Brief Symptom Inventory norms for spinal cord injury.

Investigated the effects of spinal cord injury (SCI) upon a person's response to the Brief Symptom Inventory (BSI) by analyzing differences across item-response distributions from 225 Ss with SCI (aged 17–68 yrs) vs a nonpatient normative sample of 719 Ss. The study also developed more appropriate BSI normative data for persons with SCI. Because Ss' time since injury varied at time of BSI administration, normative scores were provided within 3 groupings: at discharge from the hospital; 0–24 mo post-discharge; and beyond 24 mo. Results show that SCI Ss had higher BSI scores when compared with Ss in the normative sample. These differences were particularly significant across 8 BSI items that reflected actual SCI physical and psychosocial symptoms. SCI Ss reported more distress during the period immediately following discharge to 24 mo. Overall, BSI scores tended to be lower at discharge and after 24 mo post-discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Brief Symptom Inventory: Measuring psychological distress in spinal cord injury.

Explored the appropriateness of the Brief Symptom Inventory (BSI) as a measure of psychological distress among 79 traumatic spinal cord injured (SCI) patients (aged 18–70 yrs) and emphasized the limitations of using the BSI as a replacement for the SCL-90—Revised (SCL-90—R). Ss' BSI scores were compared with a nonpatient normative group (N?=?974). Ss were significantly more psychologically distressed in somatization, depression, and phobic anxiety than the normative group. However, several somatization symptoms endorsed by these Ss are common physical effects of SCI rather than psychosomatic complaints. When comparing BSI and SCL-90—R scores of the same Ss, significant statistical differences were found with respect to the level of psychological distress being reported by each test. The BSI may not represent an equivalent abbreviated form of the SCL-90—R for the SCI population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use by persons with recent spinal cord injuries.

Obtained substance use histories from 103 persons (aged 16–63 yrs) with recent spinal cord injuries (SCIs). Lifetime exposure to and recent use of several substances with abuse potential were greater than for a like-age national sample. Intoxication at time of injury was reported by 39%. The rate of exposure to and recent use of substances with abuse potential was significantly greater for Ss who reported intoxication at injury. Intoxication at SCI onset is a marker of preinjury substance use. It is important to screen for substance abuse in persons who incur traumatic injury. Timely assessment of and intervention for substance abuse could help enhance psychosocial and vocational outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recurrence of initial pressure ulcer in persons with spinal cord injuries

Whether treated with surgery or by conservative, nonsurgical measures, pressure ulcers recur in 5% to 91% of spinal cord injured (SCI) patients. Factors other than the surgical technique used or the standard conservative management provided may be responsible. A retrospective study of 176 SCI patients with a history of one or more pressure ulcers was conducted at the Department of Veterans Affairs Medical Center at Castle Point, N.Y. Approximately 35% of patients who received either surgical or nonsurgical treatment had a recurrence. Patients who smoked and patients with diabetes or cardiovascular disease had higher recurrence rates.     

Social support and the prediction of health complications among persons with spinal cord injuries.

Examined the relationship between interpersonal behavior and adjustment to spinal cord injury in 95 patients (aged 20–66 yrs) hospitalized at 3 facilities. In the 1st study, where predictor variables included social support, depression, and demographic factors, elements of social support were not significantly associated with reasons for hospitalizations. Older age, complete lesions, and paraplegia were significantly related to skin breakdown, cognitive problems, and less likelihood of routine checkups; tetraplegia was associated with checkups. The 2nd study reviewed the medical charts of 52 Ss from the 1st study and tallied the incidence of decubitus ulcers and urinary tract infections reported during the year. Discriminant function analysis found level of injury, lesion, age, depression, and elements of social support to be significantly predictive of health complications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Norms for the elderly on the Brief Symptom Inventory.

Administered the Brief Symptom Inventory to 364 females (mean age 73.54 yrs) and 201 males (mean age 73.92 yrs). The mean scores on the 9 primary symptom dimensions were compared with the mean scores from a normative sample of younger adults. Results indicate that the elderly reported higher levels of distress on most symptom dimensions. It is recommended that age-relevant norms be employed when using the Brief Symptom Inventory to assess self-reported psychopathology in the elderly. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vocational interests of persons with spinal cord injury.

Administered the Strong-Campbell Interest Inventory to 134 males (mean age 26.3 yrs) and 22 females (mean age 31.7 yrs) with spinal cord injury to assess Ss' vocational interests. Ss' scores were compared to the norms for men and women. Rank-order analysis indicated that males' responses showed them to be introverted and more interested in working with things than data or people. Although the smaller sample of females makes conclusions less certain, the females' responses were similar to the males'. Since the interests of these people were often incongruent with the physical limitations imposed by their disability, findings suggest that counselors must apply extra ingenuity to assist in identifying vocational alternatives. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal construct validity of Brief Symptom Inventory subscales in schizophrenia.

