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11 J. Int'l Humanitarian Action 1 (2026)

handle is hein.journals/jinthuma11 and id is 1 raw text is: Bravo etal. JournalofInternationalHumanitarian Action (2026) 11:1 Journal of International https://doi.org/10.1186/s41018-025-00183-y Humanitarian Action RESEARCH ARTICLE Open Access Moral injury among humanitarian aid personnel: a preliminary examination of associations with rumination and mental health Adrian J. Bravo1*., Michael F. Drusano2, Madi Williamson2, Rebecca J. Dunaief1, Rachel Williamson2 and Gabriela Heermans2 Abstract Given high rates of poor mental health among humanitarian aid workers, there has been a strong push for more research identifying risk and protective factors tied to poor mental health among this at-risk population. The present study examined moral injury (i.e., psychological, ethical, and/or spiritual conflict experienced when an individual's basic sense of humanity is violated) as a new form of trauma that may place humanitarian aid workers at higher risk for poor mental health outcomes. Further, we tested a model examining rumination as a mechanism linking moral injury to mental health outcomes within this population. A total of 124 (67.2% cisgender women; 59.7% White; Mean age=38.66, SD= 13.66) humanitarian aid personnel participated in a cross-sectional online survey study examining humanitarian aid experiences, moral injury, rumination, and mental health outcomes. Our preliminary findings suggest that humanitarian aid workers are susceptible to experiencing moral injury and that higher reports of moral injury were significantly associated with poorer mental health outcomes (e.g., depression, anxiety, suicidal ideation, sleep problems, memory issues). Furthermore, we found that ruminative thinking (particularly problem-focused thoughts and repetitive thoughts) indirectly linked moral injury to negative mental health outcomes among this population. Our preliminary study established the presence of at least moderate correlations between moral injury, rumination, and adverse mental health outcomes among humanitarian aid personnel. Considering complex humanitarian emergencies are becoming more commonplace, future longitudinal studies are most certainly needed in order to further understand and legitimize the threat that moral injury poses to humanitarian aid workers. Keywords Humanitarian aid personnel, Moral injury, Rumination, Mental health *Correspondence: Adrian J Bravo ajbravo@wm.edu 'Department of Psychological Sciences, William & Mary, Williamsburg, USA 'In-Sight Collaborative, Washington, USA ŠThe Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the artide's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included Springer in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.To view a copy of this licence, visit http://creativecommons.org/licenses by/4.0/.