2. Baylor Institute for Rehabilitation Spinal Cord Injury Outcomes Project SCI-OP November 3, 2014

3. Primary Investigator: Dr. Kimberley Monden Our Research Team Co- Investigator: Dr. Zina Trost Research Assistants: Alexandra Wike Lindsay Murray Sarah Finley Ashley Garner

4. Background Disability Pain Depression

5. What is the question? What factors contribute to positive versus negative outcomes following spinal cord injury? Pain Depression PTSD Function

6. We are looking at factors that have typically not received a lot of attention. Perceived Injustice

7. “…I’m angry at [the other driver] because that shouldn‘t have happened. I don’t know if they were maybe drunk, maybe they didn’t want to get caught with that but…it is because of them that I slipped. Because I was just going along, my way and I’m really angry that because of that little thing it is affecting me for the long run and they don’t know that. And it’s frustrating because I feel like in another world I would grab them and say, hey you’ve done this to me, it’s not me. I drove properly.”

8. The Construct of Perceived Injustice Procedural Injustice Interpersonal Injustice Not surprising Losses: Function Financial security Independence/autonomy Identity Quality of life Negligent others Other driver Employer Violation of rights, equity norms ● Undeserved suffering/loss ● Negligence/fault of another

9. Perceived sources of injustice following painful injury

11. Injustice Experiences Questionnaire Sullivan et al., 2008

12. “Severity/ Irreparability of loss”

13. “Blame/ Unfairness”

14. Actual Injustices “Stuckness” A note:

15. To Date (Not Much) Psychological Distress (Depression, PTSD) Pain, Pain behavior Self-report disability, Occupational disability Limited populations (Whiplash, Fibromyalgia, Smorgasbord)

16. Has not been examined in severe trauma or SCI.

17. What are we asking? Predictors Injustice Perception (IEQ) Just World Belief Centrality of Events Anger Blame Forgiveness Outcomes PTSD Depression Pain Perceived Disability Expectancies ER Demographic information: Insurance, Perceived SES, SES, Litigation Resilience Self-Efficacy And also… “I believe that most of the things that happen in my life are fair.” “I feel that this event has become part of my identity.”

18. ALSO: Predictors Pain Catastrophizing Kinesiophobia PCS TSK PAIN = HARM = AVOIDANCE = DISABILITY

19. The Nitty Gritty BIR (Baseline) 3 Months 6 Months 12 Months

20. Our Sample (N = 36) Demographics Age44.03 +/- 15.52 Age at Time of Injury42.4 +/- 6.59 Length of Stay42.72 +/- 19.59

21. Injury Related Variables

22. Other Demographics

24. Results coming in! r =.49 Perceptions of Injustice PTSD Depression Pain Perceived Disability Expectations r =.41r =.38 r =.44 r =.40 -.51

25. Results coming in! r =-.48 Just World Beliefs Perceived Injustice PTSD r =-.52

26. Centrality of Events Pain Perceived Disability Expectations r =.38 -.57 r =.45 r =.39 Results coming in! Perceived Injustice

27. State Anger DepressionPainExpectations r =.39 r =.35 -.49 r =.42 Results coming in! Trait Anger PTSDPain r =.48 r =.52 -.55 Centrality of Events Perceived Injustice Just World Beliefs

28. Results coming in! Blame & Responsibility Other People  More JWB Myself  Pain  PTSD  Higher State Anger  Less JWB  Higher Perceived Injustice

29. Forgiveness

30. Our Pain Variables Pain Catastrophizing DepressionPerceived Disability Pain r =.42 -.53 r =.39 -.54 r =.71

31. Kinesiophobia Depression Perceived Disability r =.51-.54r =.53 Expectations r =.50 Our Pain Variables

32. Litigation More likely to pursue litigation if: Higher injustice perceptions, state anger, and blame toward others. Less resilience and belief in a just world.

33. Desire to be Receiving Compensation Higher levels of forgiveness and belief in a just world -- less desire for compensation. Perceived Disability Depression State Anger

34. Conclusions THANK YOU. (THANK YOU, THANK YOU, THANK YOU) Monden, K. R., Trost, Z., Wike, A., Garner, A., & Scott, W. (2015, February). Perceived injustice after spinal cord injury: Risk factors for physical and psychological outcomes. Presentation accepted at the 17 th Annual Rehabilitation Psychology Conference. San Diego, CA.