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)     

Dyadic perfectionism as a predictor of relationship continuity and distress among college students.

This study examined the nature and impact of dyadic perfectionism over a 3-month interval within a sample of 116 college students who were currently involved in an intimate heterosexual relationship. Dyadic perfectionism scores were stable and correlated as expected with scores on concurrent measures of adult attachment orientations and relationship satisfaction. Logistic regression analyses revealed that, controlling for initial commitment status and adult attachment orientations, Time 1 dyadic perfectionism scores significantly and uniquely predicted relationship continuity 3 months later. Lastly, controlling for social desirability, relationship commitment status, and Time 1 adult attachment orientation scores, Time 1 dyadic perfectionism scores also uniquely predicted Time 2 relationship distress. Findings provide additional evidence that dyadic perfectionism is a risk factor for relationship dysfunction. (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)     

La nature et les corrélats de l'attachement au sein des relations de couple.

Studied the relationship between different styles of attachment (i.e., comforting, avoidant, and anxious-ambivalent) and marital adjustment. Ss were 248 heteresexual adults (mean age 36.7 yrs) who had been married or living together for a mean period of 11 yrs. All Ss completed 2 measures of attachment style and a scale assessing dyadic adjustment. Multiple regression analysis was used to determine interactions between attachment style and marital adjustment, and the convergent validity of the 2 measures of attachment style was analyzed. French versions of the Dyadic Adjustment Scale (G. B. Spanier, 1976) and 2 attachment style questionnaires (C. Hazan and P. R. Shaver, 1987) and (M. Mikulincer et al, 1990) were used. (English abstract) (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)     

Social problem-solving abilities and adjustment to recent-onset spinal cord injury.

ABSTRACT. Objective: To examine the relation of social problem-solving abilities to psychological and physical adjustment of persons with recent spinal cord injuries (SCIs). Design: Correlational procedures were used. Participants: One hundred eighty-six persons with recent SCI completed self-report measures during inpatient rehabilitation; 94 returned for an annual evaluation. Main Outcome Measures: Acceptance of disability, career needs, and pressure sore diagnoses. Results: Greater negative problem orientation predicted each self-report outcome variable; completeness of lesion was the best predictor of pressure sore diagnosis. Conclusions: The problem orientation component appears to relate to self-reported adjustment among persons with SCI in a theoretically consistent fashion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of marital life in Korean spinal cord injured patients

The purposes of this study were to assess the quality of marital life and to investigate the most serious problem in the marital relationships of Korean spinal cord injured patients. 30 spinal cord injured (SCI) couples (SCI husbands and their non-disabled wives) who were married prior to injury and 30 able-bodied (AB) couples participated in a questionnaire study. The quality of marital life was measured with three parameters: marital stability, marital adjustment, and marital satisfaction. The results were as follows: (1) The marriage of chronic SCI couples was not noticeably unstable when compared with that of AB couples; (2) There was no significant difference in dyadic adjustment and marital satisfaction between SCI couples and AB couples; (3) There was no significant difference in marital stability, marital adjustment, and marital satisfaction between SCI husbands and their wives; (4) SCI couples had more cohesive marital relationships and SCI husbands expressed less affection to their wives than AB husbands and (5) Sex was the most serious problem in marriages of SCI couples. In conclusion: (1) the quality of marital life in chronic SCI couples is not highly different from that of AB couples; (2) There is no significant difference in the quality of marital life between chronic SCI husbands and their non-disabled wives; and (3) It is considered necessary that rehabilitation program for SCI patients should include information on the altered physiology of sexual function of SCI patients and subsequent mutual adaptation to changed sexual function.     

A conjoint analysis of factors influencing American and Taiwanese college students' preferences for people with disabilities.

Objective: To determine the effect of demographic variables on attitudes toward disability. Participants: Eighty-three female American and 89 female Taiwanese college students. Outcome Measure: A conjoint measurement of 16 stimulus cards (representing people with varying disability labels, severity of disability, age, gender, and education). Procedures: The participants were asked to sort the stimulus cards according to their personal preferences for working with people with disabilities. Results: Younger and higher educated women with milder disabilities were preferred by both Taiwanese and American students. Preference formation is affected by both disability-related variables and other demographic variables (e.g., educational levels). Conclusion: The use of conjoint analysis to examine multiple attributes of persons with disabilities may have higher external validity than single-attribute-design studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Access to health care services among people with rehabilitation needs receiving Medicaid.

