Research Article| Volume 21, ISSUE 1-2, P195-211, January 2020

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


      • Parents of children with chronic pain show significantly higher levels of child- and self-oriented perceived injustice in relation to their child's pain than do parents of healthy children.
      • The IEQ-Pc and IEQ-Ps do not seem to fully capture the construct of parental child- and self-oriented injustice perceptions in relation to their child's pain.
      • Both measures do show associations with child pain-related functioning.


      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.


      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’.

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        • Agtarap S
        • Scott W
        • Warren AM
        • Trost Z
        Validation of the injustice experience questionnaire in a heterogeneous trauma sample.
        Rehabil Psychol. 2016; 61: 336-344
        • Brena SF
        • Sanders SH
        • Motoyama H
        American and Japanese chronic low back pain patients: Cross-cultural similarities and differences.
        Clin J Pain. 1990; 6: 118-124
        • Brislin R.W
        Back-translation for cross-cultural research.
        J Cross Cult Psychol. 1970; 1: 185-216
        • Caes L
        • Vervoort T
        • Eccleston C
        • Goubert L
        Parents who catastrophize about their child's pain prioritize attempts to control pain.
        Pain. 2012; 153: 1695-1701
        • Caes L
        • Vervoort T
        • Eccleston C
        • Vandenhende M
        • Goubert L
        Parental catastrophizing about child's pain and its relationship with activity restriction: The mediating role of parental distress.
        Pain. 2011; 152: 212-222
        • Chambers CT
        • Craig KD
        • Bennett SM
        The impact of maternal behavior on children's pain experiences: An experimental analysis.
        J Pediatr Psychol. 2002; 27: 293-301
        • Chaplin TM
        • Cole PM
        • Zahn-Waxler C
        Parental socialization of emotion expression: Gender differences and relations to child adjustment.
        Emotion. 2005; 5: 80-88
        • Claar RL
        • Walker LS
        Functional assessment of pediatric pain patients: Psychometric properties of the functional disability inventory.
        Pain. 2006; 121: 77-84
        • Craig KD.
        The social communication model of pain.
        Can Psychol. 2009; 50: 22-32
        • Crombez G
        • Bijttebier P
        • Eccleston C
        • Mascagni T
        • Mertens G
        • Goubert L
        • Verstraeten K
        The child version of the pain catastrophizing scale (PCS-C): A preliminary validation.
        Pain. 2003; 104: 639-646
      1. Crombez G, De Paepe AL, Veirman E, Eccleston C, Van Ryckeghem DML: Let's talk about pain catastrophizing measures: An item content analysis. Pain (in submission)

