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)     

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)     

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)     

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)     

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)     

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)     

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)     

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)     

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)     

Romantic attachment in individuals with physical disabilities.

Objective: To examine the relationship between adult attachment style and physical disability in intimate romantic relationships. Method: Participants were 50 individuals with adult-onset spinal cord injuries (SCI) and 50 individuals with congenital disabilities (CON) living in the community. The main outcome measures were adult attachment style and dyadic relationship adjustment. Results: Participants with SCI and CON did not differ in rates of secure versus insecure attachment, and the rates of neither group differed significantly from rates reported for persons without disability. Dyadic adjustment was clearly predicted by attachment variables and differed between the participants with SCI and those with CON; individuals with SCI reported greater total dyadic adjustment. Avoidance showed a strong negative association with dyadic satisfaction, but no association was found with dyadic cohesion. Social participation variables were associated with dyadic adjustment. For instance, mobility was positively associated with dyadic satisfaction. Conclusions: Dyadic adjustment in people with disabilities, as in other groups, is affected by attachment style, but disability and social participation variables may also affect dyadic adjustment. Clinicians should consider differences in attachment styles among persons with disabilities and their implications for intimate close relationships. (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)     

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)     

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)     

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)     

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)     

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)     

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)     

Verbal Learning Ability and Adjustment to Recent-Onset Spinal Cord Injury.

Objective: Investigate the relation between verbal learning and adjustment in individuals in inpatient spinal cord injury (SCI) rehabilitation. Setting: A rehabilitation hospital in the southeastern United States. Study Design: At admission, verbal learning ability and depressive behavior were evaluated. Prior to discharge, acceptance of disability was assessed. Participants: One hundred seven individuals (age range=18-65; 82 men, 25 women; 73 Caucasian, 34 African American). Results: Verbal learning ability accounted for 7% of the variance in acceptance of disability after controlling for demographic variables and depressive behavior. Higher levels of verbal learning ability were associated with disability acceptance. Conclusions: Verbal learning ability is associated with adjustment. Assessment of verbal learning abilities may provide useful information concerning individuals at risk for more complicated adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)