Scholars@Duke
Jason A Nieuwsma

Jason A Nieuwsma

Associate Professor in Psychiatry and Behavioral Sciences
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences
jason.nieuwsma@duke.edu
Visn 6 Mirecc, 508 Fulton Street, Durham, NC 27705
3022 Croasdaile Dr., Suite 301, Durham, NC 27705

Selected Publications

Piecing it Together: Collaborative Group Care for Moral Injury

Journal Article Current Treatment Options in Psychiatry · December 1, 2025 Purpose of Review: Integrative Mental Health (IMH), a program office in the Department of Veterans Affairs (VA) devoted to advancing integrated mental health and spiritual care, was coincidentally launched the same year that moral injury was introduced int ... Full text Cite

From Moral Injury Vulnerability to Protective Equity: The Voyage Every Surgeon Must Take.

Journal Article Ann Surg · December 18, 2024 OBJECTIVE: To examine the relationship between moral injury and surgical practice, further explore the concept of protective equity, and understand its role in mitigating the impact of morally injurious events throughout a surgical career. BACKGROUND: Mora ... Full text Link to item Cite

Validating a tool to measure spiritual beliefs, needs and resources in serious illness: The I-SPIRIT.

Journal Article J Am Geriatr Soc · July 2024 BACKGROUND: Seriously ill patients rely on spiritual and existential beliefs to support coping and approach crucial treatment and healthcare decisions. Yet, we lack gold standard, validated approaches to gathering information on those spiritual beliefs. Th ... Full text Link to item Cite

Enjoying the violence of war: Association with posttraumatic symptomatology in U.S. combat veterans.

Journal Article Psychol Trauma · May 2024 OBJECTIVE: Engaging in war-related violence can have a devastating impact on military personnel, with research suggesting that injuring or killing others can contribute to posttraumatic stress disorder (PTSD), depression, and moral injury. However, there i ... Full text Open Access Link to item Cite

Increasing chaplain support for veterans at high risk for suicide through targeted outreach: A quality improvement initiative.

Journal Article J Health Care Chaplain · 2024 The Department of Veterans Affairs (VA) has prioritized improving the identification of veterans at risk for suicide and ensuring adequate staffing of personnel to assist veterans in need. It is imperative that suicide prevention efforts make use of the fu ... Full text Link to item Cite

Measuring morality: Analyzing the factor structure of the moral foundations questionnaire in veterans.

Journal Article J Clin Psychol · April 2023 OBJECTIVES: Moral reasoning is an underexamined and potentially useful area of research relative to the care of moral injury in veterans. However, the most widely used measure of moral reasoning, the moral foundations questionnaire (MFQ), has not been vali ... Full text Link to item Cite

Identifying potentially morally injurious events from the Veteran perspective: A qualitative descriptive study

Journal Article Journal of Military, Veteran and Family Health · April 1, 2023 Introduction: Current conceptualizations of potentially morally injurious events (PMIEs) emphasize war atrocities. However, additional research on the breadth of PMIEs could inform provision of patient-centred care for those experiencing moral injury. This ... Full text Cite

Chaplain Training in Evidence-Based Practices to Promote Mental Health and Improve Care for Suicidality in Veterans and Service Members.

Journal Article Arch Suicide Res · 2023 OBJECTIVE: Chaplains are key care providers in a comprehensive approach to suicide prevention, which is a priority area for the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD). In a cohort of 87 VA and military chaplains who co ... Full text Link to item Cite

Validation of the Moral Injury Outcome Scale in acute care nurses.

Journal Article Front Psychiatry · 2023 INTRODUCTION: Moral injury, predominantly studied in military populations, has garnered increased attention in the healthcare setting, in large part due to the psychological and emotional consequences of the COVID-19 pandemic. The measurement of moral inju ... Full text Link to item Cite

Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers.

Journal Article J Gen Intern Med · June 2022 BACKGROUND: Moral injury has primarily been studied in combat veterans but might also affect healthcare workers (HCWs) due to the COVID-19 pandemic. OBJECTIVE: To compare patterns of potential moral injury (PMI) between post-9/11 military combat veterans a ... Full text Link to item Cite

Collaborative spiritual care for moral injury in the veterans Affairs Healthcare System (VA): Results from a national survey of VA chaplains.

Journal Article J Health Care Chaplain · 2022 The psychospiritual nature of moral injury invites consideration regarding how chaplains understand the construct and provide care. To identify how chaplains in the VA Healthcare System conceptualize moral injury, we conducted an anonymous online survey (N ... Full text Open Access Link to item Cite

Introduction to the special issue "Moral injury care: Practices and collaboration".