Longitudinal validity of Brief Symptom Inventory subscales was examined in a sample (N = 318) with schizophrenia-related illness measured at baseline and every 6 months for 3 years. Nonlinear factor analysis of items was used to test graded response models (GRMs) for subscales in isolation. The models varied in their within-time and between-times parameter constraints, with the homogeneous model being the least constrained, followed by the 2-parameter GRM and 1-parameter GRM. Results show that 4 subscales (Interpersonal Sensitivity, Hostility, Paranoid Ideation, Psychoticism) were consistent with the 1-parameter GRM, and 5 subscales (Somatization, Obsessive-Compulsive, Depression, Anxiety, Phobic Anxiety) were consistent with the 2-parameter GRM. There is evidence that the 9 subscales may be validly used to study change in single constructs over time. (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)     

Pregnancy in women with spinal cord injuries

Most women with spinal cord injuries (SCI) resume normal reproductive function, can have sexual relationships, and become pregnant. Pregnancy is not contraindicated in women with SCI, but pregnant women with acute or chronic SCI pose unique challenges for perinatal health care providers. The normal physiologic changes of pregnancy may predispose women with SCI to potentially life-threatening complications, including autonomic hyperreflexia, pyelonephritis, respiratory insufficiency, thrombophlebitis, and unattended delivery of the infant. This article reviews the effect of SCI on female reproduction, pregnancy, and labor, and summarizes the treatment of the pregnant woman with a spinal cord injury.     

Use of the Beck Depression Inventory in veterans with spinal cord injury.

Hypothesized that 7 Beck Depression Inventory items would be poor discriminators between depressed and nondepressed spinal cord injury Ss. To test this hypothesis, 124 veterans (aged 19–79 yrs) with spinal cord injury were administered the Beck Depression Inventory and evaluated for the presence of a major depressive episode. Ss were first administered the Mini-Mental Status Examination, interviewed and then administered the Beck Depression Inventory. Discriminant function analysis revealed that 3 of the 7 items were poor discriminators. Since clinicians are faced with the dilemma of deciding whether endorsement of Beck Depression Inventory items is indicative of depressive symptomatology or the sequelae of spinal cord injury, the authors derived cut scores appropriate for spinal cord injury patients. Data on the sensitivity and specificity of these cut scores are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spine update. Urological management in patients with spinal cord injuries

In the past, urologic complications contributed greatly to spinal cord injury mortality. With improved evaluation and treatment, this is no longer the case. Treatment should be guided by urodynamic data gathered after the resolution of spinal shock symptoms. Goals of treatment are to facilitate voiding, reduce incontinence, and prevent renal damage. Indwelling catheters are almost never indicated for long-term treatment of the neurogenic bladder. Commonly used treatments include intermittent catheterization, condom catheter drainage with sphincter ablation, and pharmaceutical manipulation. Electrical stimulation of sacral nerve roots shows promise for future therapy.     

Predicting life satisfaction among adults with spinal cord injuries.

Examined life satisfaction among 91 adults with spinal cord injury (SCI) through structured personal interviews that used the Center for Epidemiological Studies Depression Scale, Rosenberg's Self-Esteem Scale, the Life 3 Measure, and a number of items related to satisfaction with various life domains. Results suggest leisure satisfaction was the most significant predictor of life satisfaction, explaining 43% of the variance in the life satisfaction scores; an additional 16% of the variance was explained by self-esteem and health satisfaction. Findings highlight the role of leisure satisfaction in enhancing life satisfaction among individuals with SCI, given the high unemployment rate in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classification of chronic pain patients with the Brief Symptom Inventory: Patient characteristics of cluster profiles.

In this study, the psychological symptom patterns of individuals with chronic pain on the Brief Symptom Inventory (BSI) were cluster analyzed. Cluster analysis was initially performed on a sample of 1,489 people with chronic pain and then cross-validated on a smaller sample of 244 people. A 2-cluster solution was deemed most appropriate. The clusters reflected low- and high-profile elevations on all BSI subscales. As part of their clinical evaluation, participants also completed the Pain Disability Index, the adjective list from the McGill Pain Questionnaire, and a modified version of the Posttraumatic Chronic Pain Test. Among persons in the smaller sample, high-profile participants were more likely to be involved in litigation, report a higher frequency of posttraumatic stress symptoms, and display poorer psychosocial functioning. The results suggest that the BSI subgroups are associated with psychosocial characteristics that may be important in terms of treatment planning and outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunogenicity of pneumococcal vaccine in persons with spinal cord injury

