Potentially traumatic events (PTEs) are a well-known risk factor for diverse psychological difficulties. Religious and spiritual (r/s) struggles, tensions, or conflicts related to the r/s matters, and moral suffering, arising from perceived transgressions of moral values and beliefs, may co-occur following trauma and reflect value- and belief-related distress. These processes may explain and shape the link between PTE exposure and psychological outcomes, acting as mediators and moderators. A systematic review was conducted to synthesize evidence on their roles in the scientific literature. In accordance with PRISMA guidelines, a database search was conducted across PsycINFO, EBSCOhost, and Scopus. Eligibility criteria included peer-reviewed quantitative studies in adult samples measuring exposure to at least one type of PTE, r/s struggles or moral injury and distress, and negative mental health outcomes, which reported mediation or moderation models. In total, 32 studies met the eligibility criteria. The findings demonstrate a consistent pattern in which r/s struggles and moral suffering partially mediate the link between PTEs and psychological difficulties. Evidence for the moderating role of r/s struggles was less consistent. No studies examined the moderating role of moral suffering. These processes may represent mechanisms linking PTEs with adverse mental health outcomes, reflecting the importance of addressing moral and spiritual conflicts in psychological adjustment following trauma. However, the predominance of cross-sectional designs limits conclusions about causality, demonstrating the need for longitudinal research in more diverse populations.
The Role of Religious and Spiritual Struggles and Moral Suffering Following Trauma