Sexuality after spinal cord injury: A conceptual model based on women's narratives.

Objective: To investigate how women experience and conceptualize their sexuality after traumatic spinal cord injury (SCI). Research Method: Semistructured interviews and member checks with 24 women with SCI (ages 18-67) were conducted and content analyzed. Results: A conceptual model of sexual domains is proposed. Proposed domains are self- versus other focus, genital versus whole-body focus, physical versus holistic intimacy, sexuality as bodily versus mental phenomenon, exuberance versus negativity, and past versus present focus. Domains are defined and illustrated with narrative excerpts. They are conceptualized as fluid and nonexclusive. Conclusion: Endorsement of domains can change through ongoing adjustment to injury and life events. Clinical implications and suggestions for future research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Ethnicity and age issues: Attitudes affecting rehabilitation of individuals with spinal cord injury.

The individual with spinal cord injury, family, staff, and significant others bring attitudes regarding age and ethnicity into the rehabilitation team dynamic. Such preconceived attitudes may direct one's ability to be open to change and incorporate new information. The authors present 3 cases that highlight the bidirectional nature of bias challenges and the potential impact of bias issues on the hospital setting, staff, individual, family, and significant others. The bidirectional nature of bias challenges is illustrated with 2 cases of bias issues presented by individuals with spinal cord injury during hospitalization and with I case of bias impact on an individual health care provider. Interventions and strategies to maximize information sharing, education, and adjustment during hospitalization, discharge planning, and community living are discussed. Individuals may face increasing challenges in maximizing the derived benefit from both health care delivery and community services if personal bias plays a role in excluding qualified personnel from consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Spinal cord injuries: psychological, social, and vocational rehabilitation.

Reviews the book, Spinal cord injuries: Psychological, social, and vocational rehabilitation, 2nd Edition by Roberta B. Trieschmann (1988). Despite the extensive rewriting and reorganization, however, the clarity and readability of the first edition has not been sacrificed. Owners of the first edition may want to obtain this one as well. In addition to presenting the information on psycho/social/vocational dimensions of spinal cord injury (SCI) in a developmental manner, from acute onset through rehabilitation and long-term adjustment issues, the author also discusses in depth such issues as traumatic brain injury, locus of control, substance abuse, independent living, and so on. Some of the topics covered in this edition that are not dealt with in the first edition are athletics, biofeedback, community integration, gender issues, quality of life, parenting, and respirator dependency. Some topics such as aging, attitudes, family issues, and sexuality are dealt with more completely. In addition to the empirical, critical analysis of the research on SCI that the first edition was known for, the second edition also suggests ways in which the research needs to be improved and supplemented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and major depression in veterans with spinal cord injury.

Objective: To explore the relationship between posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in veterans with spinal cord injury and to compare those results with results found in veterans who had sustained other traumatic injuries. Method: To investigate the relationship between PTSD and MDD in persons with spinal cord injury, the authors examined whether individuals endorsed overlapping items on measures of both disorders, evaluated the contribution of overlapping items to comorbid diagnosis, and conducted an exploratory factor analysis. Results: The overlapping symptoms between the 2 disorders did not fully explain the high rate of comorbidity, although participants who endorsed a symptom common to MDD and PTSD on 1 measure were likely to endorse the corresponding item on another measure. In both samples, items loaded on separate PTSD and MDD factors. Conclusion: MDD and PTSD appear to represent independent reactions to trauma in those individuals who had experienced either a nonspinal cord injury or a spinal cord injury. This research also provides an initial investigation of some of the possible ways that MDD and PTSD are related by addressing psychometric issues inherent in their measurement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Preliminary Study of Acute Family Needs After Spinal Cord Injury: Analysis and Implications.

Objective: To address the paucity of research on family needs following spinal cord injury (SCI). Study Design: Prospective cross-sectional design. Setting: Inpatient SCI rehabilitation unit within a Level 1 trauma center. Participants: Family members of 17 inpatients with SCI. Main Outcome Measure: Family Needs Questionnaire (FNQ). Results: Eighteen of the 40 FNQ needs were rated as important or very important by 100% of the respondents. Health Information Needs were rated as most important and Instrumental Support Needs as least important. Involvement With Care Needs were most often met, whereas Emotional Support Needs were most often unmet. Conclusions: The FNQ is a promising measure of family members' needs after SCI and treatment planning and program evaluation tool. Findings affirm that family education is important during rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of depressive symptoms during inpatient rehabilitation for spinal cord injury: Is there an underlying somatic factor when using the PHQ?

