Korean Journal of Psychology : General

끉臾 寃깋

Korean Journal of Psychology : General - Vol. 40 , No. 3

[ Article ]
The Korean Journal of Psychology: General - Vol. 40, No. 3, pp. 301-327
ISSN: 1229-067X (Print)
Print publication date 25 Sep 2021
Received 14 Jul 2021 Accepted 20 Aug 2021
DOI: https://doi.org/10.22257/kjp.2021.

한국판 도덕손상 사건 척도 및 도덕손상 경험 척도 개발 연구

Development of the Korean Version of the Moral Injury Events Scale and Moral Injury Experience Scale
Eun-young Jang
Department of Counseling Psychology, Honam University
Correspondence to : 장은영, 호남대학교 상담심리학과, 광주시 광산구 호남대길120 지성관 6618호, Tel : 062-940-5479, E-mail : jangmean@hanmail.net

Funding Information ▼


본 연구에서는 도덕손상 사건 척도(Moral Injury Events Scale)를 한국어로 타당화하였고, 도덕손상 사건으로 인해 경험한 주관적 반응을 측정하는 도덕손상 경험 척도(Moral Injury Experience Scale)를 개발하였다. 첫 번째 연구에서 9개 문항으로 구성된 국외 도덕손상 사건 척도를 이중번역 과정을 거쳐 한국어로 구성하였고, 이 척도와 별개로 도덕손상 경험 척도를 18개의 문항으로 구성하였다. 이 27개 문항에 더하여 수치심, 죄책감 및 분노 척도에 한국 성인 496명이 온라인 조사 방식으로 응답한 자료를 분석하였다. 전체 자료를 무작위로 두 개의 표집으로 분할하여 한 표집으로 탐색적 요인분석을 실시하였고, 다른 표집으로 확인적 요인분석과 신뢰도 및 타당도 분석을 실시하였다. 요인분석 결과에서 원척도의 9개 문항 2요소 구조가 반복검증되었으며, 표준화 경로계수도 원척도와 유사한 수준으로 추출되었다. 각 요소는 6개 문항의 ‘자신 혹은 타인의 위반 지각’ 및 3개 문항의 ‘타인 배신 지각’으로 명명하였다. 도덕손상 경험 척도는 18문항 3요소가 가정되었으나, 부합도 지수를 고려하여 15문항 3요소가 타당화되었다. 각 요소는 6개 문항의 ‘자신에 의한 손상’, 3개 문항의 ‘타인에 의한 손상’ 및 6개 문항의 ‘타인의 배신에 의한 손상’으로 명명되었다. 그리고 도덕손상 사건의 두 요소와 도덕손상 경험의 세 요소가 수치심, 죄책감 및 분노와 유의한 상관관계를 보여서 수렴타당도가 확인되었다. 두 번째 연구에서 도덕손상 사건, 도덕손상 경험, 수치심, 죄책감, 분노, 우울, 일반정신건강 및 삶의만족 척도에 대한 반응을 535명으로부터 온라인 조사 방식으로 수집하였다. 첫 번째 연구와 동일한 문항분석을 실시하여 두 척도의 신뢰도와 요인구조를 재검증하였다. 준거타당도를 확인한 상관분석 결과에서 도덕손상의 다섯 가지 하위요소들은 우울감 및 일반정신건강과 유의한 상관관계를 보였고, 삶의만족과는 0에 가까운 상관관계를 보였다. 국외연구 결과와 비교하여 도덕손상 경험에서 한국인들과 미국인들이 드러낸 유사점과 차이점을 기술하였다. 도덕손상이 도덕관련 정서 및 정신건강에 미치는 효과를 논의하였고, 이 척도들의 활용방안을 제안하였다.


This study was to develop the scales that measures the extent to which Koreans perceive the events that are against their belief system and the extent to which they have suffered from those events. In the first study, the Moral Injury Events Scale comprised of nine items was constructed in Korean through double translation. Additionally, the Moral Injury Experience Scale was constructed with 18 items. In addition to these 27 items, the responses of 496 Korean adults who participated in an online survey on shame, guilt, and anger were analyzed. The total data were randomly divided with two samplings, one to conduct exploratory factor analysis and the other to test confirmatory factor analysis, reliability and convergent validity analysis. Factor analysis revealed the two-factor structure of nine items from the original scale was replicated, and standardized path coefficients were also extracted at the similar level as the original scale. Each factor was assessed according to “perceiving your or others’ breach” with six items and “perceiving others’ betrayal” with three items. The Moral Injury Experience Scale was presumed to have three factors with 18 items, but it was validated to three factors with 15 items considering the conformity index. Each factor was assessed according to “damage by yourself” with six items, “damage by others” with three items, and “damage by others’ betrayal” with six items. The two factors of major injury events and three factors of moral injury experience showed a significant correlation with shame, guilt, and anger, thereby proving convergent validity. In the second study, an online survey was conducted to collect responses about moral injury events, moral injury experience, shame, guilt, anger, life satisfaction, general mental health, and depression from 535 participants. The same item analysis as the first study was conducted to revalidate the reliability and factor structure of the two scales. In the results of the correlation analysis that verified the criterion validity, the five subfactors of moral injury showed a significant correlation with general mental health and depression, and a near-zero correlation with life satisfaction. Compared to studies conducted overseas, this research described the similarities and differences in moral injury experience of Koreans and Americans. It then discussed the effects of moral injury on morality-related emotions and mental health and suggested application plans of these scales.

