Posttraumatic growth and depreciation among Ukrainians: a structural equation modelling approach
Crecimiento postraumático y depreciación entre ucranianos: una aproximación desde el modelamiento de ecuaciones estructurales
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY
M. MEZHENSKA ET AL.
Department of Psychology, University of North Texas, Denton, TX, USA
CONTACT Mariia Mezhenska mariiamezhenska@my.unt.edu Department of Psychology, University of North Texas, 1611 W Mulberry St, Denton, TX 76201, USAABSTRACT
Background: War-related stressors can disrupt core beliefs and shape trauma outcomes, yet the distinct roles of moral processes in post-traumatic outcomes remain insufficiently understood.
Objective: To examine how war-related stressors (WRS) and core-belief disruption (CBD) relate to posttraumatic stress disorder (PTSD) symptoms, moral injury (MI), moral sensitivity (MS), posttraumatic growth (PTG), and posttraumatic depreciation (PTD) among Ukrainian adults living under ongoing war.
Method: A national sample of adults residing in Ukraine in 2025 (N = 6,340) was assessed for WRS, CBD, PTSD symptoms, MI, MS, PTG, and PTD. Scalar measurement invariance across gender and combat-exposure groups was established. Structural equation modelling was applied to test direct and indirect pathways from WRS and CBD to PTG and PTD through PTSD symptoms, MI, and MS.
Results: WRS and CBD explained substantial variance in PTSD (R² = .69), MI (R² = .37), and MS (R² = .33). MI and MS showed divergent predictive patterns: MI uniquely predicted PTD (β ≈ .36) but not PTG (β ≈ .06), whereas MS predicted PTG (β ≈ .42) but not PTD (β ≈ .03). Indirect pathways indicated that WRS and CBD were associated with higher PTD primarily through PTSD and MI, while their associations with PTG were mainly mediated by MS, with a smaller contribution from PTSD. The model accounted for significant variance in PTG (R² = .35) and PTD (R² = .48).
Conclusions: Moral injury and moral sensitivity represent distinct processes associated with depreciative and growth-related posttraumatic change. Under ongoing war conditions, moral sensitivity functions as an adaptive pathway linked to PTG, whereas moral injury functions as a risk pathway linked to PTD.
HIGHLIGHTS
- War-related stressors and core-belief disruption are strongly associated with PTSD symptoms under ongoing war conditions.
- Moral injury is uniquely associated with posttraumatic depreciation, whereas moral sensitivity is uniquely associated with posttraumatic growth.
- Indirect effects suggest that stressors in the war and disrupted beliefs relate to PTD mainly through PTSD symptoms and moral injury, but relate to PTG mainly through moral sensitivity.
Trans Abstract
Antecedentes: Los estresores relacionados con la guerra pueden alterar las creencias centrales y moldear los resultados del trauma; aun así, los roles distintivos de los procesos morales en los resultados postraumáticos permanecen poco conocidos.
Objetivo: Examinar cómo los estresores relacionados con la guerra (WRS en su sigla en inglés) y la afectación de las creencias centrales (CBD en su sigla en inglés) se relacionan con los síntomas del trastorno del estrés postraumático (TEPT), el daño moral (MI en su sigla en inglés), la sensibilidad moral (MS en su sigla en inglés), el crecimiento postraumático (CPT), y la depreciación postraumática (PTD en su sigla en inglés) en adultos ucranianos viviendo en guerra actual.
Método: Se evaluó una muestra nacional de adultos residentes en Ucrania en el 2025 (N = 6,340) para WRS, CBD, síntomas del TEPT, MI, MS, CPT, y PTD. Se estableció la invarianza de la medida de las escalas a través de los grupos por género y exposición al combate. El modelamiento de ecuaciones estructurales fue aplicado para evaluar los caminos directos e indirectos desde WRS y CBD hasta CPT y PTD a través de los síntomas del TEPT, MI, y MS.
Resultados: WRS y CBD explicaron una varianza significativa del TEPT (R² = .69), MI (R² = .37), y MS (R² = .33). MI y MS mostraron patrones predictivos divergentes: MI predijo únicamente PTD (β ≈ .36), pero no CPT (β ≈ .06), mientras que MS predijo CPT (β ≈ .42), pero no PTD (β ≈ .03). Los caminos indirectos indicaron que WRS y CBD estaban asociados con un mayor PTD primariamente a través del TEPT y MI, mientras que sus asociaciones con CPT fueron principalmente mediadas por MS, con una pequeña contribución desde el TEPT. El modelo explicó una varianza significativa en CPT (R² = .35) y PTD (R² = .48).
Conclusiones: El daño moral y la sensibilidad moral representan procesos distintivos asociados con el cambio postraumático depreciativo y relacionado con el crecimiento. En condiciones de guerra actuales, la sensibilidad moral funciona como un camino adaptativo vinculado al CPT, mientras que el daño moral funciona como un camino de riesgo relacionado con el PTD.
1.Introduction
The full-scale invasion by the Russian Federation in Ukraine in 2022 created unprecedented levels of acute and chronic traumatic exposure across all segments of the population (Kimhi et al., 2024; Lushchak et al., 2024; Ressler et al., 2024). Posttraumatic stress disorder (PTSD) is one of the most widely studied psychological outcomes following such large-scale, life-threatening events. Yet, beyond the debilitating symptoms of intrusions, avoidance, negative alterations in cognitions and mood, and arousal that constitute PTSD, war-related trauma can profoundly undermine people’s most fundamental assumptions about the world, themselves, and others – commonly referred to as core beliefs (Cann et al., 2010a).
