• Grant L Iverson, Douglas P Terry, Justin E Karr, William J Panenka, and Noah D Silverberg.
• 1 Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, Massachusetts.
• J. Neurotrauma. 2018 May 15; 35 (10): 1156-1166.

AbstractPerceived 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.

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