Keywords: moral injury, shame, guilt, anger, mental health
키워드: 도덕손상, 수치심, 죄책감, 분노, 정신건강


본 연구는 2020년 대한민국 교육부와 한국연구재단의 지원(NRF-2020S1A5A8044134)과 2020년도 호남대학교 학술연구비 지원을 받아 수행되었음.

1. Battles, A. R., Bravo, A. J., Kelley, M. L., White, T. D., Braitman, A. L., & Hamrick, H. C. (2018). Moral injury and PTSD as mediators of the associations between morally injurious. Traumatology, 24(4), 246-254.
2. Bian, J., Li, L., Sun, J., Deng, J., Li, Q., Zhang, X., & Yan, L. (2019). The influence of self-relevance and cultural values on moral orientation. Frontiers in Psychology, 10, 292-299.
3. Bravo, A. J., Kelley, M. L., Mason, R., Ehlke, S. J., Vinci, C., & Redman, J. C. (2020). Rumination as a mediator of the associations between moral injury and mental health problems in combat-wounded veterans. Traumatology, 26(1), 52-60.
4. Bryan, C. J., Bryan, A. O., Roberge, E., Leifker, F. R., & Rozek, D. C. (2018). Moral injury, posttraumatic stress disorder, and suicidal behavior among National Guard personnel. Psychological Trauma: Theory, Research, Practice, and Policy(1), 10, 36-45.
5. Choi, S. (2011). The Psychology of Koreans. Hakjisa. ISBN: 9788963306124
6. Choi, S., & Kim, K. (1999). The self in the Koreans’ mind in comparison with the Western self-consept. Korean Journal of Social and Personality Psychology, 13(2), 275-292. http://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE06373077
7. Currier, J. M., Farnsworth, J. K., Drescher, K. D., McDermott, R. C., Sims, B. M., & Albright, D. L. (2018). Development and evaluation of the Expressions of Moral Injury Scale-Military Version. Clinical Psychology and Psychotherapy, 25(3), 474-488.
8. Currier, J. M., Holland, J. M., Rojas-Flores, L., Herrera, S., & Foy, D. (2015). Morally injurious experiences and meaning in Salvadorian teachers exposed to violence. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 24-33.
9. Drescher, K. D., Foy, D. W., Kelly, C., Leshner, A., Schutz, K., & Litz, B. (2011). An exploration of the viability and usefulness of the construct of moral injury in war veterans. Traumatology, 17(1), 8-13.
10. Evans, W. R., Walser, R. D., Drescher, K. D., & Farnsworth, J. K. (2020). The Moral Injury Workbook: Acceptance and Commitment Therapy Skills for Moving Beyond Shame, Anger, and Trauma to Reclaim Your Values. New Harbinger. ISBN: 9781684034772
11. Fabricius, D. (2004). Guilt, shame, disobedience: Social regulatory mechanism and the “Inner Normative System” Psychiatry Inquiry, 24(2), 309-327.
12. Forkus, S. R., Breines, J. G., & Weiss, N. H. (2019). Morally injurious experiences and mental health: The moderating role of self-compassion. Psychological Trauma: Theory, Research, Practice, and Policy, 11(4), 630-638.
13. Hahn, D., Lee, C. H., & Chon, K. K. (1996). Korean Adaptation of Spielberger's STAI (K-STAI). Korean Journal of Health Psychology, 1(1), 1-14. UCI: I410-ECN-0102-2009-180-006949643
14. Jang, J., Lee, K., & Jang, E. (2014). The Effects of Childhood Trauma and Temperament on Prisoners` Aggression and Impulsivity: Mediational Role of Moral Judgement and Moral Emotion. The Korean Journal of Developmental Psychology, 27(3), 1-23.
15. Jin, K., Cha, M., & Song, H. (2019). The relationships between autistic trait and socio-moral judgments. Korean Journal of Culture and Social Issues, 25(2), 137-155.
16. Jordan, A. H., Eisen, E., Bolton, E., Nash, W. P., & Litz, B. T. (2017). Distinguishing war-related PTSD resulting from perpetration and betrayal-based morally injurious events. Psychological Trauma: Theory, Research, Practice, and Policy, 9(6), 627-634.
17. Kelley, M. L., Bravo, A. J., Davies, R. L., Hamrick, H. C., Vinci, C., & Redman, J. C. (2019). Moral injury and suicidality among combat-wounded veterans: The moderating effects of social connectedness and self-compassion. Psychological Trauma: Theory, Research, Practice, and Policy, 11(6), 621-629.
18. Kim, M., & Na, J. (2021). The moderating effects of gender and beneficiary on the relationship between social class and unethical behavior. Korean Journal of Social and Personality Psychology, 35(2), 75-92.
19. Koenig, H. G., Youssef, N. A., & Pearce, M. (2019). Assessment of moral injury in veterans and active duty military personnel with PTSD: A review. Frontiers in Psychiatry, 10, 443.
20. Kwon, C., & Son, E. (2020). A Review of Research on Moral Injury with its Implications to Psychotherapy and Counseling. Journal of Rehabilitation Psychology, 27(4), 83-99.