Shattered Assumptions Theory (Janoff-Bulman, 1992) posits that individuals maintain fundamental, often implicit, assumptions about the nature and order of the world and self that serve as cognitive frameworks for interpreting experiences and guiding purposeful action. These worldviews are built upon underlying beliefs about meaning, predictability, controllability, and personal invulnerability (Edmondson et al., 2011; Park, 2010). Janoff-Bulman (1992) described three overarching categories of global meaning: (1) the world is benevolent – that is, people are well-intentioned and life generally turns out favourably; (2) the world is meaningful – that life is predictable, orderly, and fair; and (3) the self is worthy – that one is good and deserving of positive outcomes. Traumatic experiences, particularly those involving human-inflicted harm, can shatter these core assumptions. Within this framework, core belief disruption (CBD) refers to the degree to which a traumatic event challenges an individual’s foundational worldview (Cann et al., 2010a). In trauma research, CBD is typically examined as a precursor that can lead to divergent outcomes, in particular posttraumatic growth (PTG) and posttraumatic depreciation (PTD), through diverse cognitive and emotional processes, such as intrusive and deliberate rumination.
PTG has been conceptualized as the experience of positive psychological change resulting from the struggle with traumatic life experiences (but not by the trauma itself; Tedeschi & Calhoun, 2004). Five core domains in which these positive changes are most reported were identified: (1) an increased sense of personal strength, (2) enhanced relationships with others, (3) recognition of new possibilities, (4) greater appreciation of life, and (5) existential or spiritual development (Shakespeare-Finch et al., 2013; Taku et al., 2008). These domains have been validated through both quantitative analyses and qualitative thematic exploration across diverse contexts (Mosher et al., 2017).
Existing research warns against viewing trauma outcomes in a simple or binary way. Thus, in parallel to PTG, individuals may experience PTD – a construct representing perceived negative changes in the same five domains (Baker et al., 2008; Cann et al., 2010b). PTD is characterized by a diminished sense of personal strength, deterioration in close relationships, a reduced recognition of new life possibilities, a weakened appreciation for life, and spiritual or existential decline. Importantly, PTG and PTD have been found to co-occur within individuals, rather than operate as mutually exclusive outcomes (Cann et al., 2010b; Taku et al., 2021).
Research on posttraumatic change emphasizes cognitive processing as a key mechanism in the development of PTG, with deliberate rumination that reflects purposeful, reflective thinking aimed at understanding the event and reconstructing meaning, linked to higher PTG (Allen et al., 2022; Cann et al., 2011; Lindstrom et al., 2013). In contrast, intrusive rumination, reflecting unwanted, recurrent trauma-related thoughts, is more associated with depreciation (Platte et al., 2022). Yet it can show a more complex pattern when PTG and PTD are examined concurrently, with evidence indicating that intrusive rumination may relate to both growth and depreciation depending on timing, co-occurring symptoms, and broader coping and meaning-making processes (Romeo et al., 2022; Taku et al., 2009). Although the cognitive pathways underlying PTG have been studied extensively (Allen et al., 2022), comparatively fewer studies have examined PTD despite evidence that PTG and PTD can co-occur and represent distinct dimensions of perceived posttraumatic change that may share some predictors while differing in others (Baker et al., 2008; Cann et al., 2010b; Romeo et al., 2022; Taku et al., 2021). Furthermore, while PTG and PTD research has been primarily focused on cognitive processing, other individual characteristics or capacities that might foster growth beyond rumination are not yet well-defined, highlighting an area for exploration.
In recent years, the moral dimension of trauma has received growing scholarly attention, particularly with the introduction of the concept of moral injury (MI). Originally developed in military psychology (Litz et al., 2009; Shay, 1994), MI refers to the persistent psychological, social, and spiritual suffering that follows exposure to events, whether perpetrated, witnessed, or experienced, that transgress a person’s deeply held moral beliefs and expectations (Litz et al., 2022). Such events, commonly referred to as potentially morally injurious events (PMIEs), can evoke intense moral emotions, including guilt, shame, anger, and feelings of betrayal, and can erode trust in oneself, in others, in institutions, or in humanity.
Although MI and PTSD often co-occur, they are conceptually and clinically distinct. PTSD is characterized by fear, helplessness, and horror in response to life-threatening events, accompanied by re-experiencing, avoidance, negative alterations in mood and cognition, and hyperarousal. MI, by contrast, centres on violations of moral integrity and may occur even in the absence of a direct threat to life (Litz et al., 2022). MI and PTSD are distinct constructs characterized by unique symptoms that can interact to heighten adverse outcomes, including suicidality (Bryan et al., 2018). Empirical evidence supports this distinction, including evidence from the Ukrainian population specifically (Mezhenska et al., in press). This highlights that MI captures a domain of posttraumatic suffering not reducible to fear-based threat appraisal or conditioning, but rather rooted in ethical disorientation and the destabilization of moral identity through emotions such as guilt, shame, anger, and betrayal.
