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Hellenthal, Andrea; Zimmermann, Peter; Willmund, Gerd; Lovinusz, Alexander; Fiebig, Rüdiger; Bozoyan, Christiane; Märcker, Andreas and Alliger-Horn, Christina (2017): Einsatzerlebnisse, moralische Verletzungen, Werte und psychische Erkrankungen bei Einsatzsoldaten der Bundesweh. In: Verhaltenstherapie, Vol. 27, No. 4: pp. 244-252

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Background: Soldiers in foreign deployments are exposed to diverse stressful experiences, resulting in an increase in mental health problems. Moral injuries and traditional personal values could play an important role in the pathogenesis of these mental health problems. Patients and Method: A Combat experiences Scale (MHAT), the Posttraumatic Stress Diagnostic Scale (PDS), the Patient Health Questionnaire (PHQ), the Moral Injuries Events Scale, and Schwartz's Portrait Values Questionnaire (PVQ) were completed by 191 soldiers of the German Armed Forces at the end of their mission in Afghanistan. Direct associations of traumatic combat experiences and traditional personal values with mental health outcome were examined by regression analysis. The mediating role of moral injuries between combat experiences and mental health problems was considered by mediation analysis. Results: The stressor 'Confrontation with hardship, suffering, and violence among the population' had a significant, direct impact on mental health problems. Moral injuries constituted a differential mediator between the stressor 'Confrontation with hardship, suffering, and violence among the population' and the mental syndromes 'posttraumatic stress disorder' and 'depression' on the one hand and alcohol abuse on the other hand. No significant associations were found between traditional personal values and mental health outcome as well as traditional personal values and moral injuries. Conclusion: Combat experiences with a moral dimension seem to be associated with mental illnesses in soldiers. This effect is mediated by the construct of moral injury. These results could contribute to further developments of preventive and therapeutic approaches.

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