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)     

Employment following spinal cord injury: A covariance structure analysis.

120 former patients of a rehabilitation center responded to a survey that tested 2 structural models of employment status following spinal cord injury. The direct effect model provided a very poor representation of the data. The model proposed in this study provided a better fit, but also fell short of the minimum acceptable goodness-of-fit standards. Educational attainment (EA), motivation to work (MTW), social support, and driving one's own car had significant direct paths to employment status. EA and lesion level were linked to MTW. Age at injury directly predicted EA. The hypothesized link between locus of control and MTW was rejected, and subsequent investigation raised questions about its direction of causality with other variables in the model. A revised model for future research was presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study.

We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50–68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does pain interference mediate the relationship of independence in ambulation with depressive symptoms after spinal cord injury?

Purpose/Objective: To test a mediational model that hypothesizes pain interference mediates the relationship between ambulatory status and depressive symptoms among participants with traumatic spinal cord injury (SCI). Research Method/Design: Responses to the Brief Pain Index (pain interference) and the Older Adult Health and Mood Questionnaire (depressive symptoms) were obtained from 1,545 adults with SCI. Logistic regression was used to calculate the odds of clinically significant symptomatology and probable major depression as a function of independence in ambulation and to evaluate the extent to which pain interference mediated the relationship between ambulation and a depressive diagnosis. Results: Partially dependent ambulators reported significantly greater odds of clinically significant symptomatology (2.30) and probable major depression (2.00) compared with independent ambulators prior to evaluation of pain interference (comparisons of wheelchair users with independent ambulators were not significant). However, these relationships were no longer significant after controlling for pain interference. Conclusions/Implications: Pain interference appears to mediate the relationship between ambulatory status and depressive symptoms after SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being

OBJECTIVE: To assess the prevalence, severity, and correlates of chronic pain in a community-based sample of men with spinal cord injury (SCI). DESIGN: Survey. SETTING: Community. PARTICIPANTS: Seventy-seven men with SCI randomly selected from a sampling frame solicited from the community. METHOD: Participants completed standardized questionnaires assessing many areas of life, were interviewed in their homes, and underwent a physical examination at a hospital. There they were interviewed by an anesthesiologist regarding chronic pain, and a nurse administered objective pain measures. RESULTS: Seventy-five percent of the men reported chronic pain. Chronic pain was associated with more depressive symptoms, more perceived stress, and poorer self-assessed health. Greater intensity of pain was related to less paralytic impairment, violent etiology, and more perceived stress. Area of the body affected by pain was related to independence and mobility. CONCLUSIONS: Because of the high prevalence of chronic pain in the population with SCI and its relation to disability, handicap, and quality of life, health care providers need to give this issue the same priority given to other SCI health issues. Analysis of individual pain components provides better information than assessing overall pain. It is futile to treat SCI pain without giving full attention to subjective factors.     

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)     

Moderating effects of three coping strategies and self-esteem on perceived discrimination and depressive symptoms: A minority stress model for Asian international students.

This study examined 3 coping strategies (reflective, suppressive, and reactive), along with self-esteem, as moderators of the relation between perceived discrimination and depressive symptoms. International students (N = 354) from China, India, Korea, Taiwan, and Hong Kong provided data via an online survey. The role of perceived general stress was statistically controlled. Hierarchical regression analyses indicated a significant direct effect of perceived discrimination, a significant 2-way interaction of perceived discrimination and suppressive coping, and a significant 3-way interaction of perceived discrimination, reactive coping, and self-esteem in predicting depressive symptoms. An increased tendency to use suppressive coping appeared to strengthen the association between perceived discrimination and depressive symptoms. In contrast, the association between perceived discrimination and depressive symptoms was not significant when reactive coping was infrequently used, but only for students with relatively high self-esteem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cultural construction of social support in Brazil: associations with health outcomes

The association of social support and health outcomes has received considerable attention in recent years, but the cultural dimension of social support has not been extensively investigated. In this paper, using data collected in a Brazilian city, we present results indicating that those individuals whose reported access to social support more closely approximates an ideal cultural model of access to social support have lower blood pressure and report fewer depressive symptoms and lower levels of perceived stress. The cultural model of social support is derived using a combination of participant observation, semi-structured interviews, and the systematic ethnographic technique of cultural consensus modelling. These results are then used to develop a measure of an individual's approximation to that model of social support in a survey of four diverse neighborhoods in the city (n = 250). We call this approximation to the ideal cultural model of social support "cultural consonance" in social support. The association of health outcomes with cultural consonance in social support is independent of individual differences in the reporting of social support, and of standard covariates. In the case of blood pressure and perceived stress, it is independent of diet, and other socioeconomic and psychosocial variables. The association with depressive symptoms is not independent of other psychosocial variables. The implications of these results are discussed with respect to research on cultural dimensions of the distribution of disease.     