Recent conceptual advances have broadened the scope of MI beyond its initial emphasis on perpetrators and witnesses also to include victims of moral transgressions, as well as beyond military settings and discrete events to encompass ongoing or pervasive contexts of moral violation (Molendijk, 2018; Molendijk et al., 2018). VanderWeele et al. (2025) define MI as ‘persistent distress arising from experiences that disrupt or threaten one’s sense of the goodness of self, others, institutions, or higher powers, or one’s beliefs about right and wrong or good and evil’ (p. 3). In summary, during the last decade, excessive research on MI underscores that trauma can be experienced not only as a threat to safety but also as a threat to one’s moral integrity, thereby expanding the scope of potential pathways to both PTG and PTD. Furthermore, while it has been theoretically hypothesized that CBD may be a key component of MI (Fleming, 2022), the relationship between MI and CBD has not yet been empirically investigated.
Acknowledgment of the moral dimension of traumatic experience invites consideration of other concepts within moral psychology that may have a significant impact on posttraumatic outcomes. In particular, the concept of moral sensitivity (MS), introduced by Rest (1986) and further developed by a range of scholars across moral psychology and professional ethics (e.g. Lützen et al., 2006; Reynolds & Miller, 2015; Weaver et al., 2008), offers a valuable framework for understanding how individuals recognize and interpret morally salient aspects of a situation, an ability that may be especially relevant in potentially traumatic experiences involving human-inflicted harm and violence. Philosophical traditions trace MS to the concept of a moral sense, described by early theorists as a faculty for perceiving right and wrong, grounded in a ‘benevolent sentiment’ toward others. This benevolent orientation fosters moral motivation – the desire to ‘do good’ – and supports the interpersonal capacity to see situations from the perspective of those who are vulnerable or harmed (Lützen et al., 2006).
Rest (1986, 1994), building on Kohlberg’s (1984) theory of moral development, places MS as the first of four components in the integrated model of moral decision making: (1) moral sensitivity, (2) moral judgment, (3) moral motivation, and (4) moral character. In this framework, moral sensitivity refers to the awareness of how one’s actions affect others and the recognition of morally relevant aspects of a situation. This component is foundational, shaping how situations are interpreted and determining whether moral considerations enter the decision-making process at all. Compared to the more cognitively focused paradigm of Kohlberg’s original theory, Rest’s model integrates affective and motivational elements, framing MS as the joint capacity to notice moral features of a situation and to emotionally register and process them within a social context. Subsequent developments conceptualize MS as a multidimensional capacity (Jordan, 2007). Lützen et al. (2006) refer to MS as an attentiveness to moral values embedded in complex or conflict-laden circumstances, coupled with self-awareness of one’s own role and responsibility in those situations. Similarly, Weaver et al. (2008) emphasize its role in decision-making within uncertainty with attunement to others’ vulnerability and relational responsiveness, while Kraaijeveld and Schilderman (2021) focus on the central role of emotions in moral functioning. Furthermore, converging evidence links MS with empathy and perspective taking, which relate to moral cognition and prosocial behaviour (Eisenberg et al., 2005; Skoe et al., 2002).
In the broader literature, the term MS is often used interchangeably with ‘ethical sensitivity’ and ‘moral awareness,’ while also being discussed alongside related constructs (Miller et al., 2014; Weaver et al., 2008). Summarizing existing scholarship, MS encompasses empathic responsiveness to suffering or injustice, awareness of morally and ethically salient features of a situation, and a sense of responsibility and motivation to act in ways that uphold moral values. While initially studied in domains such as health care, where MS helps practitioners navigate ethically complex decisions under emotional strain, the construct is equally relevant in other high-stakes and potentially traumatic and morally ambiguous contexts.
1.1.Current study
Prior research has established that trauma can disrupt fundamental worldviews and lead to a range of psychological outcomes, including PTSD symptoms, PTG, and PTD. Recently, the concept of MI has gained attention for capturing the moral and ethical dimensions of trauma. We propose MS as an additional individual difference variable that may influence posttraumatic adaptation. While CBD, PTSD symptoms, PTG, PTD, MI, and MS have been studied separately, no empirical research to date has examined their interrelationships and combined predictive power for both positive and negative posttraumatic outcomes.
In the current study, we used latent variable modelling to test a theoretically informed structural equation model linking war-related stressors (WRS) and CBD, with PTSD symptoms, MI, and MS, and subsequently with PTG and PTD. To the best of our knowledge, this is the first study to (1) empirically examine the relationship between CBD and MI; (2) investigate the role of MI in predicting both PTG and PTD; and (3) introduce and test an additional construct – moral sensitivity, which has received significant attention in moral psychology, but has not yet been examined in trauma psychology. Based on prior literature, we expected that greater WRS would be strongly associated with PTSD and moderately associated with CBD. We also expected CBD to predict PTSD symptoms and MI. Consistent with work on posttraumatic change, we expected PTSD symptoms to show a positive association with PTD and a small positive association with PTG. We hypothesized a positive association between MI and PTD and a negligible association between MI and PTG. Finally, PTG and PTD were expected to function as distinct constructs with different predictors. Because MS has seldom been examined in trauma contexts, the investigation of its role was exploratory. We explored whether WRS and CBD would be associated with higher MS, whether MS would show associations with PTG and PTD, and whether MS and MI would operate as diverging pathways from WRS and CBD to positive and negative posttraumatic outcomes. Given that the timing of CBD with WRS remains an open question, with some studies suggesting instantaneous change of CBD with traumatic experience (e.g. Center for Abuse Treatment, 2014; Falsetti et al., 2003; Habibi Soola et al., 2025; Sweeney et al., 2018) and to be consistent with Shattered Assumptions Theory (Janoff-Bulman, 1992) we specified the WRS and CBD domains as correlated predictors.
