Marriage rates among persons with spinal cord injury.

Postinjury marriage rates of 6,853 persons enrolled in the National Spinal Cord Injury Statistical Center database between 1973 and 1992 were determined. Only 781 marriages occurred, whereas 1,884 marriages were expected based on 29,660 person-years of follow-up and overall annual marriage rates that were specific for age, gender, and previous marital status. Within the study population, characteristics associated with significantly elevated marriage rates included age between 30 and 44, college education, being divorced at injury, paraplegia, independence in ambulation and activities of daily living, and not being institutionalized. Standardized marriage rates were significantly below general U.S. population norms for all study population subgroups except those who were widowed and those who were at least 45 years of age at injury. Further research should focus on identifying reasons for the reduced marriage rate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial predictors of employment status among men living with spinal cord injury.

Objective: To explore the relationship between employment status and community access, perceived community discrimination, social support from significant others, depressive symptoms, and gender-related variables for 83 men living with spinal cord injury. Study Design: Correlational research. Setting: Internet-based investigation employing spinal cord injury listservs. Main Outcome Measure: Participant employment status. Results: A forced-entry hierarchical logistic regression indicated that means of injury, community access and perceived community discrimination, social support from significant others, depressive symptoms, and men’s adherence to masculine norms for primacy of work, self-reliance, and emotional control significantly predicted employment status. Conclusions: Psychosocial variables such as community access, perceived discrimination, social support from significant others, depressive symptoms, and gender identity represent important and understudied predictors of employment status among men living with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vocational interests of persons with spinal cord injury.

Administered the Strong-Campbell Interest Inventory to 134 males (mean age 26.3 yrs) and 22 females (mean age 31.7 yrs) with spinal cord injury to assess Ss' vocational interests. Ss' scores were compared to the norms for men and women. Rank-order analysis indicated that males' responses showed them to be introverted and more interested in working with things than data or people. Although the smaller sample of females makes conclusions less certain, the females' responses were similar to the males'. Since the interests of these people were often incongruent with the physical limitations imposed by their disability, findings suggest that counselors must apply extra ingenuity to assist in identifying vocational alternatives. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differences in coping styles among persons with spinal cord injury: A cluster-analytic approach.

Two subgroups were identified and validated in a group of 53 persons with spinal cord injury by applying cluster-analytic procedures to subjects' self-reported coping and health locus-of-control belief scores. Subjects in Cluster 1 relied extensively on all seven scales of the Ways of Coping Questionnaire, had elevated external health attributions, and reported higher levels of psychological distress and depression. Subjects in Cluster 2 emphasized internal health attributions, reported less distress, and relied less on coping methods described in the Ways of Coping Questionnaire. Treatment implications of results for the two subgroups are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Employment outcomes following spinal cord injury

PURPOSE: We determined the clinical utility of proton MR spectroscopy in defining the extent of disability in benign versus secondary-progressive multiple sclerosis (MS). METHODS: Thirty patients with clinically definite MS, including 16 patients with benign MS and 14 with secondary-progressive MS, and a group of 13 healthy volunteers were studied with combined stimulated-echo acquisition mode proton MR spectroscopy and MR imaging (all patients received contrast material). RESULTS: Acute enhancing lesions of benign and secondary-progressive MS were characterized by a reduction in N-acetylaspartate (NAA)/choline and NAA/creatine and an increase in inositol compounds/creatine as compared with normal white matter. Such variations were also detected in chronic unenhancing lesions in patients with secondary-progressive MS, although they were not found in chronic unenhancing lesions in patients with benign MS. Chronic lesions of the two forms of the disease have significative differences in NAA and inositol signals. CONCLUSION: Proton MR spectroscopy is able to show metabolic changes occurring in the white matter of patients with MS. Such changes differ according to the phase (acute versus chronic) and the clinical form (benign versus secondary-progressive) of the disease.     

Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury.

Objective: The overlap of somatic-depressive symptoms and physical sequelae of spinal cord injury (SCI) has raised concerns regarding the validity of depression screens used within the SCI population. The Patient Health Questionnaire-9 (PHQ-9) measure parallels Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) criteria of major depression. The authors investigated PHQ-9 factor structure among persons with SCI at various times postinjury. Design: Data from 2,570 participants at 1 year (N = 682), 5 years (N = 517), 15 years (N = 653), and 25 years (N = 718) postinjury were used. Emergent factors were correlated with satisfaction with life. Results: A 2-factor solution emerged for all groups, with 3 affective referenced items (feeling depressed/hopeless, feeling bad about self/failure, and suicidal ideation) and 3 somatic referenced items (sleep disturbance, low energy/fatigue, and appetite disturbance) loading consistently on Affective and Somatic factors, respectively, at all time points. Factor scores negatively correlated with satisfaction with life. Conclusions: Dual factor structure of the PHQ-9 is present at various times postinjury in the SCI population. It remains unclear whether somatic item endorsement reflects depressive symptomatology per se; however, endorsement is still associated with satisfaction with life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunogenicity of pneumococcal vaccine in persons with spinal cord injury

