title: Barriers to change in depressive symptoms after multidisciplinary rehabilitation for whiplash: the role of perceived injustice.
abstract: 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.
authors.affiliation: *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.
authors.forename: Whitney
authors.initials: W
authors.lastname: Scott
authors.forename: Zina
authors.initials: Z
authors.lastname: Trost
authors.forename: Maria
authors.initials: M
authors.lastname: Milioto
authors.forename: Michael J L
authors.initials: MJ
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D058443:Catastrophization; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D019547:Neck Pain / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D010465:Perception; D011569:Psychiatric Status Rating Scales; D020377:Self Efficacy; D057566:Self Report; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*