2.Method
2.1.Procedure and participants
Detailed demographic information for participants is provided in Table 1. Participants were recruited between May 7, 2025, and July 31, 2025. The study invitation was posted on social media and sent to governmental, non-governmental, and community organizations for wider dissemination. The study targeted Ukrainian civilians and military personnel affected by the ongoing war, both within Ukraine and abroad. For the purposes of the present analysis, we focused exclusively on participants residing inside Ukraine to ensure a shared exposure environment and sociopolitical context. Moreover, respondents with completion time < 10 min were excluded from the analysis because this duration is insufficient to read instructions and thoughtfully complete the full instrument battery, indicating likely low effort responding. Eligibility criteria required participants to be at least 18 years old and to self-identify as having been affected by the full-scale war in Ukraine. After providing informed consent, participants completed the anonymous survey via Qualtrics. The final sample comprised 6340 individuals residing in Ukraine. Ethical approval was obtained from the Institutional Review Board at the University of North Texas (IRB-25-253), and all procedures adhered to the principles outlined in the Declaration of Helsinki.
Variable Category n % Gender Male 5,621 88.7 Female 709 11.2 Non-binary/other 7 0.1 Education Master’s Degree or Higher 2,030 32.1 Bachelor’s Degree 1,484 23.4 Technical Degree 1,470 23.2 High School 751 11.9 College 594 9.4 Combat Status Civilian 4,062 66.8 Currently Deployed 1,719 28.2 Past Deployed 304 5.0
All measures were originally developed in English and translated into Ukrainian using a rigorous double-back translation process. Final translations were reviewed by trauma-informed clinicians and bilingual experts to ensure cultural and contextual appropriateness.
2.2.Measures
2.2.1Sociodemographic questionnaire
Participants reported age, gender, level of education, country of current residence, and status of war zone exposure (civilians, current or past military deployment).
2.2.3Core belief disruption
Disruption of foundational assumptions was assessed using the Core Beliefs Inventory (CBI; Cann et al., 2010a). The CBI consists of 9 items designed to evaluate the extent to which a highly stressful or traumatic event – in this case, the war – led individuals to seriously re-examine fundamental assumptions about the world, themselves, others, and their future. In the present study, participants were specifically asked to reflect on their experiences during the war (e.g. ‘Because of the war, I seriously examined the degree to which I believe things that happen to people are fair,’ ‘Because of the war, I seriously examined my assumptions concerning why other people think and behave the way that they do’). Responses were rated on a 5-point Likert scale ranging from 0 (‘Not at all’) to 4 (‘Extremely’), with higher scores indicating greater disruption of core beliefs. The CBI has demonstrated good to high internal consistency across diverse trauma populations (α = .82 −.89; Cann et al., 2010), and for the current study (Cronbach’s α = .948). Corrected item-total correlations ranged from .672 (CBI8) to .855 (CBI5)
2.2.4Posttraumatic stress symptoms
Posttraumatic stress symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5; Blevins et al., 2015; Weathers et al., 2013). Participants completed the PCL-5 with instructions to rate symptoms in relation to their most stressful or disturbing war-related experience. This 20-item self-report instrument assesses symptoms across four DSM-5 PTSD symptom clusters: intrusions (Item example, ‘Repeated, disturbing, and unwanted memories of the stressful experience’), avoidance (‘Avoiding memories, thoughts, or feelings related to the stressful experience’), negative alterations in cognitions and mood (‘Having strong negative feelings such as fear, horror, anger, guilt, or shame’), and alterations in arousal and reactivity (‘Feeling jumpy or easily startled’). Participants rated whether they were bothered by each symptom over the past month using a 5-point scale (0 = ‘Not at all’ to 4 = ‘Extremely’). Systematic review of existing psychometric evidence revealed that internal consistency coefficients ranged from .83 to .97 for the PCL-5 total scale score (Forkus et al., 2023). In the current study, internal consistency of the 20-item PCL-5 was excellent, with Cronbach’s alpha of .963. Corrected item-total correlations ranged from .456 (PCL16) to .821 (PCL18), indicating strong contributions of the items to the total score.
Using empirically derived cut-off criteria (Forkus et al., 2023), PCL-5 total scores less than 31 were reported by 90.6% of participants, while 3.3% reported total scores between 31-37, and 6.1% reported total scores at or above 38.
2.2.5Moral injury
Moral injury was assessed using the Moral Injury Outcomes Scale (MIOS; Litz et al., 2022), a 14-item instrument that includes two subscales: Shame-related MI (e.g. ‘I blame myself’) and Trust Violation-related MI (e.g. ‘I have trouble seeing goodness in others’). Participants were asked to reflect on their experience in the war and rate items on a 5-point scale (0 = ‘Strongly disagree’ to 4 = ‘Strongly agree’), with higher scores indicating greater moral injury. In the consortium validation, internal consistency for the 14-item MIOS total score ranged from α = .85 to .90 across Stage II samples, with strong internal consistency also observed in Stage III samples (total α up to .95; Litz et al., 2022). In the present study, internal consistency was excellent (α = .927). Corrected item-total correlations ranged from .520 (MIOS2) to .780 (MIOS9).