21. Lee, S., & Sul, S. (2019). Ingroup-outgroup difference in moral judgment: The effect of group membership of the transgressor and the location of transgression. Korean Journal of Social and Personality Psychology, 33(1), 19-52.
22. Lee, S., Oh, S. T., Ryu, S. Y., Jun, J. Y., Lee, K. S., Lee, E., Park, J. Y., Yi, S. W., Choi, W. J. (2016). Validation of the Korean version of Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R). Korean Journal of Psychosomatic Medicine, 24(1), 83-93. https://ir.ymlib.yonsei.ac.kr/handle/22282913/151645
23. Lim, W., Lee, C., Jung, S., & Choi, D. (2019). Opinion Polarization in Korea: Its Characteristics and Drivers. Korean Development Institute. ISBN: 9791159325090
24. Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706.
25. Markus, H., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation Psychological Review, 98(2), 224-253.
26. Marschall, D., Sanftner, J., & Tangney, J. P. (1994). The State Shame and Guilt Scale. George Mason University.
27. McCarthy, J., & Deady, R. (2008). Moral distress reconsidered. Nursing Ethics, 15(2), 254-262.
28. Nash, W. P., Marino-Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the Moral Injury Events Scale. Military Medicine, 178(6), 646-652.
29. Park, J., & Jin, K. (2020). Who should share? Preschoolers’ judgments regarding the moral responsibility of ingroup and outgroup members toward “the poor”. The Korean Journal of Developmental Psychology, 33(2), 69-85.
30. Park, S., & Chang, H. (2018). The effects of guilt on obsessive compulsive symptoms: Not just right experiences as a mediator. Korean Journal of Clinical Psychology, 37(2), 144-154.
31. Porter, B., Hoge, C. W., Tobin, L. E., Donoho, C. J., Castro, C. A., Luxton, D. D., & Faix, D. (2018). Measuring aggregated and specific combat exposures: Associations between combat exposure measures and posttraumatic stress disorder, depression, and alcohol-related problems. Journal of Traumatic Stress, 31(2), 296-306.
32. Ramsey, C., Dziura, J., Justice, A. C., Altalib, H. H., Bathulapalli, H., Burg, M., Decker, S., Driscoll, M., Goulet, J., Haskell, S., Kulas, J., Wang, K. H., Mattocks, K., & Brandt, C. (2017). Incidence of mental health diagnoses in veterans of operations Iraqi freedom, enduring freedom, and new dawn, 2001-2014. American Journal of Public Health, 107(2), 329-335.
33. Robbins, A. T., Kelley, M. L., Hamrick, H., Bravo, A., & White, T. (2017). Modification to the Moral Injury Questionnaire to assess core moral injury symptomology. Poster presented at the 29th Annual Association for Psychological Science Conference, Boston, Massachusetts, USA.
34. Shin, S. (2001). The Validity and Reliability of the Korean Version of the General Health Questionnaire: KGHQ-20 & KGHQ-30. Korean Journal of Social Welfare, 46, 210-235. http://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE07238254
35. SISAIN. (2019.04.18). Men in their twenties, who are they? SISAIN Vol 604. https://www.sisain.co.kr/news/articleView.html?idxno=34373
36. Suh, E. (2005). Why are Koreans not that happy? Proceedings of the Annual Meeting of the Korean Psychological Association, Korea, 134-135. http://www.dbpia.co.kr/journal/articleDetail?nodeId=NODE06376726
37. Tangney, J. P., & Dearing, R. L. (2002). Shame and Guilt. Guilford Press. ISBN: 9781572307155
38. You, J. I., & Hong, H. Y. (2020). The Relationship between Self-Efficacy and Bystander Defending Behavior in Cyberbullying among University Students: The Mediating Effects of Moral Disengagement and Guilt. The Korean Journal of Counseling and Psychotherapy, 32(4), 1647-1668.
39. Williamson, V., Sharon A. M., Stevelink, S. A. M., & Greenberg, N. (2018). Occupational moral injury and mental health: systematic review and meta-analysis. British Journal of Psychiatry, 212(6), 339-346.
40. Wisco, B. E., Marx, B. P., Wolf, E. J., Miller, M. W., Southwick, S. M., & Pietrzak, R. H. (2014). Posttraumatic stress disorder in the US veteran population: Results from the National Health and Resilience in Veterans Study. Journal of Clinical Psychiatry, 75(12), 1338-1346.
41. Youn, H. (2018). Instrumental and Reactive Transgressions of Primary and Secondary Psychopathic Traits: Focus on Moral Emotion, Moral Disengagement, and Unethical Decision Making. Korean Journal of Clinical Psychology, 37(3), 323-338.