The association between injustice perception and psychological outcomes in an inpatient spinal cord injury sample: the mediating effects of anger

Study design: Cross-sectional study design involving completion of self-report measures. Objective: To investigate the relationship between perceived injustice, post-traumatic stress symptoms and depression in a sample of individuals receiving inpatient rehabilitation care following hospitalization for acute spinal cord injury (SCI), as well as the mediating role of anger variables. Setting: Inpatient rehabilitation program in a large urban city in the Southwestern United States. Methods: A sample of 53 participants with an average of 204.51 days (s.d. = 410.67, median = 56) post injury occurrence completed measures of perceived injustice, depression and post-traumatic stress symptoms as well as measures of trait anger, state anger, anger inhibition and anger expression. Results: Perceived injustice was significantly correlated with depression and post-traumatic stress symptoms, and accounted for unique variance in depression and post-traumatic stress symptoms when controlling for demographic and injury-related variables. Anger inhibition was found to mediate the relationship between perceived injustice and depression. Trait anger and anger expression were found to mediate the relationship between perceived injustice and post-traumatic stress symptoms. Conclusions: Consistent with previous research, perceived injustice was associated with greater depression and post-traumatic stress symptoms. The results support previous findings that anger inhibition mediates between perceived injustice and depression, and provides novel findings regarding mediation of post-traumatic stress symptoms. Results provide preliminary evidence for the role of perceived injustice in SCI and potential mechanisms by which it may exert its effects.