Perceived Injustice of Trauma: Longitudinal Prediction of Traumatic Stress Symptoms Following the October 7th Attack and Subsequent War

Traumatic events can profoundly impact cognition, mood, and behavior, manifesting in traumatic stress symptoms (TSS). Perceived injustice (PI) reflects cognitive appraisals involving severity of loss and irreparability, blame, and unfairness. We examined the relationship between PI and TSS in an Israeli convenience sample following the October 7th attack and subsequent war. We pre-registered our hypotheses that PI would positively associate with current and predict future TSS severity, beyond emotional distress-related symptoms, namely depression, anxiety, and anger. Data were collected via electronic surveys distributed through social media three months after the attack in January 2024 (TP1: n=1693; age=38.45±13.62; 56% female), and follow-up collected nine months after the attack in July 2024 (TP2: n=613; age=38.39±12.69; 61% female). TSS were measured using the PTSD Checklist-5, PI with the Injustice Experience Questionnaire, and emotional distress-related measures using NIH’s Patient Reported Outcomes Measurement Information System scales. At both timepoints, PI correlated with TSS (TP1: r=0.74, p<0.001; TP2: r=0.71, p<0.001). Emotional distress-related measures similarly correlated with TSS and PI (r=0.50-0.78; p-values<0.001). Regression analysis demonstrated that PI explained variance in TSS above and beyond emotional distress-related measures: 9.6% at TP1 (p<0.001) and 6.4% at TP2 (p<0.001). PI at TP1 correlated with TSS at TP2 (r=0.62, p<0.001) with explained variance of 4.3% (p<0.001) above and beyond TP1 emotional distress-related measures. Findings supported our pre-registered hypotheses, highlighting PI as a crucial yet understudied risk-factor for the development and maintenance of TSS. Clinically, addressing appraisals of injustice is indicated as a requisite to better understand and support coping with trauma.