MI-related constructs and social disconnection was positively associated with MI-related constructs. The narrative synthesis revealed the most consistent result related to the negative association between other-directed MI and SS. However, the outcomes of other types of MI, such as self-directed and betrayal, showed more inconsistent results. Explorations were made into the sources of support, and the role of SS in the relationship between MI and other mental health symptoms. This systematic review tentatively suggests that SS has an under-researched role in the experience of MI which could be further explored in future research. Suggestions of research topics are presented and considerations of how measures are used within MI research are discussed.
The second chapter reports on an empirical study, which had two aims relating to the exploration of MI within the homeless population in Hampshire. The first was to understand MI prevalence by comparing the scores on an MI measure between a homeless group (n=113) and a non-homeless group (n=408). MI was present in 60% of the homeless group sample. A t-test found a significant difference (t(151.41)= 2.56, p=0.006), between the groups and the mean difference = 4.12 (95% CI =.944, 7.285) indicating the homeless group has a higher rate of MI compared to the control group. The second aim was to consider if factors associated with homelessness (discrimination, adverse childhood events (ACEs), illegal activity, gender, generational poverty and substance use) alongside the transition into identifying as homeless, predicted MI. Analysis used multiple linear regressions and mediation analyses. ACEs and discrimination significantly predicted the MI total scores and were then used in the mediation analysis. It was found that PTSD symptoms mediated both variable’s relationship to MI, however only discrimination had a significant direct pathway to MI. Results are linked to theory and clinical practice, providing clinical suggestions for the inclusion of shame-informed practice into homeless services.

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ORCID for Nick Maguire: orcid.org/0000-0003-4295-8068

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