Moral Injury and Turnover Among U.S. Military Servicemembers

Background and Purpose: Moral injury refers to feelings of moral betrayal, guilt, or shame that result from experiencing, perpetrating, or witnessing actions that transgress deeply held moral beliefs. Military moral injury has been linked to mental health symptomatology including guilt, shame, loss of meaning, PTSD, depression, anxiety, substance use, and negative social and spiritual outcomes. Research has also found that moral injury predicts turnover intentions (intent to leave the military), yet less is known about turnover behavior (actually leaving the military). This study adds to emerging literature by investigating the relationship between moral injury and turnover behavior in a nationally representative sample of U.S. military servicemembers and veterans.

Methods: Data were obtained from the 2016-2018 Army Study to Assess Risk and Resilience in Servicemembers Longitudinal Study (Army STARRS-LS), Wave 1 (N = 14,508). Servicemember respondents were surveyed about their feelings of moral injury and their combat experiences. Respondents’ military service status was dichotomized into currently serving (i.e., activated, deactivated, and Reserve) or separated/retired. A logistic regression was conducted to predict service status from moral injury, with combat exposure, age, and sex as covariates.

Results: The overall model was statistically significant, X2(6) = 171.6, p < 0.001. Moral injury positively predicted service status when controlling for combat exposure, age, and sex (B = 0.06, SE = 0.01, p < 0.001). Holding all other variables constant, a one-point increase in total moral injury was related to a 6.6% greater likelihood of being separated/retired (OR = 1.07, 95% CI [1.05, 1.09]). Therefore, a respondent with no moral injury had a 12.1% chance of being separated/retired (95% CI [0.10, 0.15]), while a respondent with median moral injury had a 21.7% likelihood of being separated/retired (95% CI [0.20, 0.24]). Respondents with the maximum moral injury score had a 51.2% chance of being separated/retired (95% CI [0.41, 0.61]), over four times the likelihood of those with no moral injury. Significant covariates included combat experiences (B = 0.04, SE = <0.005, p < 0.001), being 25-29 years of age (B = -0.26, SE = 0.11, p = 0.02), and being 30-44 years of age (B = -0.67, SE = 0.11, p < 0.001).

Conclusions and Implications: These results using a nationally representative sample indicate that moral injury is a significant predictor of military servicemembers’ turnover behavior. The inclusion of age and combat experiences as control variables highlights that moral injury has a unique effect on turnover independent of age-related retirement as well as combat exposure as a whole. This underscores the need for further research to understand how moral injury can impact consequential career decisions, as well as to elucidate the mechanisms that underlie these relationships. Furthermore, it documents the significance and potential consequences of military servicemembers’ moral disagreement with aspects of their service, which has implications for recognizing and correcting military injustices.