OBJECTIVE: To determine immunogenicity and optimum timing for administering the 23-valent pneumococcal vaccine after spinal cord injury (SCI). DESIGN: Double-blind, randomized, placebo control study. SETTING: SCI unit in a tertiary care medical center and community. PARTICIPANTS: Eighty-seven persons with recent SCI. INTERVENTION: Participants were randomized to receive either placebo or pneumococcal vaccine at 16 to 18 days versus 4 to 6 months postinjury. MAIN OUTCOME MEASURES: Antibody concentrations were measured prior to intervention and 1, 2, and 12 months afterward to evaluate the immune response to five serotypes of Streptococcus pneumoniae. Effects of demographic and injury-related variables on immune response were also evaluated. RESULTS: Timing of vaccination did not influence mean antibody concentrations for any serotype (p > .05). Ninety-five percent of vaccinated persons had twofold or greater increases in antibody concentration for at least one serotype when measured 1 month after vaccination versus 35% of placebo groups (p < .01). After 12 months, 93% of vaccinated persons in both groups maintained antibody concentrations twofold or greater than baseline values. CONCLUSIONS: Most participants developed an immune response to at least one serotype that was maintained for at least 12 months. Immune response varied according to serotype. Given the favorable immune response and no effect of timing, persons with SCI should receive pneumococcal vaccine during initial hospitalization.     

Communal behaviors and psychological adjustment of family caregivers and persons with spinal cord injury.

Objective: Examined the influence of mutual communal behaviors on the adjustment reported by persons with spinal cord injury (SCI) and their family caregivers. Previous research has found that persons who have a history of mutually communal behaviors in relationships may react differently to relationship changes after an acquired physical disability than dyads with few communal behaviors. Method: Family caregivers and persons with SCI were administered measures of mutual communal behaviors, depression, and life satisfaction. Structural equation modeling was used to test the relations among caregivers' communal behaviors and care recipients' communal behaviors, depression, and life satisfaction. Results: Caregiver and care recipient reports of communal behaviors were not significantly correlated. Significant paths indicated that care recipients' communal behavior scores were positively associated with their life satisfaction, and care recipients' depression was inversely associated with their life satisfaction. Caregivers' communal behavior scores were unrelated to their self-reported adjustment. Conclusions: Caregiver-care recipient dyads may differ in their perceptions of communal behaviors in their relationships. Although care recipient reports of communal behavior may be related to their life satisfaction, communal behaviors may not serve a similar function among caregivers of persons with SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting compliance with annual follow-up evaluations in persons with spinal cord injury

In this study a representative sample of German acute care hospitals is used to describe the effects of dementia within acute care hospitals. Data from hospital patients above age 60 with the diagnosis dementia (ICD 290, 293, 294 and 310), collected over an observation period of 12 years, are compared with nondemented hospital patients at the same ages. The differences in the average length of stay between demented and nondemented patients are only relatively small in German acute care hospitals. The degree of multimorbidity is higher and hospital infections are more frequent for demented patients. The main differences occur with mortality: demented inpatients of both sexes experience a hospital mortality which is about twice as high as for nondemented patients at the same ages.     

Factors affecting employment following spinal cord injury: A qualitative study.

Examined factors that differentiated persons with spinal cord injury (SCI) who returned to work from those who did not. Ss were 6 employed persons with SCI matched with 6 unemployed persons with SCI on the basis of education, race, age, gender, time since injury, and level of function. Semistructured interviews 1 to 2 hrs in length were completed and transcribed. The responses of the employed were compared with those of the unemployed using grounded theory. The theory is inductively derived from the qualitative data. Psychological and environmental factors were the most salient factors affecting employment in this matched sample. Key psychological factors associated with employment were optimism, self-esteem, achievement orientation, and role models. Key environmental factors were monetary incentives, disincentives, access, and accommodation. Conclusions: The development of increased optimism may promote employment for persons with SCI. Employment barriers and the perception of these barriers as insurmountable need to be decreased. Policies that promote return to work with former employers are likely to improve employment rates for persons with SCI A more intensive job exploration process using job shadowing of peers and positive peer models may also improve employment after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury.