        • Eccleston C
        • Crombez G
        • Scotford A
        • Clinch J
        • Connell H
        Adolescent chronic pain: Patterns and predictors of emotional distress in adolescents with chronic pain and their parents.
        Pain. 2004; 108: 221-229
        • Engelen V
        • Haentjens MM
        • Detmar SB
        • Koopman HM
        • Grootenhuis MA
        Health related quality of life of Dutch children: Psychometric properties of the PedsQL in the Netherlands.
        BMC Pediatr. 2009; 9: 68-75
        • Fabrigar LR
        • Wegener DT
        • MacCallum RC
        • Strahan EJ
        Evaluating the use of exploratory factor analysis in psychological research.
        Psychol Methods. 1999; 4: 272
        • Faresjö T
        • Faresjö A
        To match or not to match in epidemiological studies—Same outcome but less power.
        Int J Environ Res Public Health. 2010; 7: 325-332
        • Figley CR
        Compassion fatigue: Psychotherapists’ chronic lack of self-care.
        J Clin Psychol. 2002; 58: 1433-1441
        • Flack F
        • Stahlschmidt L
        • Dobe M
        • Hirschfeld G
        • Strasser A
        • Michalak J
        • Wager J
        • Zernikow B
        Efficacy of adding interoceptive exposure to intensive interdisciplinary treatment for adolescents with chronic pain: A randomized controlled trial.
        Pain. 2018; 159: 2223-2233
        • Goubert L
        • Craig KD
        • Vervoort T
        • Morley S
        • Sullivan MJL
        • Williams AC
        • Cano A
        • Crombez G
        Facing others in pain: The effects of empathy.
        Pain. 2005; 118: 285-288
        • Goubert L
        • Eccleston C
        • Vervoort T
        • Jordan A
        • Crombez G
        Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): A preliminary validation.
        Pain. 2006; 123: 254-263
        • Hadjistavropoulos T
        • Craig KD
        • Duck S
        • Cano A
        • Goubert L
        • Jackson PL
        • Vervoort T
        A biopsychosocial formulation of pain communication.
        Psychol Bull. 2011; 137: 910-939
        • Hayton JC
        • Allen DG
        • Scarpello V
        Factor retention decisions in exploratory factor analysis: A tutorial on parallel analysis.
        Org Res Methods. 2004; 7: 191-205
        • Hechler T
        • Vervoort T
        • Hamann M
        • Tietze AL
        • Vocks S
        • Goubert L
        • Hermann C
        • Wager J
        • Blankenburg M
        • Schroeder S
        • Zernikow B
        Parental catastrophizing about their child's chronic pain: Are mothers and fathers different?.
        Eur J Pain. 2011; 15: 1-9
        • Hillebrandt A
        • Barclay LJ
        Observing others’ anger and guilt can make you feel unfairly treated: The interpersonal effects of emotions on justice-related reactions.
        Soc Just Res. 2017; 30: 238-269
        • Hofstede G
        Cultural dimensions in management and planning.
        Asia Pacific J Management. 1984; 1: 81-99
        • Hu LT
        • Bentler PM
        Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification.
        Psychol Methods. 1998; 3: 424
        • Hu LT
        • Bentler PM
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equ Modeling. 1999; 6: 1-55
        • Hunfeld JAM
        • Perquin CW
        • Duivenvoorden HJ
        • Hazebroek-Kampschreur A
        • Passchier J
        • van Suijlekom-Smit LWA
        • van der Wouden JC
        Chronic pain and its impact on quality of life in adolescents and their families.
        J Pediatr Psychol. 2001; 26: 145-153
        • Jackson DL
        • Gillaspy Jr JA
        • Purc-Stephenson R
        Reporting practices in confirmatory factor analysis: An overview and some recommendations.
        Psychol Methods. 2009; 14: 6-23
        • Jordan A
        • Eccleston C
        • Crombez G
        Parental functioning in the context of adolescent chronic pain: A review of previously used measures.
        J Pediatr Psychol. 2008; 33: 640-659
        • Jordan AL
        • Eccleston C
        • Osborn M
        Being a parent of the adolescent with complex chronic pain: An interpretative phenomenological analysis.
        Eur J Pain. 2007; 11: 49
        • Kennedy L
        • Dunstan DA
        Confirmatory factor analysis of the injustice experience questionnaire in an Australian compensable population.
        J Occup Rehabil. 2014; 24: 385-392
        • Kring AM
        • Gordon AH
        Sex differences in emotion: Expression, experience and physiology.
        J Pers Soc Psychol. 1998; 74: 686-703
        • Marsh HW
        • Hocevar D
        Application of confirmatory factor analysis to the study of self-concept: First-and higher order factor models and their invariance across groups.
        Psychol Bull. 1985; 97: 562
        • Miller MM
        • Scott EL
        • Trost Z
        • Hirsh AT
        Perceived injustice is associated with pain and functional outcomes in children and adolescents with chronic pain: A preliminary examination.
        J Pain. 2016; 17: 1217-1226
        • Miller MM
        • Wuest D
        • Williams AE
        • Scott EL
        • Trost Z
        • Hirsh AT
        Injustice perceptions about pain: Parent-child discordance is associated with worse functional outcomes.
        Pain Online. 2018; : 1-7
        • Mohammadi S
        • de Boer MJ
        • Sanderman R
        • Hagedoorn M
        Caregiving demands and caregivers’ psychological outcomes: The mediating role of perceived injustice.
        Clin Rehabil. 2016; 31: 403-413
        • Palermo TM
        Impact of recurrent and chronic pain on child and family daily functioning: A critical review of the literature.
        J Dev Behav Pediatr. 2000; 21: 58-69
        • Palermo TM
        • Chambers CT
        Parent and family factors in pediatric chronic pain and disability: An integrative approach.
        Pain. 2005; 119: 1-4
        • Palermo TM
        • Eccleston C
        Parents of children and adolescents with chronic pain.
        Pain. 2009; 146: 15-17
        • Perneger TV
        What's wrong with Bonferroni corrections.
        Br Med J. 1998; 316: 1236-1238
        • Robinson ME
        • Riley III JL
        • Myers CD
