Exploring the relationship between Adverse Childhood Experiences, Moral Injury and Social Support in a Clinical Sample of UK Military Veterans - 02/12/25

Doi : 10.1016/j.ejtd.2025.100623

Marina Beckwith ^a , David Turgoose ^a,^⁎ , Gary Latchford ^a , Dominic Murphy ^b,^c

^a Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Road, Leeds LS9 9NL

^b Combat Stress, Research Department, Tyrwhitt House, Leatherhead, Surrey, UK

^c King’s Centre for Military Health Research, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, 10 Cutcombe Road, London, UK

^⁎ Corresponding Author: David Turgoose (School of Medicine, Worsley Building, University of Leeds, Leeds LS2 9JT) School of Medicine University of Leeds Worsley Building Leeds LS2 9JT

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Abstract (250 words)

Background

Increased exposure to adverse childhood experiences (ACEs) is noted amongst military veterans, who also face unique occupational stressors during military service. Veterans are at increased risk of exposure to potentially morally injurious experiences (PMIE) and Moral Injury.

Objective

To explore the relationship between ACEs and Moral Injury in a sample of UK treatment-seeking veterans.

Participants and Setting

428 treatment-seeking veterans who accessed veterans’ mental health charity Combat Stress between 2019-2020 completed a patient experience survey.

Methods

A secondary analysis of cross-sectional survey data previously collected by Combat Stress explored the relationship between ACEs and Moral Injury using linear regression analysis. Further correlational analysis explored associations between ACEs, Moral Injury and social support.

Results

The majority of respondents experienced at least one ACE (74.6%), with 35% classed as high risk (4+ ACEs). Over half (57.1%) reported exposure to a PMIE. ACEs were associated with Moral Injury (r[239] = .207, p< .001), with Personal Abuse ACEs explaining 4.4% of the variance in Moral Injury scores ( F (1,239) = 11.086, p  = .001, 95% CI [29.30, 33.35]). 72.2% of respondents reported low perceived social support, with social support being negatively correlated with both ACEs and Moral Injury.