2.2.6Moral sensitivity
Moral sensitivity was assessed using the Moral Sensitivity Scale (MSS), a 15-item instrument developed for the present study. The development of the MSS was informed by existing moral sensitivity measures created for medical professionals and for educational settings (Lützén et al., 1994; Tirri & Nokelainen, 2011; Weaver et al., 2008), and which have been widely used to assess ethical awareness and decision-making in healthcare and educational contexts. While these instruments provided a valuable conceptual foundation, their content is highly context-specific to professional practice. To address this limitation, we adapted the underlying concepts to create a scale suitable for a general population and applicable across diverse real-world moral contexts. The MSS captures three interrelated aspects of moral sensitivity: (1) sensitivity to moral emotions – the capacity to emotionally react and respond to others’ suffering, injustice, or ethical violations. This includes empathic concern, discomfort when witnessing wrongdoing, and feelings of guilt or regret after acting against one’s values (e.g. ‘I feel a strong urge to help others when I see them in distress’; ‘I feel guilt or regret when I realize I have done something morally wrong’); (2) moral awareness and reflection – the ability to notice when situations involve ethical considerations and to think critically about what is right and wrong. This includes reflecting on one’s values, evaluating whether actions align with them, and recognizing the moral implications of decisions (e.g. ‘I often reflect on what is right and wrong’; ‘I notice when situations involve ethical dilemmas’); (3) moral responsibility – the sense of obligation to uphold fairness and act when witnessing unethical behaviour. This involves considering the feelings of others, proactively engaging to ensure fairness, and intervening to address injustice (e.g. ‘I feel responsible for ensuring fairness in my interactions with others’; ‘When I witness unethical behavior, I feel compelled to speak up’). All items were rated on a 5-point Likert scale from 0 (‘Strongly disagree’) to 4 (‘Strongly agree’), with higher scores indicating greater moral sensitivity. Internal consistency was excellent (Cronbach’s α = .977). Item-total correlations were uniformly high (.829–.900), indicating strong homogeneity. It supports treating the MSS as an essentially unidimensional indicator of moral sensitivity suitable for use as a unit-weighted composite or a single latent factor in SEM.
2.2.7Posttraumatic growth and depreciation
Posttraumatic change was assessed using the Posttraumatic Growth and Posttraumatic Depreciation Inventory – Expanded Version (PTGDI-X; Taku et al., 2021). The PTGDI-X consists of 50 items, organized as 25 bipolar pairs, each capturing opposing changes in five core domains: relating to others, new possibilities, personal strength, spiritual and existential change, and appreciation of life. Each pair includes one item reflecting positive change (PTG) and one reflecting negative change (PTD). Questions were contextualized within the wartime experience (e.g. ‘As a result of the war, I have greater appreciation for the value of my own life’ vs. ‘As a result of the war, I have less appreciation for the value of my own life’). Cronbach’s alpha for both the PTG and the PTD scales was α = .97, indicating very high internal consistency. Corrected item-total correlations ranged from .57 to .86 for PTG and from .47 to .88 for PTD.
2.3.Data analytics plan
We computed descriptive statistics (means, standard deviations) and Pearson correlations among observed total scores for all study variables (Table 3). A structural equation modelling (SEM) approach was utilized, given its statistical rigour for representing psychological constructs (Strauss & Smith, 2009), precise parameter estimates separate from error (Hoyle, 2012), and assessment of measurement invariance across groups (Neumann & Ngo, 2025). Preliminary analyses were conducted to check the dimensionality of scales via item-level analyses, and measurement invariance across various subgroups to support the use of the total sample. The examination of dimensionality is based on research highlighting the value of homogeneous constructs (Smith et al., 2009), since most psychological measures have scale-scores or sub-factors that are moderately to strongly correlated, thus signalling a higher-order unidimensional construct. Second, to maximize power and enhance generalizability of our results, we tested whether there was measurement invariance across gender and different combat exposure groups to provide assurance that the use of the total sample was viable. Thus, the measurement model was examined using different levels of analysis (items, scales) and modelling approaches (exploratory, confirmatory). An item-based seven-factor Exploratory Structural Equation Model (ESEM) was tested to obtain evidence that the items used to represent each of the latent variables (WRS, CBD, PTSD, MI, MS, PTG, PTD) approximated unidimensional factors. To provide stricter evidence of unidimensionality, an item-based seven-factor confirmatory factor analytic (CFA) model was also tested. Assuming the item-level model results would provide sufficient evidence of unidimensionality (i.e. strong item-to-factor loadings, good model fit) for all latent variables (LVs), we moved to a scale-based model to maximize the participants-to-estimated parameters ratio and precision of parameter estimates.
