Perceived Injustice is Associated with Heightened Pain Behavior and Disability in Individuals with Whiplash Injuries

The present study examined the relationship between perceived injustice associated with whiplash injury and displays of pain behavior. Individuals (N?=?85) with whiplash injuries were filmed while performing a simulated occupational lifting task. They were also asked to complete measures of pain, perceived injustice, catastrophic thinking, depression, and functional disability. Consistent with previous research, high levels of perceived injustice were associated with more intense pain, higher levels of catastrophic thinking, depression, and disability. Analyses revealed that individuals with high levels of perceived injustice displayed more protective pain behaviors than individuals with low levels of perceived injustice, regardless of the level of physical demand of the task. The relation between perceived injustice and protective pain behavior remained significant even when controlling for pain severity, catastrophic thinking, and depression. There was no significant association between perceived injustice and displays of communicative pain behavior. The results of this study suggest that the relation between perceived injustice and pain behavior might underlie the high prevalence of occupational disability in individuals who have sustained whiplash injuries. Implications for intervention are addressed.     

Treatment-Related Reductions in Disability Are Associated with Reductions in Perceived Injustice Following Treatment of Whiplash Injury

Emerging evidence suggests that perceived injustice is a risk factor for poor recovery outcomes in individuals with whiplash injuries. The present study examined the relative contributions of treatment-related reductions in pain severity, depressive symptoms, and disability in the prediction of reductions in perceived injustice in individuals with whiplash injury. The study sample consisted of 71 individuals (43 women and 28 men) who sustained whiplash injuries in motor vehicle accidents and who were enrolled in a treatment program designed to promote functional recovery following whiplash injury. For the purposes of this study, only individuals who scored above the risk threshold on a measure of perceived injustice were included in the study sample. Participants completed measures of pain severity, disability, depressive symptomatology, and perceived injustice prior to treatment and after treatment. Change scores were computed for study variables. The results revealed that reductions in pain severity and disability were correlated with reductions in perceived injustice. Regression analyses revealed that only reductions in disability contributed significant unique variance to the prediction of reductions in perceived injustice. Clinical and theoretical implications of the present findings are discussed.     

Reductions in Perceived Injustice Are Associated with Reductions in Posttraumatic Stress Symptoms Among Individuals Receiving Treatment for Whiplash Injury

Research has accumulated to suggest that perceived injustice is a risk factor for poor recovery outcomes in individuals with whiplash injuries. The present study examined the relative contributions of treatment-related reductions in perceived injustice and pain severity, in the prediction of reductions in posttraumatic stress symptoms in individuals with whiplash injury. The study sample consisted of 146 individuals (66 women, 80 men) who sustained whiplash injuries in motor vehicle collisions and were enrolled in a multidisciplinary rehabilitation program designed to promote functional recovery following whiplash injury. Participants completed measures of pain severity, disability, posttraumatic stress symptoms, and perceived injustice prior to treatment and after treatment. Pearson correlations revealed that all study variables were significantly correlated. Regression analyses revealed that, at the time of enrollment in the intervention, perceived injustice accounted for a significant proportion of the variance in posttraumatic stress symptom severity, beyond the variance accounted for by pain severity. Paired sample t-tests revealed significant reductions in perceived injustice, pain severity, and posttraumatic stress symptom severity through the course of treatment. For individuals who scored above clinical threshold on a measure of posttraumatic stress symptoms at the time of enrollment in the intervention (N?=?71), regression analyses revealed that reductions in perceived injustice accounted for a significant proportion of the variance in reduction of posttraumatic stress symptoms, beyond the variance accounted for by reduced pain severity. Clinical and theoretical implications of the present findings are discussed.     

Psychometric Properties of a Brief Instrument to Assess Perceptions of Injustice Associated with Debilitating Health and Mental Health Conditions

The present study examined the psychometric properties of a shortened and simplified version of the Injustice Experience Questionnaire (IEQ). The instructional set of the original IEQ was modified to make it better suited to the context of debilitating health and mental health conditions that do not necessarily arise as a result of injury. The number of items was reduced from 12 to 5, and the response scale was simplified. The Injustice Experiences Questionnaire – Short Form (IEQ-SF) was administered to individuals diagnosed with a chronic musculoskeletal (MSK) condition (N?=?88) or major depressive disorder (MDD) (N?=?87). The internal consistency of the IEQ-SF was acceptable. The IEQ-SF was significantly correlated with measures of pain severity, depressive symptom severity and disability in both samples. Individuals with MDD scored higher on the IEQ-SF than individuals with MSK. The IEQ-SF was shown to be sensitive to treatment-related reductions in perceived injustice. Preliminary analyses suggest that the IEQ-SF is a reliable and valid measure of disability-related injustice perceptions associated with debilitating health and mental health conditions.     