Journal Article J Health Care Chaplain · 2022 Since moral injury was introduced in the psychological literature little more than a decade ago, it has received substantial attention from mental health professionals as well as chaplains. This special issue features ways that chaplains are and can be eng ... Full text Open Access Link to item Cite

Core Components of Moral Injury Groups Co-Facilitated by Mental Health Providers and Chaplains.

Journal Article Spiritual Clin Pract (Wash D C ) · 2022 Despite increasing interest in moral injury, there is not yet consensus around what it is (and is not), who can have it and under what circumstances, or the degree and form of distress necessary to distinguish moral injury from other psychological and spir ... Full text Link to item Cite

Screening for moral injury and comparatively evaluating moral injury measures in relation to mental illness symptomatology and diagnosis.

Journal Article Clin Psychol Psychother · January 2021 Moral injury merits further study to clarify its identification, prevalence, assessment and intersection with psychosocial and psychiatric problems. The present study investigated the screening potential of the Brief Moral Injury Screen (BMIS) in a sample ... Full text Link to item Cite

Dynamic Diffusion Network: Advancing moral injury care and suicide prevention using an innovative model.

Journal Article Healthc (Amst) · September 2020 Healthcare providers across a wide variety of settings face a common challenge: the need to provide real time care for complex problems that are not adequately addressed by existing protocols. In response to these intervention gaps, frontline providers may ... Full text Link to item Cite

Religion, spirituality, and suicide risk in Iraq and Afghanistan era veterans.

Journal Article Depress Anxiety · August 2020 BACKGROUND: United States military veterans experience disproportionate rates of suicide relative to the general population. Evidence suggests religion and spirituality may impact suicide risk, but less is known about which religious/spiritual factors are ... Full text Link to item Cite

Examining faith-based collaboration in U.S. States' suicide prevention guidelines.

Journal Article J Prev Interv Community · 2020 Faith-based communities (FBCs) are recognized by most states as key players within systematic suicide prevention efforts. The aim of the present study was to conduct a thematic analysis of documents that detail the suicide prevention efforts of individual ... Full text Link to item Cite

The role of chaplaincy in LGBT veteran healthcare.

Journal Article Spirituality in Clinical Practice · September 1, 2019 For many LGBT veterans, meeting with a Department of Veterans Affairs (VA) chaplain marks the first time they are able to openly discuss their sexual and gender identity in the context of their religious/spiritual beliefs. Here we provide an overview of VA ... Full text Cite

What Ought We to Do With "Thick Terms"? A Response to Frankfurt & Coady's "Bringing Philosophy to Bear on Moral Injury and Posttraumatic Stress Disorder Construct Validation".

Journal Article J Trauma Stress · August 2019 We respond to the commentary by Frankfurt and Coady (this issue) regarding the descriptive-prescriptive framework for partially distinguishing between posttraumatic stress disorder (PTSD) and moral injury (Farnsworth, 2019). In their commentary, Frankfurt ... Full text Link to item Cite

Resting-state brain fluctuation and functional connectivity dissociate moral injury from posttraumatic stress disorder.

Journal Article Depress Anxiety · May 2019 Moral injury is closely associated with posttraumatic stress disorder (PTSD) and characterized by disturbances in social and moral cognition. Little is known about the neural underpinnings of moral injury, and whether the neural correlates are different be ... Full text Link to item Cite

A Qualitative Examination of VA Chaplains' Understandings and Interventions Related to Moral Injury in Military Veterans.

Journal Article J Relig Health · December 2018 This study examines VA chaplains' understandings of moral injury (MI) and preferred intervention strategies. Drawing qualitative responses with a nationally-representative sample, content analyses indicated that chaplains' definitions of MI comprised three ... Full text Link to item Cite

Moral Injury: Contextualized Care.

Journal Article J Med Humanit · March 2018 Amidst the return of military personnel from post-9/11 conflicts, a construct describing the readjustment challenges of some has received increasing attention: moral injury. This term has been variably defined with mental health professionals more recently ... Full text Link to item Cite

Measuring sustainability of a grassroots program in a large integrated health care delivery system: the Warrior to Soul Mate Program.

Journal Article J Mil Veteran Fam Health · 2018 INTRODUCTION: Veterans experience many physical and psychosocial adjustment problems that challenge personal relationships and social functioning and successful social reintegration. The Warrior to Soul Mate (W2SM) program uses a structured curriculum [i.e ... Full text Open Access Link to item Cite

Veteran Narratives and Suicide Prevention: A Missed Opportunity for Research?

Journal Article Military Behavioral Health · January 1, 2018 Full text Cite

Implementing Integrated Mental Health and Chaplain Care in a National Quality Improvement Initiative.

