Combat Exposure, Moral Injury Symptoms and Mental Health Among Ukrainian Active-Duty Military Personnel and Swedish Military Personnel: A Comparative Study

The aim of the study was to compare a sample of Ukrainian active-duty military personnel with Swedish military veterans in terms of combat exposure, moral injury symptoms and indices of probable PTSD, depression and anxiety. Data collection took place in 2024, and questionnaire responses were obtained from 308 Ukrainian active-duty military personnel and 504 Swedish individuals (288 active-duty veterans and 216 veterans who had left the armed forces) using established scales. All participants reported a qualifying morally stressful experience. The Ukrainian respondents reported higher combat exposure and higher mean scores on scales designed to measure severity of moral injury symptoms, probable PTSD, depression and anxiety. Linear regression analysis showed that nation, combat exposure and age (the Ukrainians were younger) contributed significantly to the explained variance and resulted in a nearly large effect size for probable PTSD, a medium effect size for depression, and nearly medium effect sizes for moral injury symptoms and anxiety. However, possibly the most important finding is that the majority of the Ukrainian participants scored below the limit for moderate severity regarding moral injury symptoms and below established cutoff values on the probable PTSD, depression and anxiety scales. A practical suggestion for military healthcare is that the moral injury indication scales and mental health scales may be useful components of stepped screening and assessment processes, with positive screens followed by clinical evaluation.