Initial Psychometric Evaluation of the Moral Injury Questionnaire — Military Version

Joseph M. Currier's 2015 paper in Clinical Psychology and Psychotherapy (electronic publication 2013) is the validation study for the Moral Injury Questionnaire — Military Version (MIQ-M), the first psychometrically validated self-report instrument for the construct. The author group includes Currier (then at the University of South Alabama, leading the analysis), Jason M. Holland, and Kent Drescher and David Foy from the National Center for PTSD's Pacific Islands Division, where the moral-injury measurement programme was initiated. The paper sits inside the Litz framework — the items operationalise the potentially morally injurious event taxonomy — but is the work of a different author group, which is significant for the field's research infrastructure.

Clinical Psychology and Psychotherapy is a Wiley peer-reviewed journal with the editorial filter of an academic clinical-psychology quarterly. The validation methodology is standard for the field: the authors administered candidate items to a community sample of 131 Iraq and Afghanistan veterans and a clinical sample of 82 returning veterans, ran factor analyses on the responses, and tested convergent validity against established measures of combat exposure, PTSD, depression, and functional impairment. One item on sexual trauma did not yield satisfactory psychometrics and was dropped; the final 19-item scale supported a unidimensional structure with strong reliability.

The headline finding — that MIQ-M scores predicted suicide risk and other mental-health outcomes after controlling for combat exposure and life-threat trauma — is the empirical claim that did the most to consolidate the construct's clinical standing. The implication is that moral injury is not simply a synonym for severe PTSD; it is doing predictive work that the existing PTSD measures do not. This is the finding that opened the door for the construct's adoption inside VA / DoD treatment-trial research, including the trials of adaptive disclosure that Litz and colleagues had been developing in parallel.

The MIQ-M itself has limitations the validation paper acknowledges and the secondary literature has continued to discuss. The unidimensional factor structure is convenient for research use but may collapse distinctions ( Shay's betrayal-by-authority framing versus Litz's perpetration-and-witnessing framing) that the philosophical and theological literature treats as substantive. The instrument is military-specific and has had to be adapted (with variable success) for healthcare-worker and civilian populations. And the items themselves encode the Litz-style definition of moral injury, which means the instrument is doing some of the conceptual work, not only measuring it.

The stake is technical and institutional. Currier writes from inside the National Center for PTSD / University of South Alabama clinical-research apparatus, with the methodological commitments — psychometric validation, factor analysis, treatment-trial-ready instruments — that research location requires. The paper is doing the work of making the construct empirically tractable; it is the infrastructural piece on which much of the post-2015 clinical moral-injury literature is built.

For the moral-injury corpus this is the principal measurement paper alongside Koenig's MISS-M (2018). The two instruments operationalise different versions of the construct: the MIQ-M is closer to a pure Litz-style PMIE measure, while the MISS-M includes explicit religious-struggle subscales. Reading the two validation papers together is the efficient way to understand how the construct is currently being measured in the field and what the methodological disagreements are.