        • Papas RK
        • Wise EA
        • Waxenberg LB
        • Fillingim RB
        Gender role expectations of pain: Relationship to sex differences in pain.
        J Pain. 2001; 2: 251-257
        • Rodero B
        • Luciano JV
        • Montero-Marín J
        • Casanueva B
        • Palacin JC
        • Gili M
        • Lopéz del Hoyo Y
        • Serrano-Blanco A
        • Garcia-Campayo J
        Perceived injustice in fibromyalgia: Psychometric characteristics of the injustice experience questionnaire and relationship with pain catastrophising and pain acceptance.
        J Psychosom Res. 2012; 73: 86-91
        • Romano JM
        • Jensen MP
        • Turner JA
        • Good AB
        • Hops H
        Chronic pain patient-partner interactions: Further support for a behavioral model of chronic pain.
        Behav Ther. 2000; 31: 415-440
        • Russell DW
        In search of underlying dimensions: The use (and abuse) of factor analysis in personality and social psychology bulletin.
        Pers Soc Psychol Bull. 2002; 28: 1629-1646
        • Sanders SH
        • Brena SF
        • Spier CJ
        • Beltrutti D
        • McConnell H
        • Quintero O
        Chronic low back pain patients around the world: Cross-cultural similarities and differences.
        Clin J Pain. 1992; 8: 317-323
        • Satorra A
        • Bentler PM
        A scaled difference chi-square test statistic for moment structure analysis.
        Psychometrika. 2001; 66: 507-514
        • Scott W
        • Trost Z
        • Bernier E
        • Sullivan MJ
        Anger differentially mediates the relationship between perceived injustice and chronic pain outcomes.
        Pain. 2013; 154: 1691-1698
        • Shao R
        • Rupp DE
        • Skarlicki DP
        • Jones KS
        Employee justice across cultures: A meta-analytic review.
        J Manag. 2013; 39: 263-301
        • Simons LG
        • Conger RD
        Linking mother-father differences in parenting to a typology of family parenting styles and adolescent outcomes.
        J Fam Issues. 2007; 28: 212-241
        • Sullivan MJ
        • Adams H
        • Horan S
        • Maher D
        • Boland D
        • Gross R
        The role of perceived injustice in the experience of chronic pain and disability: Scale development and validation.
        J Occup Rehabil. 2008; 18: 249-261
        • Sullivan MJ
        • Adams H
        • Martel MO
        • Scott W
        • Wideman T
        Catastrophizing and perceived injustice: Risk factors for the transition to chronicity after whiplash injury.
        Spine. 2011; 36: 244-249
        • Sullivan MJ
        • Davidson N
        • Garfinkel B
        • Siriapaipant N
        • Scott W
        Perceived injustice is associated with heightened pain behavior and disability in individuals with whiplash injuries.
        Psychol Inj Law. 2009; 2: 238-247
        • Sullivan MJ
        • Scott W
        • Trost Z
        Perceived injustice: A risk factor for problematic pain outcomes.
        Clin J Pain. 2012; 28: 484-488
        • Sullivan MJL
        • Bishop SR
        • Pivik J
        The pain catastrophizing scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Van Kleef GA
        How emotions regulate social life: The emotions as social information (EASI) model.
        Curr Dir Psychol Sci. 2009; 18: 184-188
        • Varni JW
        • Seid M
        • Kurtin PS
        PedsQL™ 4.0: Reliability and validity of the Pediatric Quality of Life Inventory™ version 4.0 generic core scales in healthy and patient populations.
        Med Care. 2001; 39: 800-812
        • Vervoort T
        • Goubert L
        • Eccleston C
        • Bijttebier P
        • Crombez G
        Catastrophic thinking about pain is independently associated with pain severity, disability, and somatic complaints in school children and children with chronic pain.
        J Pediatr Psychol. 2005; 31: 674-683
        • Vervoort T
        • Huguet A
        • Verhoeven K
        • Goubert L
        Mothers’ and fathers’ responses to their child's pain moderate the relationship between the child's pain catastrophizing and disability.
        Pain. 2011; 152: 786-793
        • Vervoort T
        • Trost Z
        Examining affective-motivational dynamics and behavioral implications within the interpersonal context of pain.
        J Pain. 2017; 18: 1174-1183
        • Vervoort T
        • Trost Z
        • Sütterlin S
        • Caes L
        • Moors A
        Emotion regulatory function of parent attention to child pain and associated implications for parental pain control behaviour.
        Pain. 2014; 155: 1453-1463
        • Vowles KE
        • McCracken LM
        • McLeod C
        • Eccleston C
        The chronic pain acceptance questionnaire: Confirmatory factor analysis and identification of patient subgroups.
        Pain. 2008; 140: 284-291
        • Walker LS
        • Greene JW
        The functional disability inventory: Measuring a neglected dimension of child health status.
        J Pediatr Psychol. 1991; 16: 39-58
        • Weitzner MA
        • Jacobsen PB
        • Wagner H
        • Friedland J
        • Cox C
        The Caregiver Quality of Life Index-Cancer (CQOLC) scale: Development and validation of an instrument to measure quality of life of the family caregiver of patients with cancer.
        Qual Life Res. 1999; 8: 55-63
      2. Wheaton B, Muthén B, Alwin D, Summers G. Assessing reliability and stability in panel models. In: Heise DR, editor, Sociological Methodology 1977, Jossey-Bass, San Francisco.

        • Yamada K
        • Adachi T
        • Mibu A
        • Nishigami T
        • Motoyama Y
        • Uematsu H
        • Matsuda Y
        • Sato H
        • Hayashi K
        • Cui R
        • Takao Y
        • Shibata M
        • Iso H
        Injustice experience questionnaire, Japanese version: Cross-cultural factor-structure comparison and demographics associated with perceived injustice.
        PloS One. 2016; 11e0160567
        • Zeiss A M
        • Gallagher-Thompson D
        • Lovett S
        • Rose J
        • McKibbin C
        Self-efficacy as a mediator of caregiver coping: Development and testing of an assessment model.
        J Clin Geropsychol. 1999; 5: 221-230