Variable 1 2 3 4 5 6 7 1. War-related Stressors 2. Core belief disruption 0.347*** 3. PTSD symptoms 0.651*** 0.492*** 4. Moral injury 0.357*** 0.491*** 0.541*** 5. Moral sensitivity 0.203*** 0.561*** 0.264*** 0.342*** 6. Post-traumatic growth 0.301*** 0.708*** 0.353*** 0.330*** 0.503*** 7. Post-traumatic depreciation 0.383*** 0.560*** 0.572*** 0.573*** 0.295*** 0.536*** M 12.79 10.55 11.45 6.90 28.59 38.59 19.52 SD 9.72 8.85 13.12 9.50 17.91 32.20 24.01
Underlying multidimensionality can introduce model misspecification and can affect the assessment of measurement invariance (Neufeld et al., 2024). Thus, obtaining a good fit and evidence of LV unidimensionality for the item-level ESEM and CFA models would allow us to confidently move to a scale-based model for the invariance testing. Measurement invariance was tested for three groupings: (1) civilian men vs. civilian women, (2) civilian men vs. men who were currently/previously deployed in combat, and (3) men who were currently vs. previously deployed. Change in Comparative Fit Index (ΔCFI) ≤ .01 provided statistical evidence of no significant difference between models (Cheung & Rensvold, 2002; Neufeld et al., 2024; West et al., 2012). Consistent with traditional, an unconstrained (configural) model was statistically compared to fit for a model with constrained factor loadings (metric) and then the metric model was compared to a (scalar) model (constrained loadings, intercepts) to test for evidence of strong invariance. Evidence of invariance across the groups (men/women; civilian/combat) provided confidence to pursue the primary study purpose of examining the LV associations and structural regressions among the full complement of LVs within the total sample.
Specifically, two scale-based models were tested, a CFA that allowed all LVs to correlate, and a SEM that specified the WRS and CBD LVs as predictors of PTSD, MI, MS, and these latter three LVs served as predictors of the PTG and PTD LVs. We also estimated all indirect associations (e.g. WRS → MI → PTD).
Model fit was assessed using incremental and absolute fit indices, based on traditional cutoffs (CFI ≥ .90, TLI ≥ .90, RMSEA ≤ .08, SRMR ≤ .08). These cut-offs have been recommended as indicative of acceptable model fit (West et al., 2012) to avoid falsely rejecting viable latent variable models, given that model complexity increases the difficulty of achieving conventional levels of model fit (Marsh et al., 2004). All analyses were conducted in Mplus (Muthén & Muthén, 1998/2017) using robust weighted least squares estimation for item-based models and maximum likelihood for the scale-based model. Basic statistics and correlations between study variables are also reported for descriptive purposes.
3.Results
Table 2 lists the frequencies and level of impact for all war-related exposure experiences that participants reported. Generally, almost all participants reported at least some impact of the war, and only a very small minority (N = 144, 2.2%) reported little to no impact from the war in Ukraine. For descriptive purposes, Table 3 provides means and standard deviations as well as manifest variable correlations among the study variables using total scores.
3.1.Item-level ESEM/CFA model fit
Model fit results are provided in Table 4. The seven-factor ESEM and CFA item-level models had good fit (e.g. CFI’s = .94−.95; RMSEA’s = .04−.05). Item-to-factor loadings were strong (CFAmean = .82, Range = .70 – .89; ESEMmean = .67, Range = .42 – .84), with low cross-loadings for the ESEM (mean = .05, Range .02 – .09).
Model/Sample CFI TLI RMSEA [90 CI’s] SRMR ΔCFI Total Sample 7-factor ESEM (items) .95 .94 .04 [.03 - .04] .03 7-factor CFA (items) .94 .94 .04 [.04 - .04] .07 7-factor CFA (scales) .95 .95 .05 [.05 - .06] .03 Multiple-group CFA Civilian men/women (configural) .95 .94 .06 [.05 - .06] .03 Civilian men/women (metric) .95 .95 .05 [.05 - .06] .03 .00 Civilian men/women (scalar.) .95 .94 .05 [.05 - .06] .03 .00 Civilian men/Combat men (configural) .96 .95 .06 [.05 - .06] .02 Civilian men/Combat men (metric) .96 .95 .06 [.05 - .06] .03 .00 Civilian men/Combat men (scalar) .96 .95 .06 [.05 - .06] .03 .00 Deployed/Previously deployed (configural) .95 .94 .07 [.05 - .06] .03 Deployed/Previously deployed (metric) .95 .93 .07 [.05 - .06] .04 .00 Deployed/Previously deployed (scalar) .95 .93 .06 [.05 - .07] .04 .00
3.2.Multiple-group CFA (MG-CFA) results
Across the series of MG-CFAs there was evidence for strong (scalar) invariance (i.e. ΔCFI’s = .00). Each scalar model provides latent mean estimates, with the first group’s LV means set to zero for comparison with the second group’s LV means. The results were consistent with what would be expected based on theory (e.g. exposure level) and previous research (e.g. women > men in symptomology). Compared to civilian men (set to zero), the civilian women had higher latent means for all seven LVs (LVmean = .89, p < .001). Somewhat similar results were found when comparing civilian men to men who were or had been deployed in combat (LVmean = .13, p < .01), except for no differences in latent means for MI or MS (p’s = .07). Finally, men previously deployed had higher latent means for PTSD (LVmean = .26, p < .001) and War-related stressors (LVmean = .32, p < .001), compared to those currently deployed (set to zero). The other LV mean differences were small (LVmean = .05) and did not reach significance (p > .05).
3.3.CFA model fit (scale-level)
Model fit for the CFA was good (CFI = .95; RMSEA = .05). Figure 1 provides the standardized loadings and latent correlations for the seven-factor scale-based CFA. As can be seen, the pattern of LV correlations was moderate to strong associations, in line with theory and previous research.
