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Perceived Injustice and Its Correlates after Mild Traumatic Brain Injury
Grant L Iverson1,2,3, Douglas P Terry1,2,3, Justin E Karr4
11 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts.
Abstract:
Perceived injustice is a belief that one has been treated unfairly and disrespectfully, and is suffering unnecessarily as a result of another person's actions. Perceived injustice predicts chronic disability after musculoskeletal injury but to our knowledge has not been empirically studied in people with mild traumatic brain injuries (mTBIs). We examined perceived injustice and its correlates in patients who were slow to recover from mTBI. Patients (n = 102) were recruited from four concussion clinics. The sample was on average 41.2 years old (standard deviation [SD] = 11.7; range = 21-64), 53.9% were women, and patients were evaluated 2-26 weeks post-injury (mean = 12.1, SD = 6.3). Patients completed measures assessing perceived injustice (Injustice Experience Questionnaire; IEQ), post-concussion symptoms, post-traumatic stress, depression, pain, disability, and neuropsychological performance validity. Patients frequently endorsed items such as "I just want to have my life back" (85.2%) and "people don't understand how severe my condition is" (89.1%), with 23.5% of the sample scoring in the clinically significant range on the IEQ (Total Score >30). Internal consistency was high (Cronbach's α = 0.91). Patients who failed performance validity testing (Cohen's d = 0.48) or were seeking/receiving compensation (d = 0.92) reported greater perceived injustice. Greater perceived injustice was associated with greater post-concussion symptoms (r = 0.48), traumatic stress (r = 0.69), depression (r = 0.60), bodily pain (r = 0.32), and negative expectations for recovery (r = 0.40; all p < 0.01). Given that perceived injustice is a belief system that can influence health behaviors, it might be a viable target for psychological treatment.
Insights
Perceived injustice, a belief in unfair treatment, is common in mild traumatic brain injury (mTBI) patients with slow recovery. This psychological factor is linked to worse symptoms and recovery expectations.
Area of Science:
- Neuroscience
- Psychology
- Traumatology
Background:
- Perceived injustice, the belief in unfair and disrespectful treatment leading to suffering, is a known predictor of chronic disability following musculoskeletal injuries.
- Its role in mild traumatic brain injury (mTBI) recovery has not been empirically investigated.
- This study focuses on patients experiencing prolonged recovery from mTBI.
Purpose of the Study:
- To examine the prevalence and correlates of perceived injustice in patients with slow recovery from mTBI.
- To understand the relationship between perceived injustice and various clinical outcomes in this population.
Main Methods:
- A cohort of 102 patients from concussion clinics, evaluated 2-26 weeks post-mTBI, completed validated questionnaires.
- Measures included the Injustice Experience Questionnaire (IEQ), post-concussion symptoms, PTSD, depression, pain, disability, and performance validity testing.
- Statistical analyses explored associations between perceived injustice and other variables.
Main Results:
- A significant proportion of patients (23.5%) scored in the clinically significant range for perceived injustice.
- Higher perceived injustice was reported by patients failing performance validity testing and those seeking compensation.
- Perceived injustice strongly correlated with increased post-concussion symptoms, traumatic stress, depression, pain, and negative recovery expectations.
Conclusions:
- Perceived injustice is a prevalent issue among individuals with slow recovery from mTBI.
- It is associated with a range of adverse psychological and physical symptoms, as well as poorer recovery outlook.
- Addressing perceived injustice through psychological interventions may be a promising therapeutic target for improving mTBI outcomes.
