Research Studies Completed Studies

Completed Studies

The Atlas Institute undertakes large-scale research studies in partnership with our lived experience network, researchers and community organizations. Our completed research studies, along with their results and related resources, are listed below.

Clinical Assessment Moral Injury

Moral Injury Outcome Scale (MIOS)

Scientific Summary

The Moral Injury Outcome Scale (MIOS) Consortium aims to develop and validate a content-valid international measure of moral injury as a multidimensional outcome. The psychometric development process comprises three phases. Phase I entailed the collection of multicultural, international, and multi-context phenomenological data about the lasting impact of potentially morally injurious events from service members, Veterans, clinicians, and Chaplains. Qualitative coding of the data produced content-valid operational definitions of domains of impact, which guided the generation of potential scale items and resulted in the initial MIOS. In Phase II, the MIOS was administered to service members and Veterans, and the data collected are being analyzed to trim the item set of the scale and to ensure internal consistency. In Phase III, the final MIOS will be tested for construct validity.

Lay Summary

The purpose of this project is to create a scale that measures moral injury for clinicians and researchers. It will do this by using data from a study on moral injury within military personnel and Veterans in Australia, Canada, the United Kingdom, and the United States.

Led by Boston UniversityIn Partnership With VA Boston, Phoenix Australia, Operational Stress Injury Clinic – The Royal Ottawa, Atlas

Intimate Partner Violence

Informing Responses to Intimate Partner Violence in Military or Veteran Populations within Canada

Scientific Summary

Intimate Partner Violence (IPV) refers to behaviour that occurs within an intimate relationship and causes physical, psychological or sexual harm, and includes physical, sexual, and psychological abuse, as well as controlling behaviour. IPV victimisation and perpetration may be elevated among active duty personnel and veterans, and in the context of military experiences including deployment and reintegration, combat exposure, and posttraumatic stress. This project aims to address the intersection of IPV and military or veteran status, and consider this in a Canadian context. It will review best quality evidence, from Canada and other countries, regarding the prevalence of IPV among active duty personnel and veterans, as well as responses in military and veteran specific health services. The project will be informed by a cross-sector advisory group that will support the development of this new program of research on IPV in military and veteran populations at Atlas.

Lay Summary

The purpose of this project is to review recent knowledge about intimate partner violence (IPV) prevalence. It also aims to explore how Canadian service providers identify, prevent, and treat IPV among military personnel and Veterans. This work will help health service providers identify and respond to IPV to effectively deal with it.

Led by Phoenix Australia Centre for Posttraumatic Health In Partnership With Atlas

Brain Imaging Moral Injury Post-Traumatic Stress Disorder

Improving Machine-Learning-Driven Development and Identification of PTSD Phenotypes

Scientific Summary

Characterizing the complex nature of each PTSD patient’s presentation poses a difficult challenge given the heterogeneous nature of PTSD symptoms. This is especially relevant for more complex PTSD symptom profiles, including moral injury. Recent efforts in neuroimaging-based machine learning have demonstrated the possibility of characterizing PTSD phenotypes using neuroimaging markers combined with the first-person experience of individuals suffering from PTSD. Our project builds on this body of work by studying the changes in neural activity underlying moral injury using simultaneous electroencephalogram (EEG)-functional magnetic resonance imaging (fMRI) biomarkers.

Collected concurrently, the fMRI signal will help identify the regions of interest that correlate with moral injury at great spatial resolution, while the EEG signal will be used to identify the finer temporal variations occurring at these regions of interest. These measures will provide crucial information about the brain changes associated with the first-person experience of moral injury. Such advances will be critical to our understanding of moral injury and will facilitate a personalized treatment approach to moral injury. Furthermore, this work will be an important step in reducing the stigma of mental illness by allowing the invisible injury of moral injury to become visible.

Lay Summary

The purpose of this project is to find new measurable biological signs that can help describe the way in which PTSD uniquely presents itself in an individual. The project will meet this goal by using brain-imaging technology. Information from this project may be used to create new individualized PTSD treatments.

Led by McMaster University In Partnership With University of Western Ontario, Atlas

Moral Distress Moral Injury Peer Support

The Role of Peer Support in Responding to Moral Injury in Public Safety Personnel

Read the findings of the study

Scientific Summary

Attention to the potential for moral injury in healthcare, public safety and related frontline occupations has grown over the past decade and has increased dramatically since the start of the COVID-19 pandemic. Individuals in these roles are exposed to a variety of endemic and potentially traumatic stressors and frequently face situations that may result in moral injury. The application of the construct of moral injury in different frontline contexts indicates that there is an urgent need to better understand the nature and effects of potentially morally injurious events (PMIEs) in specific populations such as Public Safety Personnel (PSP), where the concept has not been widely applied. This project aims to: identify what categories of events PSP might experience as morally challenging, distressing, or as PMIEs; examine the contextual factors that limit or enable them to act in accordance with their values; explore how PSP make sense of and cope in the face of these events; determine if and how PSP engage peers as part of this process; and identify if there are skills, competencies, and/or practices that can enhance peer support for PSP who have been exposed to such events.

Lay Summary

The purpose of this project is to understand whether and how potentially morally injurious events and the concepts of moral distress and moral injury are relevant to public safety personnel, including paramedics, communications officers, and equipment and supply technicians.
This project also aims to find out the potential impacts of those experiences, as well as if and how peer support is helpful in making sense of them.
Lastly, the project will explore how peer support programs could focus on moral distress and moral injury in their curriculum. By learning more about how these personnel make sense of, and cope with, potentially morally injurious events with the support of their peers, we aim to equip these peers to provide that support.

Led by AtlasIn Partnership With The Royal Ottawa

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