Perceived Injustice Predicts Intention to Litigate: Findings from a Spinal Cord Injury Sample

The current study examined the association between perceived injustice (assessed by the Injustice Experiences Questionnaire) and intent to litigate in a sample of individuals who had recently suffered a spinal cord injury and were currently on an inpatient rehabilitation unit. Higher perception of injustice was associated with reported interest in litigation. In logistic regression analyses, perceived injustice uniquely differentiated between individuals who foresaw involvement in litigation versus those who did not, with the blame/unfairness factor of the Injustice Experiences Questionnaire emerging as more significant than the severity/irreparability of loss factor. Both anticipated litigation and higher perception of injustice were associated with greater attribution of responsibility for injury to other person(s) and reduced forgiveness across a number of domains. Finally, a receiver operating characteristic (ROC) curve analysis was conducted to identify IEQ score most associated with anticipated litigation. This study is the first to examine perception of injustice in a spinal cord injury sample or the association between perceived injustice and litigation intent. Results support the possibility that psychological appraisals of injury may have significant legal ramifications.     

Compensation System Experience at 12 Months After Road or Workplace Injury in Victoria,Australia

Seeking or receiving compensation after injury is frequently associated with poor recovery. Previous research has shown that the stressful nature of compensation procedures and perceived injustice may cause secondary harm. This study examined compensation system experiences in compensation claimants in Victoria, Australia, and explored the relationship between these experiences and injury outcomes. One hundred and sixty compensable patients (120 male, 75.0 %) aged 18–67 years (M?=?43.01, SD?=?14.31), hospitalized for an injury in a motor vehicle crash (n?=?137) or at work (n?=?23), participated. Participants completed questionnaires about compensation system experience, pain, and psychological symptoms 12 months after injury. Principal component analysis (PCA) of the compensation system experience items revealed three components explaining 66.64 % of the variance in compensation experience: (1) “negative procedural experience” (47.29 %), (2) “compensation supported recovery” (10.43 %), and (3) “positive procedural experience” (8.92 %). Worse experience on all components was associated with worse pain (severity, interference, catastrophizing, disability) and psychological symptoms (anxiety, depression, PTSD, perceived injustice). Compensation system experience reflected both negative and positive procedural factors, and feeling supported through recovery. Most participants reported having positive experiences; however, those who were frustrated or stressed from compensation procedures had worse pain and psychological health outcomes. While this association is likely to be bidirectional with “non-recovery” also impacting on compensation experience appraisals, compensation schemes should nonetheless address modifiable sources of procedural injustice (e.g., arduous paperwork and approvals processes) and reinforce procedures that generate perceptions of support (e.g., timely and appropriate access to health services).     

Legal Representation and Dissatisfaction with Workers’ Compensation: Implications for Claimant Adjustment

This study examined relationships between attorney retention and adjustment outcomes for Workers’ Compensation low back claimants at post-settlement (N?=?1,464; 21 months post-claim settlement) and long-term follow-up (N?=?371; 72 months post-claim settlement). Claimants were classified into three groups: those who had not retained an attorney (no attorney group, 15%); those who had retained an attorney, but for reasons other than dissatisfaction with Workers’ Compensation medical treatment (attorney group, 31%); and those who had retained an attorney specifically because of dissatisfaction with Workers’ Compensation medical treatment (dissatisfied/attorney group, 54%). Groups were compared on demographic characteristics, Workers’ Compensation variables, and adjustment indicators of pain intensity, pain-related disability, general physical and mental health status, and pain catastrophizing. Relative to the no attorney and attorney groups, claimants in the dissatisfied/attorney group were younger, had longer time to settlement, and reported greater post-settlement socioeconomic stress and catastrophizing. At long-term follow-up, the dissatisfied/attorney group reported higher levels of disability and catastrophizing, as well as lower levels of mental health status, relative to the other groups. The results suggest that attorney retention that is motivated by dissatisfaction with Workers’ Compensation medical care is a significant risk factor for poor adjustment, not only in the intermediate time frame following claim settlement, but also over the long term. Findings are discussed in the context of “perceived injustice” in the Workers’ Compensation system and the mechanisms by which dissatisfaction and attorney retention may impact adjustment.     

