Understanding Extreme Injustice Appraisal Phenotypes in Newly Acquired Spinal Cord Injury

To identify and characterize extreme phenotypes of injustice appraisals among individuals with recent spinal cord injury (SCI), with the goal of improving psychosocial interventions and future clinical research.

Cross-sectional analysis using baseline data from a longitudinal cohort study.

Four inpatient rehabilitation centers in the United States.

A total of 101 adults (aged ≥18y) with recent traumatic or nontraumatic SCI who completed baseline assessments, including the Injustice Experience Questionnaire (IEQ).

Participants were classified into low (IEQ≤12) and high (IEQ≥26) injustice appraisal phenotypes using the 25th and 75th percentiles of IEQ. Measures included the Patient Health Questionnaire-8, Posttraumatic Stress Checklist (PCL-5), State-Trait Anger Expression Inventory-II, Appraisals of Disability: Primary and Secondary Scale, and the International Spinal Cord Injury Quality of Life Basic Data Set.

Compared with individuals with low injustice appraisals, those with high injustice appraisals presented with significantly higher depressive symptoms (Patient Health Questionnaire-8: 10.3 vs 3.3; P<.001), posttraumatic stress symptoms (PCL-5: 29.8 vs 6.6; P<.001), anger (state anger: 14.2 vs 7.4; P<.001), and maladaptive appraisals (Appraisals of Disability: Primary and Secondary Scale: 23.7 vs 13.4; P<.001). They also reported lower satisfaction across all quality of life domains (all P<.01). Effect sizes were large to very large (Hedges' |g| range, 0.89-4.61) and displayed substantial psychological and emotional differentiation between phenotypes.

Extreme phenotyping of injustice appraisals revealed unique psychosocial profiles among individuals with recent SCI. High injustice appraisals were associated with elevated distress and reduced quality of life, emphasizing the need for targeted interventions addressing perceptions of unfairness and loss in early rehabilitation. Identifying these phenotypes offers a framework for future studies and intervention development to improve psychological outcomes after SCI.