Traumatic injury and perceived injustice: Fault attributions matter in a "no-fault" compensation state

PLoS One. 2017 Jun 5;12(6):e0178894. doi: 10.1371/journal.pone.0178894. eCollection 2017.

Abstract

Background: Traumatic injury can lead to loss, suffering and feelings of injustice. Previous research has shown that perceived injustice is associated with poorer physical and mental wellbeing in persons with chronic pain. This study aimed to identify the relative association between injury, compensation and pain-related characteristics and perceived injustice 12-months after traumatic injury.

Methods: 433 participants were recruited from the Victorian Orthopedic Trauma Outcomes Registry and Victorian State Trauma Registry, and completed questionnaires at 12-14 months after injury as part of an observational cohort study. Using hierarchical linear regression we examined the relationships between baseline demographics (sex, age, education, comorbidities), injury (injury severity, hospital length of stay), compensation (compensation status, fault, lawyer involvement), and health outcomes (SF-12) and perceived injustice. We then examined how much additional variance in perceived injustice was related to worse pain severity, interference, self-efficacy, catastrophizing, kinesiophobia or disability.

Results: Only a small portion of variance in perceived injustice was related to baseline demographics (especially education level), and injury severity. Attribution of fault to another, consulting a lawyer, health-related quality of life, disability and the severity of pain-related cognitions explained the majority of variance in perceived injustice. While univariate analyses showed that compensable injury led to higher perceptions of injustice, this did not remain significant when adjusting for all other factors, including fault attribution and consulting a lawyer.

Conclusions: In addition to the "justice" aspects of traumatic injury, the health impacts of injury, emotional distress related to pain (catastrophizing), and the perceived impact of pain on activity (pain self-efficacy), had stronger associations with perceptions of injustice than either injury or pain severity. To attenuate the likelihood of poor recovery from injury, clinical interventions that support restoration of health-related quality of life, and adjustment to the impacts of trauma are needed.

Publication types

  • Observational Study

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Catastrophization / physiopathology
  • Catastrophization / psychology
  • Cohort Studies
  • Compensation and Redress
  • Disability Evaluation
  • Disabled Persons / psychology
  • Female
  • Humans
  • Length of Stay
  • Linear Models
  • Male
  • Middle Aged
  • Pain / physiopathology
  • Pain / psychology*
  • Pain Measurement
  • Quality of Life / psychology*
  • Registries*
  • Social Perception*
  • Surveys and Questionnaires
  • Trauma Severity Indices
  • Victoria
  • Wounds and Injuries / pathology
  • Wounds and Injuries / psychology*

Grants and funding

This work received support from Australian Research Council (ARC) Linkage Project Grant (LP120200033) in collaboration with the Victorian Transport Accident Commission (TAC) - NGK MJG PC PAJ JP SJG, Platform Access Grant (PAG), Monash University (PAG15-0026) - MJG NGK, National Health & Medical Research Council of Australia (NHMRC) Early Career Fellowship (APP1036124) - MJG, National Health & Medical Research Council of Australia (NHMRC) Career Development Fellowship (APP1048731) - BJG, and National Health & Medical Research Council of Australia (NHMRC) Practitioner Fellowship (APP545926) - PC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.