title: Do compensation processes impair mental health? A meta-analysis.
abstract: BACKGROUND
  Victims who are involved in a compensation processes generally have more health complaints compared to victims who are not involved in a compensation process. Previous research regarding the effect of compensation processes has concentrated on the effect on physical health. This meta-analysis focuses on the effect of compensation processes on mental health.
  
  
  METHODS
  Prospective cohort studies addressing compensation and mental health after traffic accidents, occupational accidents or medical errors were identified using PubMed, EMBASE, PsycInfo, CINAHL, and the Cochrane Library. Relevant studies published between January 1966 and 10 June 2011 were selected for inclusion.
  
  
  RESULTS
  Ten studies were included. The first finding was that the compensation group already had higher mental health complaints at baseline compared to the non-compensation group (standardised mean difference (SMD)=-0.38; 95% confidence interval (CI) -0.66 to -0.10; p=.01). The second finding was that mental health between baseline and post measurement improved less in the compensation group compared to the non-compensation group (SMD=-0.35; 95% CI -0.70 to -0.01; p=.05). However, the quality of evidence was limited, mainly because of low quality study design and heterogeneity.
  
  
  CONCLUSIONS
  Being involved in a compensation process is associated with higher mental health complaints but three-quarters of the difference appeared to be already present at baseline. The findings of this study should be interpreted with caution because of the limited quality of evidence. The difference at baseline may be explained by a selection bias or more anger and blame about the accident in the compensation group. The difference between baseline and follow-up may be explained by secondary gain and secondary victimisation. Future research should involve assessment of exposure to compensation processes, should analyse and correct for baseline differences, and could examine the effect of time, compensation scheme design, and claim settlement on (mental) health.
authors.affiliation: Department of Law, VU University, Amsterdam, The Netherlands. n.elbers@vu.nl
authors.forename: Nieke A
authors.initials: NA
authors.lastname: Elbers
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Hulst
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Arno J
authors.initials: AJ
authors.lastname: Akkermans
authors.forename: David J
authors.initials: DJ
authors.lastname: Bruinvels
mesh_terms: D000062:Accidents, Occupational / Q000191:economics / Q000523:psychology*; D000063:Accidents, Traffic / Q000191:economics / Q000523:psychology*; D035881:Compensation and Redress; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019300:Medical Errors / Q000191:economics / Q000523:psychology*; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D013997:Time Factors; D014947:Wounds and Injuries / Q000191:economics / Q000523:psychology*