Social Determinants of Health on Moral Injury: The Role of the Social and Community Context Restricted; Files Only
Lee, Jiwon (Spring 2025)
Abstract
Moral injury (MI) refers to the social, psychological, or spiritual suffering that may arise after an event conflicts with core moral beliefs (Borges et al., 2022). While MI has been widely studied in military and healthcare populations (Hines et al., 2021; Wisco et al., 2017), emerging research suggests it is also relevant to civilians, particularly when structural and social conditions contribute to potentially morally injurious events (PMIEs) (Borges et al., 2022). However, limited empirical research examines the socioenvironmental factors shaping MI in civilians. This study addresses this gap by applying the Social Determinants of Health (SDOH) framework to explore the role of socioenvironmental factors in MI. Variables of interest corresponded to each SDOH key area (e.g., Healthcare Access and Quality, Education Access and Quality, Social and Community Context, Economic Stability, and Neighborhood and Built Environment).
This study hypothesized that lesser socioeconomic resources—characterized by lower educational attainment, lower income, lack of health insurance coverage and greater neighborhood deprivation—would be associated with more severe MI. Additionally, greater exposure to childhood maltreatment and lifetime trauma would also be associated with more severe MI. Data from the Fani Affective Neuroscience Lab and the Grady Trauma Project were analyzed using multiple linear regression. A civilian sample of 385 adults (ages 18–65 years) completed self-report surveys. Secondary analyses explored the role of race-related stress and the moderating effect of subjective social status (SSS) in MI.
Findings revealed that higher childhood maltreatment, lifetime trauma exposure, and race-related stress significantly predicted higher MI, with trauma serving as a central mechanism. The relationship between childhood maltreatment and MI was moderated by SSS, with individuals of higher SSS showing stronger associations. These results highlight the potential influence of the Social and Community Context SDOH key area on psychological outcomes such as MI and underscore the need for interventions targeting social environments and systemic factors, particularly those influenced by historical and racial disparities. This research contributes to the understanding of MI in civilians and provides insights for developing targeted interventions to address systemic risk and protective factors, fostering a more equitable approach to mental health care.
Table of Contents
Introduction (Page 10)
Methods (Page 26)
Participants and Procedures (Page 26)
Materials and Measures (Page 27)
Design (Page 32)
Data Analyses (Page 32)
Results (Page 33)
Sample Characteristics (Page 33)
Primary Analysis (Page 34)
Secondary Analyses (Page 34)
Figure 1 (Page 35)
Discussion (Page 36)
Limitations (Page 51)
Future Directions (Page 52)
Conclusion (Page 54)
References (Page 55)
Table 1 (Page 69)
Table 2 (Page 72)
Table 3 (Page 73)
Table 4 (Page 74)
Appendix A (Page 75)
Appendix B (Page 77)
Appendix C (Page 79)
Appendix D (Page 82)
Appendix E (Page 83)
Appendix F (Page 84)
About this Honors Thesis
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File download under embargo until 22 November 2025 | 2025-04-02 22:30:02 -0400 | File download under embargo until 22 November 2025 |
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