Perceptions of Injustice Predict Poor Recovery Following Debilitating Injury: Implications for Claim Management and Rehabilitation

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1 Perceptions of Injustice Predict Poor Recovery Following Debilitating Injury: Implications for Claim Management and Rehabilitation F Michael Sullivan, PhD Professor and Director of Recover Injury Research Centre Faculty of Health and Behavioural Sciences University of Queensland

2 Disability-Related Psychosocial Risk Factors Catastrophizing Beliefs/Expectancies Injustice Fear Psychosocial risk factors have been shown to account for as much as 30% of the variance in the magnitude of pain-related disability. Disability-Related Psychosocial Risk Factors Perceived Injustice Why study perceived injustice in individuals with painful injuries?

3 If only he could see what he has done to my life. My life will never be the same. Nothing will ever make up for what I ve gone through. What did I do to deserve this?

4 MPQ TSK BDI IES PCS IEQ admission Pain Return to work 7 weeks 12 months Perceived Injustice and Treatment Response for Post-Traumatic Stress Symptoms Associated with Whiplash Injury Symptoms of PTSD high IEQ scores low IEQ scores T1 T2 T3 Week 1 Week 7 (Sullivan et al., 2009) Perceived Injustice and Response to Treatment for Depression Associated with Whiplash Injury The Impact of Perceived Injustice Symptoms of depression Week 1 Week 7 high IEQ scores low IEQ scores Increases symptom severity. Leads to prolonged work-disability. Persistence of depressive symptoms. Persistence of PTSD symptoms. Fosters transition from acute to chronic pain. (Scott et al., 2014)

5 Justice Violations Influence Pain Experience and Expression 10 negligence control immersion 1 immersion 2 Susceptibility to Perceived Injustice (Trost et al., 2013) Domains of Justice Violations Distributive Justice Interpersonal Justice Compensatory Justice Sex Differences in Perceived Injustice Retributive Justice 0 Men Women

6 Catastrophizing Perceived Injustice How does Perceived Injustice Impact on Outcomes? Proving Injustice to Others

7 Negative Emotional Reactions Perceived Injustice Depression Disability

8 Melancholics always seem as though they had been slighted or treated with great injustice Freud, Mourning and Melancholia Perceived Injustice Anger Retribution Motives Disability

9 Goals Recovery Revenge Return to work Parenting responsibilities Spousal responsibilities Resume recreational activities Retribution Motives Expressions of Anger or Hostility Reduced Engagement in Treatment Non-Compliance Sources of Perceived Injustice Litigation

10 Scott et al 2016 Interviewed claimants with high IEQ scores. Item query semi-structured interview. Identify sources of injustice. Identify reasons for injustice appraisal. The Other Driver The Insurer The Health Professional The Family Member Self 60% 72% 75% 60% 10% Reasons for Injustice Responsible for causing injury. Study: Emergence of Perceived Injustice Score above 18? Interviewed about potential sources of injustice Disrespectful interactions. Medical report had claim consequences. Injury Punitive responses. Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

11 Treatment Current Approaches to Rehabilitation are not Effective in Reducing Perceptions of Injustice. Pain catastrophizing Fear of movement Self-efficacy 25% 20% 25% Reducing Perceptions of Injustice Guided disclosure techniques. Validation techniques. Perceived injustice 9% Thought monitoring techniques. Targeting the sources of perceived injustice.

12 Risk-Targeted Intervention to Reduce Perceptions of Injustice Prevention 10 8 Insurer policy/adjudication process. IEQ-SF Scores Week 1 Week 10 MDD MSK Disrespectful interactions. Dismissive or minimizing communication. Advocacy/Litigation. Sullivan et al 2016 The Research Team Whitney Scott, PhD Esther Yakobov, BA Zina Trost, PhD Thank you Heather Adams, RSW