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Barriers to Change in Depressive Symptoms After Multidisciplinary Rehabilitation for Whiplash: The Role of Perceived Injustice

Scott, Whitney BA*; Trost, Zina PhD; Milioto, Maria PT; Sullivan, Michael J. L. PhD*

doi: 10.1097/AJP.0000000000000095
Original Articles

Objective: Depressive symptoms complicate patients’ recovery after musculoskeletal injury. There is strong evidence to support the utility of multidisciplinary approaches for treating comorbid pain and depressive symptoms. Despite this, a significant proportion of patients may not experience meaningful reductions in depressive symptoms following intervention. The purpose of this study was to identify barriers to change in depressive symptom during multidisciplinary rehabilitation for patients with whiplash injuries.

Methods: A total of 53 patients with clinically meaningful levels of depressive symptoms before participating in a standardized multidisciplinary rehabilitation program participated in this study. Patients completed self-report measures of depressive symptoms, demographic factors, pain intensity, disability, posttraumatic stress symptoms, pain catastrophizing, perceived injustice, and self-efficacy upon commencement and completion of the rehabilitation program. Analyses examined whether pretreatment variables predicted change in depressive symptoms over treatment and the maintenance of clinically meaningful levels of depressive symptoms at posttreatment.

Results: Duration of work absence and perceived injustice were significant unique predictors of percent change in depressive symptoms in a linear regression analysis. Perceived injustice was the only significant unique predictor of the presence of clinically meaningful levels of depressive symptoms at posttreatment in a logistic regression analysis.

Conclusions: The results suggest that the identification of patients with high levels of perceived injustice and implementation of targeted interventions for these patients might contribute to greater improvements in their depressive symptomatology.

*Department of Psychology, McGill University, Montreal, QC, Canada

Department of Psychology, University of North Texas, Denton, TX

Centre d’ Évaluation et de Réadaptation de l’Est, Montreal, QC

The authors declare no conflict of interest.

Reprints: Michael J. L. Sullivan, PhD, Department of Psychology, McGill University, 1205 Doctor Penfield Avenue, Montreal, QC, Canada H3A1B1 (e-mail: michael.sullivan@mcgill.ca).

Received November 1, 2013

Received in revised form April 5, 2014

Accepted March 2, 2014

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