Objective: To test the hypothesis that a 2-factor solution, including a somatic factor, best accounts for the response pattern to the Patient Health Questionnaire-9 (PHQ-9) during inpatient rehabilitation after spinal cord injury (SCI). Research Design: 568 adults with traumatic SCI were administered the PHQ-9 during inpatient rehabilitation. The PHQ-9 was developed to identify depressive disorders based on DSM-IV criteria. Results: Maximum likelihood confirmatory factor analysis was used to compare unidimensional and alternative 2-factor models. The results suggested that the 2-factor solution with 3 somatic items (sleep disturbance, poor energy, appetite change) was a better solution than either a unidimensional model or 2-factor model that included psychomotor retardation as a fourth somatic item. The root mean square error of approximation with 3 somatic items fell within the acceptable range of less than .08 (.073). The 2 factors were highly correlated (.76) but within the acceptable range (less than .80). Conclusions: There may be 2 underlying factors with the PHQ-9, including a somatic factor, when measuring depressive symptoms during inpatient rehabilitation for SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meeting with clay: Individual narratives, self-reflection, and action.

The arts-based qualitative research presented in this article explores the interaction between nonartists and a specific art material, clay, and on reflection, the meaning that they make from this interaction. The aspect of meaning making focused on relates to a typology of thinking and doing strategies that emerged from the research. Thinking and doing are seen as 2 aspects of a creative process here with clay, which are interdependent. The thinking category encompasses 4 groups in which the participants employ different modes of thinking strategies. Different modes of thinking create a different kind of doing with the material. These "dialogues" between creator and material can be seen to exemplify individual ways of "making sense" in the interaction between sensing, feeling, thinking, and doing; and the material, in which structure, process, content, and meaning intertwine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury.

Study Design: Systematic review. Objective: To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). Method: Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. Results: Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. Conclusions: CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Positive psychological variables in the prediction of life satisfaction after spinal cord injury.

Objective: To examine relationships between select positive psychological variables and life satisfaction in persons with spinal cord injury during acute rehabilitation and 3 months after discharge. Design: Prospective observational design; correlational and regression analyses. Eighty-seven adults who were participating in in-patient, acute rehabilitation for spinal cord injury in two metropolitan hospitals completed the following measures: Benefit finding Scale, Hope Scale, Brief Symptom Inventory, COPE, Positive and Negative Affect Schedule, and Satisfaction with Life Scale. Results: Hypothesized relationships of hope and positive affect (facilitator variables) with greater life satisfaction during the initial acute rehabilitation period were supported. Facilitators, as measured at baseline, accounted for a significant amount of variance in life satisfaction above and beyond barrier variables (depression, negative affect, and avoidant coping) both during the acute rehabilitation phase (R2 change = .20, p R2 change = .09, p     

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: A randomized clinical trial.

Purpose: To compare coping effectiveness training (CET) with supportive group therapy (SGT) for anxiety, depression, and adjustment to injury in an acute spinal cord injury/dysfunction (SCI/D) rehabilitation population. CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups (Kennedy, Duff, Evans, & Beedie, 2003; King & Kennedy, 1999). The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition, SGT. Research Method: Participants (N = 40) entering a hospital-based program were assigned to treatment condition using block randomization. Questionnaire mood measures were completed at program admission, program discharge, and 3-month postdischarge follow-up. Adjustment to disability was assessed at follow-up only. Analyses of variance tested for group differences in anxiety, depression, and adjustment to injury. Results: Both groups reported reductions in mood symptoms with no differences between treatment conditions. However, similar reductions were obtained after fewer sessions of CET. Symptoms of depression increased in both groups following hospital discharge. Conclusions: Clinical and research implications, including innovative interventions during the period after discharge, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the Patient Health Questionnaire and the Older Adult Health and Mood Questionnaire for self-reported depressive symptoms after spinal cord injury.

Objective: To directly compare estimates of potential depressive disorders and clinically significant depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) and Older Adult Health and Mood Questionnaire (OAHMQ) among participants with spinal cord injury (SCI). Research Design: 727 participants from a hospital in the Southeastern United States were administered the PHQ-9 and OAHMQ during a follow-up survey. We compared the rates of depressive disorders using cutoff scores and diagnostic criteria for each instrument. No independent psychiatric diagnostic interviews were conducted. Results: The PHQ-9 and OAHMQ were significantly correlated (r = .78), and both were correlated with satisfaction with life (r = ?.48, ?.54). Using recommended diagnostic scoring procedures, 10.7% of participants met the diagnostic criteria for major depressive disorder with the PHQ-9; 9.3% met the criteria for major depression based on PHQ-9 ≥ 10; and 19.7% based on PHQ-9 ≥ 15. Using the OAHMQ, 19.7% reported probable major depression and 44.5% clinically significant symptomatology. Conclusions: The measures were highly correlated overall. However, the estimated prevalence of depressive disorders varied substantially between the 2 instruments. These estimates were comparable to those previously reported for each instrument (i.e., higher rates with the OAHMQ). Therefore, differing estimates of depressive disorders reported in the literature using these instruments were largely attributable to the instruments themselves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individualizing relaxation training in spinal cord injury: Importance of injury level and person factors.

Objective: To illustrate the value of modifying relaxation training techniques according to level of spinal cord injury. Participants and Setting: Six individuals receiving psychological services on an inpatient spinal cord injury unit. Procedure: Psychological assessment and interdisciplinary team consultation were used to develop individualized relaxation training protocols. Results: Staff observations and patient self-reports revealed improvements in various behavioral and affective factors (e.g., reduced pain, increased participation in therapy, diminished depression). Conclusions: Clinicians should consider level of spinal cord injury and individual differences when selecting relaxation techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep problems in individuals with spinal cord injury: Frequency and age effects.

