Child pain-related injustice appraisals mediate the relationship between just-world beliefs and pain-related functioning.

BACKGROUND: Research among adult and paediatric samples suggests that pain-related injustice appraisals contribute to adverse pain-related functioning. However, a singular focus on pain-related injustice appraisals carries the risk of underestimating the role of broader concepts of justice. This study examined the unique roles of child pain-related injustice appraisals and just-world beliefs in understanding disability and physical, emotional, social and academic functioning, as well as the mediating role of injustice appraisals in the relationship between just-world beliefs and functioning. METHODS: Participants comprised a school sample of 2,174 children (Study 1) and a clinical sample of 146 paediatric chronic pain patients (Study 2) who completed the Injustice Experience Questionnaire (IEQ), Personal and General Belief in a Just World scales (JWB-P/G), Functional Disability Inventory (FDI), Pain Catastrophizing Scale for Children (PCS-C) and Pediatric Quality of Life Inventory (PEDSQL). RESULTS: For both samples, child pain-related injustice appraisals were associated with poorer functioning, after controlling for just-world beliefs, catastrophizing, pain intensity, age and sex. In the school sample, injustice appraisals mediated the associations of both personal and general just-world beliefs with functioning. In the clinical sample, injustice appraisals mediated the association of personal, but not general, just-world beliefs with all functioning scales. CONCLUSIONS: The current findings attest to the unique role of pain-related injustice appraisals in understanding child pain-related functioning and their explanatory value in understanding the relationship between fundamental just-world beliefs and child pain-related functioning. SIGNIFICANCE: The present study adds to emerging literature on the adverse effects of child pain-related injustice appraisals in the context of pain, through showing that pain-related injustice appraisals are uniquely associated with pain-related functioning and mediate the relationship between just-world beliefs and pain-related functioning. These findings suggest that interventions may target pain-related injustice appraisals as a mechanism for change in children.

Mothers' appraisals of injustice in the context of their child's chronic pain: An interpretative phenomenological analysis.

BACKGROUND: In line with research highlighting the role of observer appraisals in understanding individuals' pain experience, recent work has demonstrated the effects of parental child- and self-oriented injustice appraisals on child pain-related outcomes. However, research on parental injustice appraisals is in its infancy and lacks a valid and context-specific operationalization of what parental injustice appraisals of child pain precisely entail. The current study presents an in-depth qualitative analysis of parental child- and self-oriented appraisals of injustice in the context of their child's chronic pain. METHODS: Twenty-one mothers of children living with chronic pain participated in one of five focus group interviews conducted in Ghent (Belgium), Glasgow (Scotland) and Indianapolis (USA). RESULTS: The interviews were subjected to interpretative phenomenological analysis, which revealed three key justice-related themes, labelled 'You shouldn't be in this much pain', 'The problem's probably with the mother' and 'At least it's not cancer'. Maternal injustice appraisals focused mainly on the child rather than the self and reflected various perceived barriers to their efforts to provide quality of life for their child. A fourth theme labelled 'Not everybody gets a healthy child' reflected maternal strategies to effectively cope with the child's condition and the associated appraisals of injustice. CONCLUSIONS: The current findings attest to the relevance of (child- and self-oriented) injustice in the parental experience of caring for a child with chronic pain and provides insight into the specific content and scope of these appraisals. As such, this study provides valuable insights to further research in this area. SIGNIFICANCE: The current study presents an in-depth qualitative analysis of parental appraisals of injustice in the context of their child's chronic pain condition. The findings provide valuable insights into the phenomenology of this construct and may inform future research and assessment methods. Furthermore, the themes reported in this study may contribute to clinical practice, as they may raise awareness of parental concerns regarding their child's pain management.

Parental Injustice Appraisals in the Context of Child Pain: Examining the Construct and Criterion Validity of the IEQ-Pc and IEQ-Ps.

A growing pediatric and adult literature highlights the role of injustice appraisals in adjustment to pain. However, interpersonal injustice dynamics have remained largely unexplored. The present study investigated the factor structure and criterion validity of parentally adjusted versions of the Injustice Experience Questionnaire, assessing child-oriented (IEQ-Pc) and self-oriented appraisals (IEQ-Ps) in the context of child pain. Participants were triads of healthy children (N = 407, Mage = 12) and both their parents and dyads of children with chronic pain (N = 319, Mage = 14) and 1 parent. In both samples, children completed measures of functional disability and quality of life (physical, emotional, social, and academic); parents completed the IEQ-Pc, IEQ-Ps, and a measure of parental catastrophizing about child pain. Across samples, a confirmatory oblique two-factor model (Severity/Irreparability-Blame/Unfairness) provided a better fit to the data compared to a one-factor model; nevertheless, the two-factor solution was considered suboptimal. A post hoc exploratory factor analysis consistently revealed 1 factor. In terms of criterion validity, the IEQ-Pc and IEQ-Ps demonstrated differential associations depending on the child's pain versus healthy status, independent of parental catastrophizing. Further, findings in the healthy sample indicated that fathers' self-oriented injustice appraisals related to lower child social function. In the clinical sample, parental child-oriented injustice appraisals related to greater child functional disability and lower physical, emotional, social, and academic function. Current findings support the unique role of parental injustice appraisals, assessed by the IEQ-Pc and IEQ-Ps, in understanding child pain, but also suggest these may only partially capture the phenomenology of parental injustice appraisals in the context of child pain. PERSPECTIVE: This manuscript presents an examination of the construct and criterion validity of 2 parentally adjusted versions of the Injustice Experience Questionnaire. These measures could be valuable tools for clinicians in examining how parents respond to their child's pain as it impacts both the child's life and the parents'.