OBJECTIVE: To determine immunogenicity and optimum timing for administering the 23-valent pneumococcal vaccine after spinal cord injury (SCI). DESIGN: Double-blind, randomized, placebo control study. SETTING: SCI unit in a tertiary care medical center and community. PARTICIPANTS: Eighty-seven persons with recent SCI. INTERVENTION: Participants were randomized to receive either placebo or pneumococcal vaccine at 16 to 18 days versus 4 to 6 months postinjury. MAIN OUTCOME MEASURES: Antibody concentrations were measured prior to intervention and 1, 2, and 12 months afterward to evaluate the immune response to five serotypes of Streptococcus pneumoniae. Effects of demographic and injury-related variables on immune response were also evaluated. RESULTS: Timing of vaccination did not influence mean antibody concentrations for any serotype (p > .05). Ninety-five percent of vaccinated persons had twofold or greater increases in antibody concentration for at least one serotype when measured 1 month after vaccination versus 35% of placebo groups (p < .01). After 12 months, 93% of vaccinated persons in both groups maintained antibody concentrations twofold or greater than baseline values. CONCLUSIONS: Most participants developed an immune response to at least one serotype that was maintained for at least 12 months. Immune response varied according to serotype. Given the favorable immune response and no effect of timing, persons with SCI should receive pneumococcal vaccine during initial hospitalization.     

Operant conditioning of spinal stretch reflexes in patients with spinal cord injuries

Hyperactive spinal stretch reflexes (SSRs) often occur with spinal cord injuries (SCI). These altered SSRs may impair movement. Recent studies in monkeys and human subjects have indicated that the magnitude of SSRs can be modulated using operant conditioning. The purpose of this study was to determine whether hyperactive biceps brachii SSRs could be operantly conditioned downward. Seventeen chronic (> 1 year postlesion) spinal cord-injured patients participated. Subjects were trained to keep biceps background (prestretch) electromyographic (EMG) activity and elbow angle at predetermined levels prior to having the elbow rapidly extended by a torque motor to elicit the biceps SSR. All subjects participated in six baseline sessions over a 2-week period. Then, subjects were randomly assigned to either control or training groups for the next 24 sessions over an 8-week period. By the end of the study, training subjects had significantly reduced biceps SSRs (t test, P < 0.001), while control subjects SSRs were not significantly reduced (t test, P > 0.05). The reduced SSRs persisted for up to 4 months following cessation of training. The results of this study support the hypothesis that hyperactive SSRs can be operantly conditioned downward in SCI patients.     

Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury.

Objective: The overlap of somatic-depressive symptoms and physical sequelae of spinal cord injury (SCI) has raised concerns regarding the validity of depression screens used within the SCI population. The Patient Health Questionnaire-9 (PHQ-9) measure parallels Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) criteria of major depression. The authors investigated PHQ-9 factor structure among persons with SCI at various times postinjury. Design: Data from 2,570 participants at 1 year (N = 682), 5 years (N = 517), 15 years (N = 653), and 25 years (N = 718) postinjury were used. Emergent factors were correlated with satisfaction with life. Results: A 2-factor solution emerged for all groups, with 3 affective referenced items (feeling depressed/hopeless, feeling bad about self/failure, and suicidal ideation) and 3 somatic referenced items (sleep disturbance, low energy/fatigue, and appetite disturbance) loading consistently on Affective and Somatic factors, respectively, at all time points. Factor scores negatively correlated with satisfaction with life. Conclusions: Dual factor structure of the PHQ-9 is present at various times postinjury in the SCI population. It remains unclear whether somatic item endorsement reflects depressive symptomatology per se; however, endorsement is still associated with satisfaction with life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Perceived risk for influenza in veterans with spinal cord injuries and disorders.

Objective: Guided by the extended parallel process model (EPPM), the objective was to assess control processes dominant in influenza behavior decisions. Design: Cross-sectional survey. Results: Response rate was 31% (n=968). Regarding influenza risk, 59% were in danger control. Those in fear control were more likely to report influenza infection (p=.000). In the nonvaccinated, those in fear control were more likely to indicate not knowing where to get the vaccine (p=.016) and that it was unavailable (p=.027), and those in danger control believed they did not need it (p=.023). Zero critical values were more likely to indicate that no health provider recommended the shot (p=.002). Conclusions: Most perceived efficacy to be stronger than threat related to influenza; according to the EPPM, they are aware of their risk but recognize their ability to avert it. For those in danger control, messages should focus on increasing perceptions of severity and susceptibility to positively affect behavior change. For those in fear control, messages should focus on efficacy only. With a critical value of zero, no threat is induced, and a high-threat/high-efficacy approach should be taken. (PsycINFO Database Record (c) 2010 APA, all rights reserved)