Journal Article Psychiatr Serv · December 1, 2017 This column describes the development, implementation, and outcomes of a quality improvement learning collaborative that aimed to better integrate chaplaincy with mental health care services at 14 participating health care facilities evenly distributed acr ... Full text Link to item Cite

Diagnostic Accuracy of Screening Tests and Treatment for Post-Acute Coronary Syndrome Depression: A Systematic Review.

Journal Article Ann Intern Med · November 21, 2017 BACKGROUND: Patients who have had an acute coronary syndrome (ACS) event have an increased risk for depression. PURPOSE: To evaluate the diagnostic accuracy of depression screening instruments and to compare safety and effectiveness of depression treatment ... Full text Link to item Cite

A problem-solving intervention for cardiovascular disease risk reduction in veterans: Protocol for a randomized controlled trial.

Journal Article Contemp Clin Trials · September 2017 BACKGROUND: Health behaviors related to diet, tobacco usage, physical activity, medication adherence, and alcohol use are highly determinative of risk for developing cardiovascular disease. This paper describes a study protocol to evaluate a problem-solvin ... Full text Link to item Cite

A Next Step in Suicide Prevention.

Journal Article Psychiatr Serv · April 1, 2017 Full text Link to item Cite

Professional Quality of Life and Changes in Spirituality Among VHA Chaplains: A Mixed Methods Investigation.

Journal Article J Health Care Chaplain · 2017 A mixed method design was implemented to examine the spirituality and emotional well-being of Veterans Health Administration (VHA) chaplains and how potential changes in spirituality and emotional well-being may affect their professional quality of life. F ... Full text Link to item Cite

Chaplaincy Encounters Following a Suicide Attempt.

Journal Article J Health Care Chaplain · 2017 This descriptive study examines the provision of chaplaincy services to veterans who sought health care at a Department of Veterans Affairs (VA) Medical Center following a suicide attempt. A system-wide VA database of suicidal behavior was used to identify ... Full text Link to item Cite

Theodicies and professional quality of life in a nationally representative sample of chaplains in the veterans' health administration.

Journal Article J Prev Interv Community · 2017 This study examined the role of theodicies or theological/philosophic attempts to resolve existential dilemmas related to evil and human suffering in chaplains' professional quality of life (ProQOL). A nationally representative sample of 298 VHA chaplains ... Full text Link to item Cite

Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy.

Journal Article Suicide Life Threat Behav · April 2016 Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users ... Full text Link to item Cite

Does This Patient Have Posttraumatic Stress Disorder?: Rational Clinical Examination Systematic Review.

Journal Article JAMA · August 4, 2015 IMPORTANCE: Posttraumatic stress disorder (PTSD) is a relatively common mental health condition frequently seen, though often unrecognized, in primary care settings. Identifying and treating PTSD can greatly improve patient health and well-being. OBJECTIVE ... Full text Link to item Cite

Possibilities within acceptance and commitment therapy for approaching moral injury

Journal Article Current Psychiatry Reviews · August 1, 2015 Moral injury and acceptance and commitment therapy (ACT) are both topics that have only quite recently been introduced into the mental health literature. Although inquiries into these two domains have been advanced independent from one another, both challe ... Full text Cite

Evaluating the implementation and sustainability of a program for enhancing veterans' intimate relationships.

Journal Article Mil Med · June 2015 The Warrior to Soul Mate (W2SM) program is a grassroots initiative on the part of Veterans Affairs chaplain services to provide relationship enhancement skills to veterans and significant others based on the Practical Application of Intimate Relationship S ... Full text Link to item Cite

Collaborating across the Departments of Veterans Affairs and Defense to integrate mental health and chaplaincy services.

Journal Article J Gen Intern Med · December 2014 BACKGROUND: Recognizing that clergy and spiritual care providers are a key part of mental health care systems, the Department of Veterans Affairs (VA) and Department of Defense (DoD) jointly examined chaplains' current and potential roles in caring for vet ... Full text Link to item Cite

Pastoral care use among post-9/11 veterans who screen positive for mental health problems.

Journal Article Psychol Serv · August 2014 As a result of their military experience, veterans with mental health problems may have unique motivations for seeking help from clergy. Patterns and correlates of seeking pastoral care were examined using a nationwide representative survey that was conduc ... Full text Link to item Cite

No wrong door to smoking cessation care: a Veterans Affairs Chaplain survey.

Journal Article Mil Med · May 2014 Cigarette smoking disproportionately affects veterans, particularly those with psychiatric diagnoses. Chaplains working within the Department of Veterans Affairs (VA) play key roles in emotional, physical, and spiritual health care of veterans, and veteran ... Full text Link to item Cite

Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness: a systematic review and meta-analysis.