Family caregivers of persons with spinal cord injury: Predicting caregivers at risk for probable depression.

Objective: To determine the percentage of family caregivers of persons with spinal cord injury (SCI) with probable depression and to test the hypothesis that dysfunctional problem-solving abilities would be significantly predictive of risk status after taking into account important demographic characteristics and caregiver health. Design: Correlational and logistic regression analyses of data collected in a cross-sectional design. Participants: Eighteen men and 103 women caregivers (mean age of caregivers = 45.66 years, SD = 12.88) of individuals with SCI. Main Outcome Measure: The Inventory to Diagnose Depression. Results: Nineteen caregivers (15.7%) met criteria on the Inventory to Diagnose Depression for a major depressive disorder. A dysfunctional problem-solving style was significantly predictive of caregiver depression, regardless of the severity of physical impairment of the care recipient or the physical health of the caregiver and caregiver demographic variables. Conclusions: The percentage of caregivers with probable depressive disorder may parallel that observed among persons with SCI, using a more conservative self-report measure designed to assess symptoms associated with a depressive syndrome. Family caregivers with a dysfunctional problem-solving style and assisting individuals with more severe injuries may have probable depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life activities among individuals with spinal cord injury living in the community: Perceived choice and perceived barriers.

Objective: To apply the World Health Organization model of functioning to a study of perceived choice over life activities and barriers to engaging in life activities among persons with spinal cord injury. Participants and Setting: This large community-dwelling sample included 255 participants from 2 urban sites and 1 rural site. Measure: Items from the Participation of People With Mobility Limitations Survey were used. Results: Approximately half of the participants reported little or no perceived choice with employment, and the majority reported low levels of satisfaction with choice with employment. Access to employment was limited by physical barriers (48%) and transportation (46%). Physical impairment, pain, and fatigue were also barriers. Conclusions: Improvements of workplace and transportation accessibility, increased vocational supports, and interventions to decrease pain and fatigue are needed to ensure participation for persons with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses.

The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial discrimination stress, coping, and depressive symptoms among Asian Americans: A moderation analysis.

The purpose of our study was to explore: (a) the association between racial discrimination stress and depressive symptoms, and (b) how coping (e.g., individualistic/collectivistic and dispositional/situation-specific coping) attenuated or strengthened this association specifically among Asian Americans. Data were collected from 201 Asian Americans in a large Midwestern state university through an online survey. Results from a hierarchical regression indicated that racial discrimination stress significantly predicted depressive symptoms over and beyond perceived general stress and perceived racial discrimination. For the moderation effect, the simple effect analyses indicated that low utilization of reactive coping strategies and a high helpfulness rating of family support reduced the strength of association between racial discrimination stress and depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developmental relations between perceived social support and depressive symptoms through emerging adulthood: Blood is thicker than water.

Longitudinal trajectories of depressive symptoms, perceived support from family, and perceived support from friends were examined among 816 emerging adults (480 women; 59%). In the context of a larger longitudinal investigation on the predictors and course of depression, data were drawn from eight self-report questionnaire assessments that roughly spanned the third decade of life. An age-based scaling approach was used to model trajectories of depressive symptoms and perceived social support between the ages of 21 and 30. Associative models of the relations between depressive symptoms and perceived social support from family and friends were tested. Results indicated that depressive symptoms decreased and perceived social support increased during the study period. Associative models suggested that among women, higher initial levels of perceived support from family predicted slower decreases in depressive symptoms (b = .34, p     

The relationship of community quality to the health of women and men

Using a 1996 community survey of behavioral risk factors, this cross-sectional study of 804 residents in a rural community examines the relationship of community quality to the health status of women and men. We use two categories of community factors to assess community quality: measures of the social quality of community life, and measures of community quality that focus on the physical environment. Health status is assessed by four measures that examine perceived health status and functioning. Regression results indicate that there is a significant relationship between the quality of the community and health status for both women and men. Specifically, women's perceptions about the social quality of their community are positively associated with their perceived health status and functioning; furthermore, these relationships are significantly different from those of men. Men's perceptions of their physical environment are significantly related to their reported functioning and health, to a limited extent these relationships are different from women. These relationships support our hypothesis that gender differentially affects the relationship between community quality and health.     

Psychological well-being after spinal cord injury: Perception of loss and meaning making.

Objective: This study examined the influence of medical injury severity, perceived loss of physical functioning (conceptualized as physical resource loss), and global meaning making on psychological well-being among 79 veterans living with a spinal cord injury. Measures: Structured interviews were completed to assess perceived loss of physical abilities using the Conservation of Resources—Evaluation and SF-36 Health Survey, global meaning making (Purpose in Life scale), and psychological well-being (Sense of Well-Being Inventory). Medical injury severity was calculated from medical records. Results: Medical injury severity was not related to psychological well-being, whereas perceived loss of physical functioning was inversely associated. Global meaning making was significantly related to and accounted for a large portion of the variance in psychological well-being. Results suggest that global meaning making partially mediates perceived loss of physical resources and psychological well-being. Conclusion: The perceived loss of physical abilities and the generation of meaning and purpose in life are important variables that relate to positive adaptation following spinal cord injury. Treatment implications related to factors that increase quality of life following spinal cord injury are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community competence and violently acquired spinal cord injury: Employment as a peer role model.

