Perceived Injustice After Mild Traumatic Brain Injury

Objective:

To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI).

Design:

Observational study.

Setting:

TBI outpatient unit.

Participants:

Adult patients aged 18 to 68 years with mTBI ( n = 100) or orthopedic injury ([OI]; n = 34).

Main Measures:

The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory–Second Edition (BDI-II), PTSD Checklist–Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected.

Results:

Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ ( r _s = 0.638, P < .01), BDI-II ( r _s = 0.612, P < .01), PCL-C ( r _s = 0.679, P < .01), and PVAS ( r _s = 0.232, P < .05). The association between IEQ and PCL-C ( r _s =0.797, P < .01) and BDI-II ( r _s = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance.

Conclusions:

Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.