3.4.SEM fit
Figure 2 (Panel A) displays the standardized parameters for the SEM. Model fit was good (CFI = .95; RMSEA = .05). The results indicated that both WRS and CBD were able to account for significant variance in PTSD symptoms (r2 = .69), MI (r2 = .37) and MS (r2 = .33). These five LVs accounted for significant variance in PTG (r2 = .35) and PTD (r2 = .48). Most LV correlations and structural paths were significant, though differed substantively depending on the specific path.1 Note that the SEM structural relations are akin to partial correlations. For instance, after accounting for the covariation between WRS and CBD, as well as the path between CBD and symptoms of PTSD, the structural path between WRS and PTSD symptoms was beta = .66, compared to the bivariate latent variable (LV) correlation between WRS and PTSD of r = .79.
Within this context, we note that the correlations between MI and PTG (r = .34) and between MI and PTD (r = .61) were moderate to strong in association, yet the structural paths between MI and PTG (beta = .06) and MI and PTD (beta = .36) were substantially reduced after accounting for the correlations between MI and MS and between MI and PTSD symptoms, along with their paths between PTG and PTD, as well as the effects of WRS and CBD on MI. Similarly, the correlations between MS and PTG (r = .51) and MS and PTD (r = .30), respectively, were strong to moderate, though the structural path between MS and PTD (beta = .03) was substantially reduced after accounting for the other LV effects. The path between MS and PTG (beta = .42) remained strong after accounting for the other LVs. The pattern of associations suggests the presence of significant indirect effects.2
3.5.Indirect effects
Figure 2 (Panel B) displays all significant standardized indirect parameters. The pattern of results clearly shows that the indirect effects of WRS and CBD through PTSD and MI were linked with increases in PTD. In contrast, the indirect effects of WRS and CBD, respectively, through PTSD and MS were significantly linked with PTG.
4.Discussion
The current study examined how war-related stressors and core-belief disruption are associated with posttraumatic growth and posttraumatic depreciation, and whether these associations are influenced by PTSD symptoms, moral injury, or moral sensitivity.
Consistent with Shattered Assumptions Theory (Janoff-Bulman, 1992) and meaning-making models (Park & Folkman, 1997; Park, 2010), as well as core PTG theory (Cann et al., 2010; Tedeschi & Calhoun, 1996, 2004), the current results highlight significant disruptions of core beliefs in this large sample of Ukrainian adults. More specifically, the ongoing war was associated with violations in global beliefs about (a) fairness and justice, (b) controllability, (c) others’ motives and behaviour, (d) close relationships, (e) personal abilities and strengths/weaknesses, (f) expectations for the future, (g) life meaning, (h) spiritual or religious beliefs, and (i) personal value or worth.
In the context of an ongoing war, exposure matters most for threat-based distress: WRS showed a strong association with PTSD symptoms, indicating that continued danger and war-related events are strongly related to symptoms of intrusions, avoidance, negative alterations in cognitions and mood, and arousal that constitute PTSD. WRS showed a moderate to strong association with CBD, consistent with the idea that persistent wartime stress undermines global assumptions about safety, controllability, justice, the self, and others. In contrast, the path between WRS and MI was low-moderate, and the link between WRS and MS was negligible, suggesting that simply ‘more exposure’ is not sufficient to produce moral distress or heightened moral attunement.
The pattern of CBD associations with PTSD, MI, and MS provides additional insight. CBD was strongly related to MS and was moderately linked with MI and PTSD. This pattern implies that when Ukrainian adults’ core assumptions are shaken, they may be more likely to become more morally attentive or attuned (higher MS), with less potential vulnerability to morally charged appraisals (higher MI). In other words, exposure (WRS) primarily increased the level of PTSD symptoms directly through ongoing danger and highly stressful situations that war implies, whereas CBD appears to be a proximal cognitive bridge from exposure to moral meaning processes (higher MS and MI). The more modest CBD–PTSD link indicates that shattered assumptions also contribute to PTSD symptoms, but less so than direct threat exposure.
Consistent with prior findings in other trauma contexts (Liu et al., 2017), PTSD showed a small-to-moderate positive link with PTG. PTG theory explains this pattern by proposing that distress can function as a catalyst triggering intrusive rumination that keeps the trauma cognitively salient and, when sufficiently processed and supported, can shift into deliberate, goal-directed rumination and meaning reconstruction, yielding perceived growth. By contrast, PTSD was linked more strongly with PTD, suggesting that threat- and arousal-based symptoms are more closely aligned with depreciative change.
To our knowledge, this is the first investigation connecting MI within the PTG/PTD framework. MI showed a moderate effect with PTD but was near-zero with PTG. These findings suggest that MI predominantly tracks depreciative change, with negligible direct association with perceived growth.