Purpose: To understand how employment as a peer role model within a rehabilitation hospital affects the development of community competence among young men and women with violently acquired spinal cord injury (VASCI). Design: A mixed-method, multiple case study design was incorporated, in which 2 cases were selected for study, including 10 individuals who were currently employed as peer role models and 10 individuals who were not. Results: Results revealed several differences between the 2 cases, as peer role models demonstrated greater knowledge and use of community resources. Furthermore, results highlighted the processes by which these changes occurred, including that peer role models had more direct exposure to resources, engaged in the act of sharing resources with others, and experienced an increased connection to positive networks. Conclusions: Findings suggest that the experience of employment as a peer role model within a rehabilitation setting may facilitate connections between individuals with VASCI and the community supports and resources necessary for successful postinjury adjustment. Implications for future research and theory are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blood pressure lowering effect of low intensity aerobic training in elderly hypertensive patients

OBJECTIVE: The prevalence and etiology of pre- and postpartum depressive symptoms in women in a variety of family forms have been well documented, but relatively little research has been conducted on the adjustment of their male partners. The authors' goals in this study were 1) to estimate rates of depression during the pregnancy and 8 weeks following the birth of a child in a large representative community sample of fathers in different family structures and 2) to explore the role of stressful life events, social and emotional support, the quality of the partner relationship, and socioeconomic circumstances. METHOD: This study describes the relations of family setting and other correlates to men's depressive symptoms during the pregnancies (18 weeks gestation, on average) and 8 weeks after the births of children for 7,018 partners of female participants in the Avon Longitudinal Study of Pregnancy and Childhood. RESULTS: Men living in stepfamilies had-significantly higher levels of depressive symptoms before and after the birth than did men in more traditional families. The effect of stepfamily status on depression was mediated by education, life events, social support, social network, and level of aggression in the partnership. CONCLUSIONS: There are similarities in the patterns and correlates of depression after the birth of a child for men and women. These findings point to the importance of family and partnership ecology in the adjustment of men before and after the birth of a child.     

Social support as a mediator in the relation between functional status and quality of life in older adults.

The relations among physical functioning, social support, depressive symptoms, and life satisfaction were examined in a national sample of 4,734 adults age 65 and older. Regression analyses were used to examine the relative importance of objective and subjective support measures in understanding the relation between physical impairment and quality of life. Impairment was associated with fewer friendship contacts, fewer family contacts, less perceived belonging support, and less perceived tangible aid, but only measures of perceived support predicted depressive symptomatology. A structural equation modeling approach was then used to explore the mediational role of perceived social support in the relation between impairment and quality of life variables. Results are consistent with the hypothesis that lower reported social support is an important reason for decreases in life satisfaction and increases in depressive symptoms found among older adult populations. Implications for understanding the role of social support in attenuating the effects of physical disability in older adults are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An integrated model of self-harm: Identifying predictors of intent.

The present study was conducted to investigate a Theory of Planned Behaviour (TPB) model, which integrated social–cognitive and symptom variables as predictors of self-harm intent. Participants were 62 young adults with a history of self-harm who completed a series of online questionnaires to investigate the role of depressive symptoms and TPB components as predictors of self-harm intent. Social–cognitive variables predicted unique variance in self-harm intent after controlling for depressive symptoms. Specifically, more favourable attitudes toward self-harm and a lack of perceived behaviour control at the time of self-harm were unique predictors of intent. In the context of more frequent self-harm, attitudes remained a significant and unique predictor of self-harm intent. Favourable attitudes toward self-harm and a lack of perceived control at the time it occurred partially mediate the relation between depressive symptoms and self-harm intent. Findings provide preliminary support for a self-harm model comprising symptom and social–cognitive variables. Results offer new avenues for future research, highlight conceptual issues, and suggest several clinical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of social relationships with depressive symptoms: Testing an alternative to social support.

Low social support and expressed emotion have been associated with depression, but no studies examined their relative contributions. A self-report questionnaire was developed to measure family emotional involvement and perceived criticism to assess the main components of family expressed emotion. 83 family practice patients older than 40 yrs responded to a survey assessing depressive symptoms, social support, life events, and expressed emotion. Perceived criticism, intense emotional involvement, and negative life events were all independently associated with depressive symptoms. After controlling for expressed emotion, the association of low social support with depressive symptoms was no longer statistically significant. Results support the primacy of family interactions (with high perceived criticism and emotional involvement) over low social support in explaining the association between social relationships and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)