Objective: To investigate access to care for individuals with rehabilitation-related conditions receiving fee-for-service Medicaid. Study Design: Telephone survey. Participants: One hundred thirty-eight individuals with spinal cord injury (SCI), brain injury (BI), or stroke. Main Outcome Measures: Frequency of difficulty or failure to access medical services, perceived effect on health, services most difficult to access, and reasons for difficulty. Results: People with SCI reported the most frequent difficulty accessing services (87%), followed by persons with BI (79%) and stroke (65%). In a subgroup of respondents, 60% reported failure to receive at least 1 service; 81% reported that access difficulties affected health or daily routine. Conclusions: People with rehabilitation-related disabilities may experience greater barriers to needed services than the larger population of persons with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peak oxygen uptake of 12-18-year-old boys living in a densely populated urban environment

The prevalence of self-reported alcohol and marijuana use, along with alcohol abuse as measured by the Short Michigan Alcoholism Screening Test, was assessed for a community-based sample (n = 123) of persons with spinal cord injury (SCI). Correlates of alcohol and marijuana use and alcohol abuse also were examined, including demographic variables, measures of impairment, disability, and handicap, SCI medical complications, and measures of subjective assessment such as health rating, health maintenance behaviors, depression, life satisfaction, perceived stress, pain, and social support. Prevalence of alcohol use (59%) and marijuana use (16%) in persons with SCI was less than that of comparison groups in the general population. However, prevalence of alcohol abuse (21%) exceeded that of general population studies. Participants who abused alcohol shared the following criteria: (1) perceived their overall health as worse than those who did not abuse alcohol; (2) were more depressed; and (3) experienced more stress in their lives than those who did not abuse alcohol. Participants who used marijuana were younger at the time of the study and were younger at injury. They were also more depressed and more stressed. The indications of alcohol abuse in one in five persons with SCI living in the community mandates that screening, treatment, and referrals be part of any rehabilitation treatment program.     

Neuropsychological impairments after spinal cord injury: A comparative study with mild traumatic brain injury.

Objective: To determine if individuals with mild traumatic brain injury (MTBI) perform differently on neuropsychological measures than individuals with spinal cord injury (SCI) having no loss of consciousness. Design and Participants: Data were collected prospectively on 33 matched pairs of individuals with SCI or MTBI. Independent t tests were performed to identify differences between the SCI and MTBI groups. Results: Although those with SCI generally outperformed individuals with MTBI, no meaningful between-groups differences were noted on 5 of the 10 neuropsychological tests administered. Greater than 40% of the SCI patients were identified as having impairments in processing speed, motor speed, and verbal learning. Conclusions: Treatment planning after SCI should include procedures to identify cognitive deficits that may complicate adjustment to disability and delay acquisition of new skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social judgment toward job applicants with disabilities: Perception of personal qualities and competences.

Objective: Building on D. Stone and A. Colella's (1996) model, this article examines how job applicants with or without a physical disability are evaluated in relation to the nature of the job. Design: Data from 284 management undergraduates were collected through 2 experimental studies based on the same paradigm: Participants had to evaluate individuals with or without a disability applying for jobs that did or did not involve a great deal of interpersonal contact (Study 1) and for jobs typically reserved for men or for women (Study 2). Results: Job applicants with disability were rated more negatively than applicants without disability in poor-fit conditions (job involving a great deal of interpersonal contact, or male job). This devaluation was particularly marked in issues reflecting competence. By way of contrast, individuals with disabilities received higher ratings on personal qualities. Conclusions: To promote the employment of persons with disabilities, it is important not only to improve the level of qualification of people with disabilities but also to attempt to change the nature of perception of these individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of relationship maintenance on psychological distress and dyadic adjustment among couples coping with lung cancer.

Objective: Relationship maintenance strategies help to ensure the continuation of valued relationships by keeping them at a certain level of intimacy. This study evaluated how lung cancer patients' and spouses' efforts to maintain their relationships affected their psychological and marital adjustment over time. Design: Psychosocial questionnaires were administered within 1 month of lung cancer treatment initiation (baseline) and 3 and 6 months later to 158 lung cancer patients and their spouses. Main Outcome Measures: Study outcomes were global severity index scores on the Brief Symptom Inventory, and total scores on the Dyadic Adjustment Scale. Results: Multilevel modeling analyses using the Actor-Partner Interdependence Model showed that, regardless of gender or social role (i.e., patient or spouse), individuals who engaged in the strategies of positivity, networks, and shared tasks reported less distress at baseline than other participants. Over time, the effects of providing more assurances and experiencing a partner's increased reliance on social networks differed: patient distress was exacerbated, and spouse distress was alleviated. Couples where both partners engaged in more frequent maintenance behaviors reported greater dyadic adjustment at baseline and over time. Conclusion: For couples coping with lung cancer, the initial treatment period may be an important time that sets the tone for future spousal interactions. Engaging in relationship maintenance during this stressful time may help mold more resilient relationships and facilitate adjustment as the disease progresses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body and sexual esteem as mediators of the physical disability-interpersonal competencies relation.