Workers’ Compensation Claimants with Low Back Pain: the Role of Dissatisfaction in the Transition to Disability

Workers’ compensation systems represent naturalistic settings that often are perceived as unjust by the injured workers for which such systems were developed. This study examined the role of dissatisfaction with medical care and employer treatment on disability outcomes among a cohort of workers who had sustained low back injuries. A race-stratified sample of 358 workers (171 African-Americans, 203 Caucasians) with first incident low back pain was evaluated 21 months and again at 72 months after claim settlement. Evaluation included data related to demographics, socioeconomic factors, injury severity, claim settlement, satisfaction with workers’ compensation (WC) processes, and disability status. Multinomial logistic regression analysis was used to predict disability status (no disability vs. early disability vs. late disability) at each of the two time points. Analyses revealed contributions of multiple variables to early disability, including unique variance related to dissatisfaction with medical care and treatment by the employer. At 72 months, only demographic factors (age, race) and the receipt of temporary total disability (TTD) after injury predicted late disability. Results are discussed relative to the contribution of injustice perceptions and systemic factors; directions for future research are proposed.     

Racial prejudice, perceived injustice, and the Black-White gap in punitive attitudes

Conflict theory and previous research suggest that the Black-White difference in support for harsh criminal punishments may be linked to anti-Black prejudice among Whites and perceived injustice among Blacks. Using survey data from the 2001 Race, Crime and Public Opinion Study, this article examines the sources of the racial gap in levels of punitiveness. Two main explanations are tested: perceived racial bias in the criminal justice system and racial prejudice. The results indicate that, together, racial prejudice and perceived racial bias explain the Black-White gap in punitive attitudes.     

From Unfulfilled Wants to the Experience of Injustice: Women's Sense of Injustice Regarding the Lopsided Division of Household Labor

The present research deals with factors that contribute to women's sense of injustice regarding the lopsided division of household labor. The proposed model of perceived injustice combines elements of the distributive justice framework of Major (1993) and Thompson (1991), the two-factor model of relative deprivation (Crosby, 1982), and the attribution-of-blame model of judgments of injustice (Mikula, 1993). The results of a study with 132 employed women are consistent with the proposed model and show that unfulfilled wants, perceived violations of entitlement, and attributions of blame directly affect women's perceptions of being unjustly treated by their partners. Beyond that, women's judgments of injustice were indirectly affected by the outcomes of various comparison processes through their impact on perceived violations of entitlement. Finally, attributions of responsibility and perceived lack of justifications contributed indirectly to the experience of injustice through their impact on the amount of blame attributed to the partner. The findings provide evidence for the usefulness of the theories considered in this study to understand and predict women's sense of injustice, and their integration into a single model of perceived injustice.     

Race,Ethnicity, and Perceived Minority Police Presence: Examining Perceptions of Criminal Injustice Among Los Angeles Residents

Although the conventional wisdom holds that increasing the number of minority officers will enhance residents' perceptions of police and the criminal justice system, further systematic investigation of this hypothesis may be needed. Building on the group‐position thesis, the representative bureaucracy theory, and prior research, this study investigates whether perceived minority police presence within residents' neighborhoods affects residents' perceptions of criminal injustice, whether this effect is more pronounced for minority residents and in minority neighborhoods, and whether perceived minority police presence has a stronger effect on perceptions of criminal injustice for minority residents in more integrated and white neighborhoods than minority residents in minority neighborhoods. Analyses of data collected from Los Angeles, CA, show that residents perceive a lower level of criminal injustice when they report that officers in their neighborhoods are not white‐dominated, and this finding is not dependent on the respondent's race/ethnicity or the racial/ethnic composition of the neighborhood. In addition, perceived minority police presence seems to have a weak to no effect on residents' perceptions of criminal injustice for Hispanic communities. We discuss these findings and their implications for theory, research, and policy.     

