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The longitudinal association between moral injury appraisals and psychological outcomes in refugees

Published online by Cambridge University Press:  02 December 2020

Angela Nickerson*
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW Australia
Yulisha Byrow
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW Australia
Joel Hoffman
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW Australia
Meaghan O'Donnell
Affiliation:
Phoenix Australia, University of Melbourne, Parkville, VIC, Australia
Richard A Bryant
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW Australia
Natalie Mastrogiovanni
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW Australia
Tadgh McMahon
Affiliation:
Settlement Services International, Ashfield, NSW, Australia Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
Greg Benson
Affiliation:
Settlement Services International, Ashfield, NSW, Australia
Vicki Mau
Affiliation:
Australian Red Cross, North Melbourne, VIC, Australia
Belinda J. Liddell
Affiliation:
School of Psychology, University of New South Wales, Sydney, NSW Australia
*
Author for correspondence: Angela Nickerson, E-mail: anickerson@psy.unsw.edu.au

Abstract

Background

Refugees report a diverse array of psychological responses following persecution and displacement. Little is known, however, regarding the mechanisms that underlie differential psychological reactions in refugees. This study investigated the longitudinal impact of negative moral appraisals about one's own actions [i.e. moral injury-self (MI-self) appraisals] and others' actions [i.e. moral injury-other (MI-others) appraisals] on a variety of psychological symptoms over a period of 6 months.

Methods

Participants were 1085 Arabic, Farsi, Tamil, or English-speaking refugees who completed a survey at baseline and 6 months later either on-line or via pen-and-paper. The survey indexed demographic factors, exposure to potentially traumatic events (PTEs), exposure to ongoing stressors, MI-other appraisals, MI-self appraisals, re-experiencing and arousal symptoms, and feelings of sadness, anger and shame.

Results

Findings indicated that, after controlling for demographics, PTE exposure and ongoing stressors, MI-other appraisals predicted increased re-experiencing and hyperarousal symptoms, and feelings of sadness and shame. MI-self appraisals predicted decreased feelings of shame, and decreased re-experiencing symptoms. In contrast, psychological symptoms at baseline did not as strongly influence MI appraisals 6 months later.

Conclusions

These findings highlight the important role that cognitive appraisals of adverse events play in the longitudinal course of psychological symptoms. These results thus have important implications for the development of tailored psychological interventions to alleviate the mental health burden held by refugees.

Type
Original Article
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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