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)     

Association of daily stressors and salivary cortisol in spinal cord injury.

Objective: Examine the diurnal variation of salivary cortisol in adults with spinal cord injury (SCI) and the effect of stressors on cortisol and mood. Method: Ecological momentary assessment (EMA) to capture cortisol, stress, and mood from 25 persons with SCI and 26 without SCI. Data were analyzed using linear mixed models. Results: There were no systematic differences between groups on missing data. Diurnal variation of cortisol of participants with SCI reflected an expected pattern. No significant group differences for cortisol diurnal pattern, stress, or mood; when group interactions were significant, results indicated lower cortisol reactivity to stress in participants with SCI. Stress had a significant impact on positive, negative and agitated moods. Conclusions: Stress in daily life and its association with cortisol and mood were largely similar between persons with and without SCI. A key methodological contribution is the demonstration of using EMA to collect biological and behavioral data in the field from participants with SCI. The use of EMA in rehabilitation psychology research has great potential to advance our understanding of the dynamics of daily life with disability. (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)     

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)     

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)     

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)     

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)     

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)     

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)     

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)     

Stress appraisal in women with spinal cord injury: Supplementary findings through mixed methods.

A study was conducted to examine how women with spinal cord injury (SCI) perceive the stressors they encounter, and how cognitive appraisal is associated with coping and life satisfaction. Fifty women with SCI were interviewed regarding their experience with stress and coping. The interviews were then coded using a framework based on stress and coping theory (transactional model). The systematic application of quantitative methods to the coded interview data allowed for statistical analyses, which demonstrated that the context in which the women spoke about their experiences with various stressors was associated with coping strategies, time since injury, and life satisfaction. Although stress and coping are commonly seen as interacting constructs that influence quality of life outcomes, current findings suggest that appraisal of stressors in the context of loss (more common among women more recently injured) may have a direct impact on life satisfaction apart from any coping strategies put into effect. Interventions designed to facilitate coping with loss and enhance problem-solving skills, along with education about available resources, may foster a sense of empowerment after SCI and ultimately change how stressors are perceived and managed in order to dampen their negative impact on life satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Purpose in life as a mediator of adjustment after spinal cord injury.

Objective: Determine how purpose in life influences adjustment after spinal cord injury (SCI). Study Design: Cross-sectional survey with mediation analysis. Subjects: 1,391 adults with traumatic SCI 1 or more years prior. Main Outcome Measure: Ladder of Adjustment (N. M. Crewe & J. S. Krause, 1990). The Purpose in Life scale (PIL: .J. C. Crumbaugh, 1968), the Zuckerman-Kuhlman Personality Questionnaire (M. Zuckerman, D. M. Kuhlman, J. Joireman, P. Teta, & M. Kraft, 1993), and the Multidimensional Health Locus of Control scale (K. A. Wallston, B. S. Wallston, & R. DeVellis, 1978) were assessed. Results: PIL mediated between most measures and adjustment. Conclusions: Logotherapy is effective in strengthening purpose in life. Its use with persons with SCI may improve their adjustment and quality of life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exercise as stigma management for individuals with onset-controllable and onset-uncontrollable spinal cord injury.

Studies have suggested that individuals with physical disabilities are often stigmatized and are perceived to possess less favorable physical and psychological characteristics than individuals without disability. Purpose: To investigate whether able-bodied adults' perceptions of people with different causes of spinal cord injury (SCI) are influenced by physical activity status information. Method and Participants: Each participant (N = 198) read all five vignettes describing individuals with SCI who had varying levels of physical activity participation and cause of injury information (e.g., onset-uncontrollable [hit by impaired driver] and onset-controllable [caused by impaired driving]). After reading each vignette, participants completed a 12-item Warmth and Competence Questionnaire to evaluate each target. One-way repeated measures multivariate analyses of variance were conducted to examine the within-subjects differences. Results: Physically active individuals with onset-uncontrollable SCI were rated most favorably on warmth and competence. Physically active individuals with onset-controllable SCI also were rated more favorably on warmth and competence than physically inactive targets with onset-controllable SCI. Conclusion: A physically active lifestyle may be beneficial in managing the stigma experienced by individuals with both onset-controllable and onset-uncontrollable SCI. (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)     

The association between threat appraisals and psychological adjustment in partners of people with spinal cord injuries.

Objective: To explore the psychological factors associated with adjustment in partners of people with spinal cord injuries (SCIs). Participants and Design: Forty partners of people with SCIs. The study had a cross-sectional design. Main Outcome Measures: Beck Depression Inventory, the State Trait Anxiety Inventory Form Y-1, Social Provisions Scale, COPE, and an appraisal scale. Results: Approximately one third of partners reported levels of anxiety and depressive symptoms above the clinical cut-off points indicating elevated levels of emotional distress. Factors hypothesized to account for levels of emotional distress on the basis of the cognitive-appraisal model of stress and coping were found to be explanative. In particular, high threat appraisal, higher use of avoidance (emotion-focused) coping, and lack of approach (problem-focused) coping were found to predict higher levels of anxiety and depressive symptoms. Conclusions: Partners of people with SCIs are at risk of emotional distress. Factors that might help identify at-risk partners are identified and psychological interventions that might help partners are discussed. (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)     

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)     

The relation between spirituality and quality of life among individuals with spinal cord injury.

Objective: To determine how spiritual-based coping relates to quality of life in individuals with spinal cord injury (SCI). Design, Setting, & Participants: A telephone interview of 75 participants, primarily Caucasian single men aged 19 to 71 (enrolled in the Northern New Jersey Spinal Cord Injury Model System). Measures: Ellison's Spiritual Well-Being Scale, Duke Health Profile, Craig Handicap Assessment and Reporting Technique, Diener's Satisfaction With Life Survey. Results: Virtually all participants (98.7%) reported using some form of spiritual-based coping. Quality of life was highest among participants who use existential spiritual as opposed to religious spiritual coping. In particular, existential spirituality shared 27% variance with overall perceived life quality. Conclusions: Spiritual-based coping might be encouraged as a possible strategy to improve life quality. Clinicians should be cognizant of ongoing spiritual practices among persons with 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)