Objectives: To examine whether body and sexual esteem mediated the associations between sexual satisfaction, perceived disability severity, and social perceptions of the disability and interpersonal competencies. Research Method/Design: Web-based survey with 326 adults with a range of physical disabilities. Main Outcome Measures: Perceived interpersonal competence in initiating relationships and being assertive in negative situations. Results: For men, sexual satisfaction, social perceptions of the disability, and perceived severity of the disability significantly predicted competence with relationship initiation. Sexual satisfaction and social perceptions of the disability predicted competence with negative assertion. For women, social perceptions of the disability predicted both interpersonal competencies, and sexual satisfaction predicted competence with negative assertion. Aspects of body esteem mediated the relations between the predictor variables and the interpersonal competencies. Conclusions: Findings indicate the importance of perceived attractiveness to others in mediating the negative relations between impact of the disability and interpersonal competencies. Findings also suggest important gender differences in variables predictive of interpersonal competencies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of participants in a supported education program for adults with psychiatric disabilities

OBJECTIVE: Supported education programs provide assistance, preparation, and support to individuals with psychiatric disabilities who desire to pursue postsecondary education. To determine the extent to which "typical" clients with severe mental illness can participate in a supported education program, the study examined characteristics of participants in a large supported education program. METHODS: Baseline interviews with participants in a supported education program in the metropolitan Detroit area gathered demographic data, as well as information about school, work, and psychiatric history; social adjustment and support; psychiatric symptoms; and self-perceptions in the areas of school efficacy and self-esteem. Cluster analysis used five variables (sex, age, educational attainment, work background, and symptoms) to produce a client typology. RESULTS: Five clusters emerged: well-functioning young men, young aspiring women, young dependent men, well-functioning but unemployed participants, and distressed unemployed participants. The clusters also differed on a large number of variables not used in the cluster analysis. However, members of all clusters had similar rates of program participation and first-semester attendance. Overall, the supported education participants were younger, better educated, and higher functioning than subjects in general samples of persons with severe mental illness. Although many participants had significant problems with symptoms, social adjustment, and substance abuse, they were able to remain active program participants. CONCLUSIONS: The results indicate that supported education is a feasible alternative for many individuals to meet goals for educational advancement, personal development, and better jobs.     

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)     

Alcohol abuse history and adjustment following spinal cord injury.

Objective: Examined the relation of alcohol abuse history to emotional adjustment and pressure sore occurrence during the 1st 3 years following Spinal Cord Injury (SCI). Study Design: Comparisons were made between varying levels of prior abuse and depression and disability acceptance. A model predicting pressure sore occurrence over 3 years was computed. Participants: One hundred seventy-five persons completed the self-report measures; 105 were available for pressure sore evaluations. Main Outcome Measures: The Inventory to Diagnose Depression, the Acceptance of Disability Scales, and pressure sore occurrence. Results: Alcohol abuse was not associated with depression or disability acceptance. Severe alcohol abuse history was associated with pressure sores over the 3 years. Conclusions: Persons with prior history of severe alcohol abuse may be at increased risk for pressure sore occurrence during the 1st years of SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dyadic coping in metastatic breast cancer.

Objective: Couples facing metastatic breast cancer (MBC) must learn to cope with stressors that can affect both partners’ quality of life as well as the quality of their relationship. Common dyadic coping involves taking a “we” approach, whereby partners work together to maintain their relationship while jointly managing their shared stress. This study prospectively evaluated whether common dyadic coping was associated with less cancer-related distress and greater dyadic adjustment for female MBC patients and their male partners. Design: Couples (N = 191) completed surveys at the start of treatment for MBC (baseline), and 3 and 6 months later. Main Outcome Measures: Cancer-related distress was assessed with the Impact of Events Scale; dyadic adjustment was assessed using the short-form of the Dyadic Adjustment Scale. Results: Multilevel models using the couple as the unit of analysis showed that the effects of common positive dyadic coping on cancer-related distress significantly differed for patients and their partners. Whereas partners experienced slightly lower levels of distress, patients experienced slightly higher levels of distress. Although patients and partners who used more common negative dyadic coping experienced significantly greater distress at all times, the association was stronger for patients. Finally, using more common positive dyadic coping and less common negative dyadic coping was mutually beneficial for patients and partners in terms of greater dyadic adjustment. Conclusion: Our findings underscore the importance of couples working together to manage the stress associated with MBC. Future research may benefit from greater focus on the interactions between patients and their partners to address ways that couples can adaptively cope together. (PsycINFO Database Record (c) 2010 APA, all rights reserved)