CYNICAL STREETS: NEIGHBORHOOD SOCIAL PROCESSES AND PERCEPTIONS OF CRIMINAL INJUSTICE*

Studies have found that African Americans are more likely to perceive racial biases in the criminal justice system than are those from other racial groups. There is a limited understanding of how neighborhood social processes affect variation in these perceptions. This study formulates a series of hypotheses focused on whether perceived racial biases in the criminal justice system or perceptions of injustice vary as a function of levels of moral and legal cynicism as well as of adverse police–citizen encounters. These hypotheses are tested with multilevel regression models applied to data from a sample of 689 African Americans located in 39 neighborhoods. Findings from the regression models indicate that the positive association between structural disadvantage and perceptions of injustice is accounted for by moral and legal cynicism. Furthermore, adverse police encounters significantly increase perceptions of injustice; controlling for these encounters reduces the strength of the association between cynicism and injustice perceptions. Finally, the findings reveal that cynicism intensifies the association between adverse police encounters and perceptions of criminal injustice. The results are discussed in terms of their implications for research regarding perceived biases in the criminal justice system and neighborhood social processes.     

Motor Vehicle Collisions and Their Consequences—Part II: Predictors of Impairment and Disability

A significant number of persons involved in motor vehicle collisions (MVCs) evidence persistent changes in physical, psychosocial, and cognitive functioning consequent to physical injury. While post-injury impairment and disability can sometimes be predicted with knowledge of injury type and injury severity, post-injury experiences of pain, psychological distress, cognitive dysfunction, and role disruption have been determined to contribute to injury-related impairment and disability. This article represents the second part of a two-part review of MVCs and their consequences. In part I of the review, research findings related to physical, psychosocial, and cognitive changes that occur consequent to injury-causing MVCs are described. In this article, measures used to document the severity of physical injuries are reviewed, along with the most widely accepted definitions of impairment and disability. Models that have been proposed to explain the progression from injury to impairment and disability are reviewed, including a more recently proposed model created specifically to guide the assessment and management of MVC-related outcomes. The greater part of this article is devoted to the review of findings related to physical, psychological, and cognitive predictors of post-MVC impairment and disability. The relation of these predictors to post-MVC impairment and disability is described across three specific injury contexts: (1) whiplash-associated disorders, (2) traumatic brain injury, and (3) polytrauma. In each context, findings related to recovery of function in the form of return to work are summarized, along with findings related to the contribution of compensation to injury-related symptoms and impairments. Although not characterized as a physical injury, chronic pain serves frequently as the post-injury symptom that persists beyond all injury management and rehabilitation efforts and that contributes significantly to MVC-related functional impairment, disability, and emotional distress. It is appropriate, therefore, to include in this review a discussion of those MVC studies that specifically address impairment and disability occurring in relation to chronic pain. The article ends with the identification of ongoing research challenges and future directions for both the study of MVCs and their associated sequelae and clinical practice with persons who are experiencing the consequences of MVC-related injuries.     

Explaining “Pain and Suffering” Awards: The Role of Injury Characteristics and Fault Attributions

The present research explored factors thought to affect compensatory awards for non-economic ham (pain and suffering) in personal injury cases. Experiment 1 showed that the nature and severity of the plaintiffs injury had a strong effect on perceptions of the extent of harm suffered and on award amounts. The parties' relatively active or passive roles in causing the injury affected assessments of their degree of fault, but perceived fault had little influence on awards. Experiment 2 replicated with more varied cases the strong impact of injury severity on harm perception and on awards for pain and suffering. In both studies, the disability and the mental suffering associated with injuries were stronger predictors of awards than were pain and disfigurement.     

The Social Context of Responses to Injustice: Considering the Indirect and Direct Effects of Group-Level Factors

Whether individuals evaluate a distribution of outcomes to be unfair and how they respond to it depends upon the social context and their perceptions of why the objective injustice occurred. Here we examine a general feature of the situation that highlights what is often overlooked in distributive justice research: the impact of the group. We conceptualize such impact in terms of the group value model of procedural justice (Lind and Tyler, 1988) and in terms of collective sources of legitimacy (Walker and Zelditch, 1993). The former highlights how the extent to which one feels valued by the group may enhance perceptions of distributive justice (net of actual outcomes) and thus ameliorate the impetus to respond to objective injustice. The latter considers how the dynamics of group influence may reduce the propensity to respond behaviorally to perceived injustice. Our analysis shows how procedural justice and legitimacy (in the forms of authorization and endorsement) may affect attributions in a work setting, and, in turn, influence individuals' justice perceptions and reactions. By combining these elements, we chart for the first time the relative impact of two factors representing elements of the group on an individual's evaluation of and response to distributive injustice.     

