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Understanding the association between perceived injustice, depression symptoms, and stigma in individuals with traumatic spinal cord injury

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Abstract

Study design

This is a secondary analysis of data from a cross-sectional, observational study.

Objectives

The study aimed to determine whether stigma mediates the relationship between preceived injustice and depression symptoms among individuals with spinal cord injuries.

Setting

Secondary analysis of participants enrolled in the Spinal Cord Injury Model System at a specialty rehabilitation hospital in the Western United States.

Methods

A sample of 225 participants completed the questionnaires; eight participants were removed due to incomplete data, resulting in a final sample size of 217 participants (79% male; 21% female). Participants were, on average, 53 years old and were predominantly male, white, and 20 years post-injury. A bootstrap** mediation analysis was conducted to evaluate the stigma-mediated relationship between injustice appraisals and depression symptoms. Injustice appraisals were assessed using the Injustice Experience Questionnaire, stigma with the Spinal Cord Injury Quality of Life Stigma–Short Form, and depression symptoms with the Patient Health Questionnaire–9.

Results

Stigma was found to mediate the relationship between injustice appraisals and depression, with an estimated proportion mediated of 80.9% (p ≤ 0.0001).

Conclusions

This study provides a novel finding that the relationship between injustice appraisals and depression symptoms is mediated by stigma. Consistent with previous research, injustice appraisals were associated with greater severity of depression symptoms. Results provide further evidence for the role of injustice appraisals after spinal cord injury and a potential mechanism (i.e., stigma) by which it may exert its effect on depression symptoms.

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Fig. 1: Mediation model.
Fig. 2

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Data availability

The data supporting this study’s findings are available from the corresponding author upon request.

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Funding

Funding

The initial study was funded by the Scott and Paul Pearsall grant from the American Psychological Foundation; however, the work to conduct this secondary data analysis was not funded.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA

    Joshua W. Peiffer, Angela Philippus & Kimberley R. Monden

  2. Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Karen Kanaster

Authors
  1. Joshua W. Peiffer
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  2. Angela Philippus
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  3. Karen Kanaster
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  4. Kimberley R. Monden
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Contributions

JP was responsible for develo** the research question, writing the introduction and methods, extracting data, and creating the reference list. AP was responsible for interpreting results, editing the manuscripts, and reviewing the summary of findings. KK was responsible for conducting and writing the results of the mediation analysis. KRM was responsible for bivariate data analyses, creating tables and figures, interpreting results, and writing the discussion.

Corresponding author

Correspondence to Kimberley R. Monden.

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Competing interests

The authors declare no competing interests.

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Peiffer, J.W., Philippus, A., Kanaster, K. et al. Understanding the association between perceived injustice, depression symptoms, and stigma in individuals with traumatic spinal cord injury. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-01007-3

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