A novel contribution of this study is the inclusion of MS, a construct largely new to trauma research. In moral psychology, MS has been linked to personal growth and practical wisdom (Weaver et al., 2008). Our findings extend this view: MS showed a moderate positive association with PTG and a near-zero association with PTD, suggesting that MS may function as an adaptive resource in trauma recovery, helping translate core-belief disruption into positive posttraumatic transformation. Notably, MS and MI appear to operate in distinct ways once core beliefs are disrupted. MS, a capacity encompassing (a) moral-emotional attunement to others’ suffering and wrongdoing, (b) moral awareness and reflective appraisal of ethically salient situations and value–action alignment, and (c) a sense of moral responsibility and action orientation, functions like a meaning-making resource: when CBD ‘activates’ people’s assumptive world, higher MS is associated with greater PTG and negligible PTD, suggesting that ethical attunement helps channel disruption into deliberate reflection and value-consistent action. By contrast, MI, marked by appraisals of moral violation, guilt/shame, and betrayal, tracks depreciative change and shows little link to growth in this wartime sample, consistent with the idea that ongoing, unresolved violations constrain opportunities for moral repair. Yet, the same activation of core beliefs can bifurcate toward sensitivity (and supporting PTG) or toward injury (amplifying erosion and PTD). This divergence underscores MS as a potential protective/process variable and MI as a risk/process variable, inviting future investigation of MS as a target for intervention in trauma care. Taken together, these findings suggest that moral sensitivity has practical clinical relevance and may constitute a promising target for assessment and intervention in trauma-focused care, for example, by recognizing the importance of moral concerns, validating moral pain, navigating moral disorientation, and cultivating moral awareness, perspective-taking, and value clarification to support adaptive meaning-making and posttraumatic growth.
Finally, the findings align with prior research on Ukrainians during the war in terms of PTSD burden (and MI) in civilians (Zasiekina et al., 2023). However, this evidence was gathered soon after the full-scale invasion and included many displaced respondents – a group repeatedly shown to report greater PTSD than non-displaced Ukrainians (Johnson et al., 2022; Shevlin et al., 2018). Thus, early estimates likely reflect acute-phase elevations and are not directly comparable to current resident-population baselines. By focusing on individuals residing in Ukraine and leveraging a much larger sample, our estimates perhaps provide a more stable approximation of population levels for late spring and summer 2025.
4.1.Limitations
The current study has several limitations. First, the cross-sectional design does not allow for causal inferences and cannot capture the dynamic changes in psychological responses that may occur during the ongoing war. Second, MSS was developed based on established theoretical frameworks in moral psychology and demonstrated good psychometric properties in the current study. While it has not yet undergone extensive validation in other trauma-exposed populations, the current findings provide initial evidence of its utility and relevance in understanding posttraumatic growth and depreciation. Third, while we acknowledge that moral concepts may be interpreted differently across individuals, in this study, morality was assessed independently of religiosity, spirituality, and religious rules, focusing instead on ethical awareness, attunement, and value-based decision-making. Finally, while all measures were translated using rigorous double back-translation and showed strong measurement performance in this dataset (including good item-level model fit and scalar invariance across gender and combat-exposure groups), such instruments as PCL-5, CBI, MIOS, and PTGDI-X have not previously undergone formal Ukrainian-language validation. Although this is a common, widely accepted, and ethically responsive approach in cross-cultural research, particularly in high-urgency settings, future research should conduct comprehensive validation studies of Ukrainian versions of these measures.
4.2.Conclusions, clinical implications, and future directions
The overall study model suggests that war stressor exposure and belief disruption are related to both PTG and PTD, but through distinct mechanisms. PTSD symptoms and MI were more strongly associated with PTD, whereas MS was more strongly associated with PTG. Importantly, PTG and PTD were not mutually exclusive. Rather, they represent different directions of perceived change that can co-occur but show distinct predictors. This study further underscores, at a societal level, the importance of recognizing that psychological adaptation following the onset of war is multidimensional and cannot be adequately captured by focusing on a single outcome in isolation. By modelling war-related stressors and disrupted core beliefs together with threat-based symptoms (PTSD) and moral processes (MI and MS), the findings provide an integrative picture of how negative and positive posttraumatic changes (depreciation and growth) can emerge through partially distinct pathways. From a public health and policy perspective, this integrated framework supports the need for coordinated responses that simultaneously address psychopathological symptoms and moral/meaning-related processes.
The findings of this study have several important clinical implications. First, routine screening in war-affected settings may be strengthened by assessing not only PTSD symptoms but also MI symptoms (shame-related distress and trust-violation appraisals), given that these domains jointly index elevated risk for posttraumatic depreciation. Second, case formulation may benefit from explicitly differentiating fear- and threat-based sequelae (PTSD symptomatology) from moral pain (MI), because these processes often co-occur yet reflect partially distinct clinical needs and, therefore, distinct intervention targets. Third, the pattern of findings suggests clinical value in integrating moral repair strategies, including validating morally salient emotional reactions, developing moral awareness, supporting moral meaning-making, and strengthening moral processes linked to growth. Finally, in emergency contexts where resources are limited, brief and scalable service-delivery models may prioritize stabilization of PTSD symptoms while also creating structured opportunities to process morally laden emotions and support value-consistent coping.
Future research should use longitudinal designs to test temporal ordering and potential reciprocal relations among CBD, PTSD symptoms, MI, and MS, and to evaluate whether within-person changes in MS and MI predict subsequent trajectories of growth and depreciation. In addition, further psychometric validation of the MSS is warranted, including replication across independent trauma-exposed populations, evaluation of convergent and discriminant validity, and tests of sensitivity to change in intervention studies.
Acknowledgements
We thank all participants who generously contributed their time to complete the survey during an exceptionally challenging period. Their willingness to share their experiences made this research possible. We also acknowledge and appreciate everyone who assisted in disseminating the survey, whose efforts ensured broad and diverse participation.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
Dataset and materials publicly available at https://osf.io/fqw8v/files.