Objective: To examine associations between pain severity, psychological distress, catastrophizing, and indices of functional disability in a sample of persons with spinal cord injury (SCI). Catastrophizing was examined as a potential mediator of associations between pain severity, psychological distress, and functional disability. Design and Participants: Questionnaires assessing pain severity, psychological distress, catastrophizing, pain interference, and community integration were completed by 237 persons with SCI. Results: Psychological distress and pain severity were associated significantly with greater functional disability. Moreover, the association between pain severity and functional disability was strongest among persons with high psychological distress. Catastrophizing appeared to mediate the associations between pain severity, psychological distress, and functional disability. Conclusions: Pain severity and psychological distress have the potential for both direct and interactive effects on functional disability, possibly through the mediating effects of catastrophizing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Girls with spinal cord injury: Social and job-related participation and psychosocial outcomes.

Objective: To examine social and job-related participation among girls with spinal cord injury (SCI) and relationships between participation, depression, and quality of life. Participants and Setting: This sample included 97 girls (aged 7–17 years) who had sustained SCI at least 1 year prior to interview, and who were receiving care at three pediatric SCI centers within a single hospital system. Measures: Participants completed the Children’s Assessment of Participation and Enjoyment, Children’s Depression Inventory, and Pediatric Quality of Life Inventory. Caregivers completed a demographics form. Results: Girls participated more often in social activities than in job-related activities and participated in social activities with a more diverse group and further from home. A broader context of social participation was related to lower depression, which in turn was related to higher quality of life. Higher frequency of job-related participation was related to lower depression, which in turn was related to higher quality of life. Conclusions: Social and job-related participation are related to psychosocial outcomes among girls with SCI. Participation in social and job-related activities should be a focus of rehabilitation for girls, because the skills gained from this involvement may help build resilience against future obstacles to socialization and employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between pressure sores and psychosocial adjustment in persons with spinal cord injury.

Demonstrated a relationship between the occurrence of pressure sores during inpatient medical rehabilitation and scores on the Human Service Scale (HSS). 566 Ss with spinal cord injury who were 1–4 yrs postinjury participated. Results indicate that Ss who had developed pressure sores during inpatient rehabilitation scored lower on the HSS 1–4 yrs after discharge than did Ss who had not developed such sores. Possible explanations of this relationship are discussed with respect to activity repertoire, psychosocial adjustment, and compliance vs control. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and the prediction of health complications among persons with spinal cord injuries.

Examined the relationship between interpersonal behavior and adjustment to spinal cord injury in 95 patients (aged 20–66 yrs) hospitalized at 3 facilities. In the 1st study, where predictor variables included social support, depression, and demographic factors, elements of social support were not significantly associated with reasons for hospitalizations. Older age, complete lesions, and paraplegia were significantly related to skin breakdown, cognitive problems, and less likelihood of routine checkups; tetraplegia was associated with checkups. The 2nd study reviewed the medical charts of 52 Ss from the 1st study and tallied the incidence of decubitus ulcers and urinary tract infections reported during the year. Discriminant function analysis found level of injury, lesion, age, depression, and elements of social support to be significantly predictive of health complications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting employment status at 2 years' postdischarge from spinal cord injury rehabilitation.

Objectives: This exploratory study examined the extent to which postinjury employment was predictable when patients were followed up 2 years' postdischarge from a specialist Spinal Cord Injury (SCI) Unit. Participants and Design: Seventy-two individuals with SCI for whom there were discharge Functional Independence Measure (FIM) scores, 60 complete sets of data were available for Discriminant Function Analysis. Results: Using a combination of variables assessed prior to or shortly after discharge from rehabilitation, complemented by psychosocial variables assessed at the time of follow-up, moderate classification accuracy was achieved with respect to employment status at the 2-year follow-up period (72%), with the set of predictor variables being more accurate at predicting those subsequently in paid employment (83%) than those not (67%). Conclusions: The main implication of the study results is that nontraditional variables (i.e., variables other than injury and demographic variables), including, particularly, contextual environmental variables such as community integration, access to transport, and social support, are worthy of further research, especially because many of these are amenable to rehabilitation program interventions, and thus may facilitate the attainment of enhanced rates of postdischarge employment among those living with SCI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social support and the well-being of persons with spinal cord injury living in the community.

100 men and 40 women (all aged 19–77 yrs) with spinal cord injury completed a social support questionnaire, the Center for Epidemiologic Studies Depression Scale, the Life Satisfaction Index Form A, and a single-item self-assessment of health status. A physician assessed the presence or absence of urinary tract infection from laboratory findings and determined the absence, presence, and severity of pressure ulcers from physical examination. Amount of social support was positively related to life satisfaction and physical well-being. Satisfaction with one's support network was associated negatively with depressive symptomatology and positively with life satisfaction. There were significant differences in the correlations between life satisfaction and total social support for men and women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding health outcomes: Physical secondary conditions in people with spinal cord injury.