Objectives: The two objectives of this study were (a) to replicate the previous finding of more severe sleep difficulties in a sample of individuals with spinal cord injury (SCI) compared with normative samples, and (b) to examine the associations between aging variables (specifically, chronological age, duration of SCI, age at SCI onset) and the severity of sleep difficulties. Design: Cross-sectional survey. Research Method: A survey was administered to 620 individuals with SCI that included measures of demographic characteristics and sleep difficulties. Results: The findings indicated that sleep problems are more common in individuals with SCI than in normative samples. In addition, younger participants in our sample reported more sleep problems than did older participants. Duration of SCI and age at onset, however, were not significantly associated with sleep difficulties. Conclusion: The analyses used in this study provide a model for examining age effects using concurrent survey data that may be useful for other investigators interested in studying the associations between age-related variables and important health-related domains. (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)     

Spinal Cord Injury Pain: Impact, Classification, Treatment Trends, and Implications From Translational Research.

Pain following spinal cord injury (SCI) has been recognized as a significant problem in the literature for over half a century. Prevalence estimates have varied widely, with most reports suggesting this to be an extremely common condition (60%-90%). Severe pain is reported by perhaps 25%, but for these persons, pain is literally the "insult added to injury." Effective treatments with a substantial body of empirical support did not exist until recently, and research progress has been compromised by lack of a standardized method for classifying and assessing pain. Encouraging developments for both assessment and treatment have occurred and are reviewed. There have been parallel developments in research using animal models of SCI pain that argue for exploration of translational work from animals to humans. Areas of research in which psychologists have been active and/or could become active are reviewed, both in clinical and translational research arenas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cluster Analysis and Chronic Pain: An Empirical Classification of Pain Subgroups in a Spinal Cord Injury Sample.

Objective: To determine the existence of homogeneous spinal cord injury (SCI) pain subgroups. Design: Prospective longitudinal design. Participants: Persons with traumatic onset SCI (N = 1,334) with self-reported pain, pain interference, and depression. Outcome Measures: Pain (Numerical Rating Scale); pain interference (item from the Short Form-12); and depression (Brief Patient Health Questionnaire). Results: Multivariate clustering revealed 4 SCI pain subgroups: low pain (low pain intensity, pain interference, and depression); positive adaptation to pain (high pain intensity, low pain interference and depression); minimal distress (high pain intensity, high pain interference, and low depression); and chronic pain syndrome (high pain intensity, pain interference, and depression). Conclusions: The characteristics of homogeneous SCI pain subgroups may be important for clinicians to consider in treatment planning and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Men with serious injuries: Relations among masculinity, age, and alcohol use.

Objective: To increase understanding of masculine role attitudes and conflicts associated with alcohol use among men with serious injuries. Participants and Measures: Fifty-two Midwestern adult men with spinal cord injury or traumatic brain injury completed masculine role attitudes and conflicts and alcohol consumption instruments. Age and blood alcohol content at injury were obtained from records. Results: Younger men reported greater pursuit of status, drive for dominance, and risk taking but less self-reliance and overall masculine role conflict. Earlier age of injury was associated with greater pursuit of status and drive for dominance but less self-reliance, restrictive emotionality, and overall masculine role conflict. Endorsement of dominance correlated positively with number of alcoholic drinks per drinking episode (rs = .43) and binge drinking (rs = .47). Masculine role conflict associated with success, power, and competition correlated with number of drinks per drinking episode (rs = .46). Implications: Greater awareness and sensitivity to masculinity-related attitudes and conflicts may (a) reduce psychological barriers to accepting assistance, (b) promote active engagement in rehabilitation activities, (c) avoid counterproductive ambivalence and resistance, and (d) improve the therapeutic working alliance associated with favorable outcomes among men with serious injuries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preferred methods and messengers for delivering physical activity information to people with spinal cord injury: A focus group study.

Objective: To explore the perceptions of people with spinal cord injury (SCI) regarding preferred messengers and methods for obtaining physical activity (PA) information. Design: Using a phenomenological approach and interviewing techniques, five focus groups discussed PA information delivery methods and messengers. Participants: Sixteen community-dwelling adults with SCI (62.5% tetraplegia, 37.5% paraplegia; at least one-year postinjury) whose PA levels ranged from sedentary to regularly active. Results: Content analyses revealed that the preferred media for obtaining PA information were passive sources (e.g., Internet, DVDs, newsletters). The preferred messengers were peers and health service providers. There were diverse perspectives about the value and types of PA messages to share with people in the acute, rehabilitation, and postdischarge stages. Conclusions: The methods and messengers identified in this study illustrate the need for interdisciplinary engagement among various program and health care providers to work together to effectively deliver PA information to all individuals with SCI. People will be receptive to different messages, from different channels, at different times. (PsycINFO Database Record (c) 2011 APA, all rights reserved)