The Occupational Moral Injury Scale: Development and Validation in Frontline Health and First Responder Workers

Moral injury is an emerging construct that has been primarily examined in military groups but is increasingly expanding to a broader range of nonmilitary occupational settings. A key barrier to this research on moral injury in broader occupational groups has been the lack of valid and reliable measures specifically developed for nonmilitary settings. The current article addresses this gap by developing the Occupational Moral Injury Scale (OMIS), a measure designed to capture both morally injurious events (MIEs) and primary markers of moral injury (guilt, shame, anger, loss of trust, existential conflict) in any occupational setting, without the need for modification. A combination of confirmatory factor analyses and item response theory analyses was used in scale development and refinement. Drawing upon a sample of 1,454 primarily frontline health and first responder workers across two studies, factor analytic results revealed an expected bifactor structure of five primary factors capturing exposure to MIEs (commission with agency, commission under duress, act of omission, witnessing, betrayal) and a general factor of moral injury. Subscales demonstrated excellent internal consistency, and when compared to theoretically relevant constructs OMIS scores demonstrated strong convergent and divergent validity. Differential validity was also observed among the OMIS subscales. The OMIS provides a psychometrically validated tool for assessing moral injury risk in any occupational setting. The OMIS will help facilitate further research and understanding of how moral injury presents in high-risk occupational settings beyond the military and allow for direct comparison between these groups for the first time.