Objective: To examine the association of predisposing characteristics and enabling characteristics with physical secondary conditions through health practices and health care use in people with spinal cord injury (SCI). Design: Cross-sectional survey mailed to adults in portions of the northeastern and northwestern United States. Participants: Two hundred seventy adults with SCI recruited through durable medical equipment supply companies. Main Outcome Measures: Self-reported health practices, health care use, and physical secondary conditions. Results: In the Andersen behavioral model, F increment tests supported findings that predisposing characteristics accounted for 12% of variance in secondary conditions, enabling characteristics accounted for 16%, and health practices and health care use accounted for another 13%. Path analysis revealed that health care use mediated self-efficacy and interpersonal support. Conclusions: Predisposing characteristics including self-efficacy, enabling characteristics, and health care use are associated with physical secondary conditions in complex ways. More research is needed on measures of health practices and their relation to secondary conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inpatient hospital utilization among veterans with traumatic spinal cord injury

OBJECTIVE: To describe the pattern of inpatient hospital utilization, up to 15 years after injury, among a cohort of veterans with service-connected traumatic spinal cord injury (SCI). PATIENTS: A cohort of 1,250 male veterans, with traumatic SCI occurring between 1970 and 1986, who visited the VA within 1 year of injury, was assembled from VA administrative files; diagnosis was verified by examining hospital discharge summaries. DESIGN: Computerized record linkage among Department of Veterans Affairs (VA) administrative files was used to determine patterns of inpatient hospital utilization. MAIN OUTCOME MEASURE: Pattern of inpatient admissions and length of stay (LOS). RESULTS: Patients were typically white males injured in their mid-twenties. The initial VA hospitalization began approximately 6 weeks after injury and lasted 4 to 7 months, depending on injury level and completeness. Subsequent hospitalizations usually lasted approximately 10 days, but 22% of stays exceeded 1 months. Most hospitalizations took place in specialized SCI Centers. Comparing the 1980s with the 1970s, patients in the 1980s entered VA facilities sooner after injury, were more likely to visit SCI Centers, and had shorter initial stays. Rates for the incidence of rehospitalization decreased rapidly in years 2-5 after injury and declined less rapidly thereafter. Occupancy rates and proportion rehospitalized followed similar patterns. The incidence rate for persons with complete quadriplegia was approximately twice that of patients with incomplete paraplegia. Between 1970 and 1991, both the rehospitalization incidence rate and LOS decreased by approximately 20%. Only 10% of patients accounted for 46% of the total LOS. LOS during the first five years was predictive of later LOS. CONCLUSIONS: The pattern of rehospitalization in VA facilities was generally consistent with that of the Model Systems. Efforts toward preventing rehospitalization should target persons with previous high utilization.     

Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors

The prevalence and correlates of pressure ulcers in terms of their number, severity, and anatomical location were studied in a community-based sample of 100 men and 40 women with spinal cord injury. Thirty-three percent (n = 46) presented with one or more ulcers of at least one stage I severity when visually examined. Twenty-one individuals had more than one ulcer, the maximum number of ulcers being seven. Of 87 ulcers for which severity ratings were available, 30 (34.5%) were stage I, 33 (37.9%) were stage II, and 24 (27.6%) were either stage III or IV. Individuals with an ulcer exhibited more paralysis and were more dependent on others in activities of daily living. A greater proportion of blacks had more severe ulcers (stages III and IV) than their white counterparts. Persons with more severe ulcers incurred their injury later in life, and had significantly lower mean scores on the Occupation and Mobility dimensions of the Craig Handicap Assessment and Reporting Technique. The findings suggest that factors governing initial development of a pressure ulcer differ in part from those responsible for an ulcer progressing in severity.     

Qualitative analysis of the peer-mentoring relationship among individuals with spinal cord injury.

Objectives: To identify salient dimensions and outcomes of the peer-mentoring relationship among individuals with spinal cord injury (SCI). To understand from the perspective of the mentee how the mentoring relationship differs from other supportive relationships. Study Design: Qualitative. Participants: Convenience sample of 7 mentees from a hospital-based SCI peer-mentoring project. Method: Telephone interviews with mentees were conducted 1-4 months postdischarge, and results were coanalyzed with grounded theory methodology. Results: Mentees emphasized the impact of the mentor in terms of his or her practical, emotional, and identity-changing influence. Relationship quality was influenced by multiple factors (e.g., age, friendliness). Five components of the relationship (credibility, equitability, mutuality, acceptance, normalization) differentiated mentoring from other supportive relationships. Conclusions: Peer mentors provide a unique combination of supportive elements not replicated by other relationships. Mentoring programs are useful interventions for facilitating adjustment after SCI. Recommendations for implementing a mentoring program are provided on the basis of participant suggestions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)