Trends and Thematic Clusters in Moral Injury Research: A Bibliometric Analysis.

Abstract

Moral injury (MI) spans biological, psychological, social, and spiritual domains, yet systematic bibliometric evaluation remains scarce. A bibliometric analysis of Scopus-indexed publications containing "moral injury" (1992-2025) was conducted using three search strategies (i) Title-Abstract-Keywords (TAK), (ii) Abstract-only (AO), and (iii) Title-only (TO). Publication types, annual trends, and the performance of authors, institutions, countries, sponsors, and journals were examined. A total of 2,081 documents were identified, including articles (1,491), reviews (164), book chapters (193), and editorials (75). TAK yielded 1,655 records, AO 1,400 records, and TO 879 records, demonstrating notable variation in dataset size. Output remained limited until 2017, followed by rapid growth from 2018, peaking in 2025. The USA led global production, followed by the UK, Canada, and Australia. TAK analysis identified the most prolific authors in this review by country: in the USA, Maguen, S. (36) and Koenig, H.G. (34); in the UK, Greenberg, N. (37) and Murphy, D. (36); in Canada, McKinnon, M.C. (23) and Nazarov, A. (21); and in Australia, Carey, L.B. (13) and Nickerson, A. (10). Other top contributors by country are also identified. Within this study, prolific institutions included VA Medical Center, King's College London, Western University, McMaster University, Duke University Medical Center, and the Boston University Chobanian and Avedisian School of Medicine. Prominent journals were 'Psychological Trauma: Theory, Research, Practice, and Policy', the 'European Journal of Psychotraumatology', 'Traumatology', 'Frontiers in Psychiatry', and the 'Journal of Religion and Health'. Title-based co-word analysis (AO and TO datasets) identified ten thematic clusters covering psychological outcomes, military and healthcare contexts, ethics, assessment, and interventions. Analysis of the top 100 most cited papers highlighted five foundational themes in conceptualization, measurement, mental health outcomes, and treatment approaches. MI research expanded rapidly after 2018, emphasizing the need for methodological transparency through a bibliometric study across multidisciplinary fields. While not all authors/coauthors or their respective institutions and nations have been acknowledged within this analysis of MI research, nevertheless the significant leaders have been identified, as have a number of key research and clinical themes. Search strategy selection however, substantially determines dataset size, contributor visibility, and thematic representation, hence a number of limitations regarding this analysis are noted.