Journal Article J Clin Psychiatry · May 2014 OBJECTIVE: Individuals with serious mental illness have high rates of cardiovascular disease (CVD) risk factors and mortality. This systematic review was conducted to evaluate pharmacologic and behavioral interventions to reduce CVD risk in adults with ser ... Full text Link to item Cite

Utilization of hospital-based chaplain services among newly diagnosed male Veterans Affairs colorectal cancer patients.

Journal Article J Relig Health · April 2014 The aim of the study was to examine utilization of chaplain services among Veterans Affairs patients with colorectal cancer (CRC). In 2009, the Cancer Care Assessment and Responsive Evaluation Studies questionnaire was mailed to VA CRC patients diagnosed i ... Full text Link to item Cite

The Role of Military and Veterans Affairs Chaplains in the Treatment of Alcohol Problems

Journal Article Pastoral Psychology · February 1, 2014 Chaplains can play a unique and valuable role in the treatment of alcohol dependence, a condition that has physical, psychological, and spiritual dimensions. To best fulfill this role, chaplains need to have a broad understanding of the nature of alcohol p ... Full text Cite

Recovery on higher ground: Spirituality in the treatment of substance abuse

Journal Article Current Psychiatry · February 1, 2014 Cite

Evidence-based chaplaincy care: attitudes and practices in diverse healthcare chaplain samples.

Journal Article J Health Care Chaplain · 2014 Leaders in health care chaplaincy and practice guidelines, such as the Association of Professional Chaplains' Standards of Practice, call for chaplains to develop an evidence-based approach to their work. The extent to which practicing chaplains accept thi ... Full text Link to item Cite

The role of moral emotions in military trauma: Implications for the study and treatment of moral injury

Journal Article Review of General Psychology · January 1, 2014 Moral injury, a term coined to represent the potential negative outcomes following transgression of deeply held moral values and beliefs, has recently gained increased recognition as a major concern among militaryservice members exposed to trauma. However, ... Full text Cite

Altered resting-state functional connectivity of basolateral and centromedial amygdala complexes in posttraumatic stress disorder.

Journal Article Neuropsychopharmacology · January 2014 The amygdala is a major structure that orchestrates defensive reactions to environmental threats and is implicated in hypervigilance and symptoms of heightened arousal in posttraumatic stress disorder (PTSD). The basolateral and centromedial amygdala (CMA) ... Full text Open Access Link to item Cite

Confidentiality and mental health/chaplaincy collaboration

Journal Article Military Psychology · January 1, 2013 Confidentiality can both facilitate and inhibit working relationships of chaplains and mental health professionals addressing the needs of service members and veterans in the United States. Researchers conducted this study to examine opportunities for impr ... Full text Cite

Chaplaincy and mental health in the department of Veterans affairs and department of defense.

Journal Article J Health Care Chaplain · 2013 Chaplains play important roles in caring for Veterans and Service members with mental health problems. As part of the Department of Veterans Affairs (VA) and Department of Defense (DoD) Integrated Mental Health Strategy, we used a sequential approach to ex ... Full text Link to item Cite

Brief psychotherapy for depression: a systematic review and meta-analysis.

Journal Article Int J Psychiatry Med · 2012 OBJECTIVE: Because evidence-based psychotherapies of 12 to 20 sessions can be perceived as too lengthy and time intensive for the treatment of depression in primary care, a number of studies have examined abbreviated psychotherapy protocols. The purpose of ... Full text Link to item Cite

Indigenous perspectives on depression in rural regions of India and the United States.

Journal Article Transcult Psychiatry · November 2011 Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Mode ... Full text Link to item Cite

Examination of the utility of psychotherapy for patients with treatment resistant depression: a systematic review.

Journal Article J Gen Intern Med · June 2011 OBJECTIVE: To examine the utility of psychotherapy in managing treatment resistant depression. DATA SOURCES: PubMed, PsycInfo, Embase, Cochrane Registry of Controlled Clinical Trials, article bibliographies. REVIEW METHODS: Eligible articles had to be in E ... Full text Link to item Cite

How etiological explanations for depression impact perceptions of stigma, treatment effectiveness, and controllability of depression.

Journal Article J Ment Health · February 2010 BACKGROUND AND AIMS: There is controversy regarding how etiological explanations for depression, particularly biological explanations, influence perceptions of stigma, perceived controllability of depression, and perceived effectiveness of depression treat ... Full text Link to item Cite

Providers' perceptions of barriers to the treatment of emotional disorders in non-urban primary care clinics

Journal Article Primary Care and Community Psychiatry · December 1, 2008 Context: Primary care providers (PCPs) are often the main source of mental health treatment in rural areas. Greater concerns about income and insurance, negative attitudes to mental illness and help-seeking, limited availability of mental health referrals, ... Full text Cite