A Psychosocial Risk-Targeted Intervention to Reduce Work Disability: Development, Evolution, and Implementation Challenges

Research has been consistent in showing that certain psychosocial variables can increase the risk for prolonged work disability. Four psychosocial variables have emerged as robust predictors of disability across a wide range of debilitating health and mental health conditions. These include catastrophic thinking, symptom exacerbation fears, disability beliefs, and perceived injustice. The Progressive Goal Attainment Program (PGAP) is a psychosocial risk-targeted intervention that was developed to reduce psychosocial barriers to work resumption in individuals with debilitating health or mental health conditions. This paper describes the conception, developmental process, and the evolution of the PGAP. Research studies are summarized that have played a significant role in the developmental trajectory of the PGAP. Some of the legal and legislation-relevant challenges that were faced in the development and implementation the PGAP are discussed.     

Fabrications of justice

This paper focuses on false beliefs that create or maintain injustice, particularly those false beliefs held by the unjustly disadvantaged. Those who benefit from injustice may intentionally lead those disadvantaged by unjust distributions, procedures, or interpersonal treatment to believe that no injustice exists, that the injustice is minimal, or that the injustice that exists cannot be reduced. Research on procedural and interactional justice suggests that perceived injustice is reduced where those affected by a decision have an opportunity to offer an opinion (voice) prior to the decision, and where the decision maker offers a justifying account for the decision. False beliefs in control and dignity may be intentionally created by decision makers to perpetuate their unjust advantage. Suggestions are offered to identify the processes through which fabrications of justice have their effects and the situations in which they are most likely to occur.Earlier versions of this paper were presented at the meeting of the International Society of Political Psychology, Secaucus, New Jersey, July 1–5, 1988 and at the International Conference on Social Justice and Societal Problems, Leiden, The Netherlands, August 1–3, 1988. Thanks for their coments on earlier drafts to participants at both events, and to three anonymous reviewers forSocial Justice Research.     

交通事故致眼部伤残84例分析

目的研究交通事故眼部损伤的致伤方式、损伤特征、伤残等级鉴定等相关问题。方法对本所2007年3月至2009年3月鉴定的84例交通事故眼部损伤致残案例进行回顾性分析．分别研究其致残原因、鉴定时机及鉴定方法。结果视力障碍是最主要的致残原因，其余如眼球缺失，眼睑、泪器损伤和外伤性白内障及视野缺损等情形则相对少见；大部分眼外伤均为单眼损伤，致残后果也多为Ⅶ～Ⅹ级。结论通过一些测试和视觉电生理技术，可有效地提高视力障碍鉴定的准确性：对于一些存有眼部既往疾病的伤者，应要求其尽可能提供伤前视力或眼科资料；对于一些视觉功能存在变化可能的眼部损伤，可适当延后鉴定时机。     

Pain, Impairment, and Disability in the AMA Guides

Physicians use the American Medical Association's Guides to the Evaluation of Permanent Impairment, 5th edition to evaluate millions of disability applicants each year. As major contributors to the chapter in the Guides devoted to assessing impairment associated with pain, we confronted the difficulties of incorporating pain into the Guides' overall evaluation system. Analysis of these difficulties is complicated by the paucity of research on the Guides, and by ambiguities and contradictions that pervade it. We propose that the ambiguities can be reduced if impairment is consistently defined in terms of organ or body part derangement, and disability in terms of activity limitations at the level of the whole person. We also propose a distinction between objective factors that may influence a person's ability to perform activities following injury. We suggest that when physicians examine disability applicants, they should evaluate both objective measures of organ or body part dysfunction and subjective reports of applicants -- especially ones regarding pain. We conclude that a comprehensive medical evaluation of disability applicant encompasses more than an impairment assessment.     

伤残等级重新评定45例分析

目的探讨道路交通事故、工伤及其他意外事故所致人身伤害的伤残等级重新评定结论改变的原因。方法回顾性分析杭州求正司法鉴定所2007年3月—2009年3月受理的伤残等级重新评定案件45例。结果重新鉴定结论较之原鉴定结论有改变的共计12例（26.7%）,结论改变原因分别为错误引用条款、鉴定时机掌握不当、漏鉴或误鉴伤情、人工假体鉴定掌握不当、未能准确分析伤病关系及未能准确适用工伤伤残晋级原则等。结论伤残鉴定应准确把握鉴定时机,正确理解标准条款的内涵,采用合适的医学和法医学技术,并充分了解各种相关规定的要求。