Depression and subjective well-being among 97 American Indians with spinal cord injury: A descriptive study.

ABSTRACT. Objective: To measure both clinical and nonclinical aspects of depression and subjective well-being (SWB) among a sample of American Indians with spinal cord injury (SCI) and to identify factors associated with depression and SWB. Study Design: Interviews were conducted by telephone with all participants except those who did not have telephones (who returned materials by mail). Setting: A large rehabilitation hospital in the western-Rocky Mountain region of the United States. Participants: Ninety-seven American Indians with SCI completed a health-related interview that included measures of depression and SWB. All participants were adults with traumatic SCI of at least 1 year in duration, most of whom lived on reservations. Main Outcome Measures: Measures of biographic and injury status, depression, SWB, activities, and health-related behaviors. Results: The American Indian sample reported elevated levels of depression and diminished SWB in 5 of 8 areas relative to previous studies on non-American Indians with SCI. Hierarchical multiple regression accounted for 59% of the variance in depression scores and between 10% and 52% of the variance in SWB scales… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among acute spinal cord injury patients: A study utilizing the Zung Self-Rating Depression Scale.

Administered the Self-Rating Depression Scale (SRDS) an average of 63 days post-injury to 58 acute spinal cord injury (SCI) patients (aged 18–55 yrs) and 51 age-matched healthy controls (CTLs). Mean SRDS scores were 37.1 for CTLs and 49.0 for SCI Ss. Several factors, including age, yrs of education, level of injury (paraplegic vs quadriplegic), etiology of injury (violent vs nonviolent), presence of acute closed head injury, or recent history of alcohol or substance abuse, had no association with SRDS scores. Since undiagnosed and untreated depression may compromise an SCI patient's adaptation to injury and motivation during rehabilitation, abnormally elevated SRDS scores may help to determine which patients might require more focused psychological assessment and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric symptomatology among alcoholics: Comparisons between African Americans and Caucasians.

Using data collected on 190 patients in a hospital-based substance abuse treatment center in a large midwestern city, this study compared psychiatric symptomatology between 39 African-American and 151 Caucasian adults. Although the groups were equivalent in consumption and frequency of usage, African-American alcoholics used significantly more substances (beyond alcohol) than did Caucasians. With regard to psychiatric symptomatology, African Americans reported higher levels of somatization, obsessive–compulsive behavior, depression, hostility, paranoid ideation, and psychoticism, and an overall higher degree of stress. Although the overall level of alcoholic self-reported severity did not distinguish the 2 groups, African Americans exhibited lower levels of global functioning as assessed by trained clinical staff. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and life adjustment after spinal cord injury: An exploratory study.

This study identified the relationship between personality and multiple components of life adjustment after spinal cord injury (SCI). One hundred five men completed the NEO Personality Inventory (NEO-PI), a measure of personality. In general, the NEO-PI accounted for the greatest amount of variance of scales reflecting general adaptation. Of the global domains, only two scales were strongly associated with the SCI outcomes. Among the NEO-PI facet scales, Depression was correlated with the greatest number of outcomes, whereas Warmth, Positive Emotions, Actions, and Values were correlated with superior outcomes. These findings suggest that assessment of personality is an invaluable aid in predicting long-term outcomes after SCI and should remain a priority in diverse rehabilitation settings. (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)     

The influence of social support and active coping on depression among African Americans and Latinos with disabilities.

Examined relationships among depression, active coping, and social support in a sample of 109 African Americans and 57 Latinos with a variety of disabling conditions, including physical, chronic illness, neurological, sensory, emotional, substance abuse, and cognitive disabilities. Ss' ages ranged from 18 to over 61 yrs old. Measures included a short version of the Beck Depression Inventory, the Personal Resources Questionnaire and the condensed version of the Behavioral Attributes of Psychosocial Competence Scale. Findings indicate that active coping, satisfaction with social support, and type of disability were significant predictors of depression for African Americans, whereas active coping, perception of severity of disability, and social support were significant predictors of depression for Latinos. These findings underscore the importance of testing separate models for African Americans and Latinos. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among Latinos in the United States: A meta-analytic review.

The authors conducted a meta-analytic review to assess the prevalence of major depressive disorder and depressive symptoms among Latinos compared with non-Latino Whites in the United States using community-based data. Random-effects estimates were calculated for 8 studies meeting inclusion criteria that reported lifetime prevalence of major depressive disorder (combined N = 76,270) and for 23 studies meeting inclusion criteria that reported current prevalence of depressive symptoms (combined N = 38,997). Findings did not indicate a group difference in lifetime prevalence of major depressive disorder (odds ratio = 0.89, 95% confidence interval = 0.72, 1.10). Latinos reported more depressive symptoms than non-Latino Whites (standardized mean difference = 0.19, 95% confidence interval = 0.12, 0.25); however, this effect was small and does not appear to suggest a clinically meaningful preponderance of depressive symptoms among Latinos. Findings are examined in the context of theories on vulnerability and resilience, and recommendations for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differences in coping styles among persons with spinal cord injury: A cluster-analytic approach.

Two subgroups were identified and validated in a group of 53 persons with spinal cord injury by applying cluster-analytic procedures to subjects' self-reported coping and health locus-of-control belief scores. Subjects in Cluster 1 relied extensively on all seven scales of the Ways of Coping Questionnaire, had elevated external health attributions, and reported higher levels of psychological distress and depression. Subjects in Cluster 2 emphasized internal health attributions, reported less distress, and relied less on coping methods described in the Ways of Coping Questionnaire. Treatment implications of results for the two subgroups are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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)     

Depression among elderly Chinese immigrants: an exploratory study

Despite an increase in the population of elderly Chinese immigrants, little is known about their mental health problems. The most prevalent mental health problem of elderly people-depression-often goes unrecognized and untreated. In an interview format, the author administered the Geriatric Depression Scale and measures of health status, living situation, stressful life events, and informal support to a community sample of 50 elderly Chinese immigrants recruited at senior centers and meal sites. Respondents who rated their health as good, who lived with others, and who were satisfied with help received from family members were least likely to be depressed. The impact of these factors on the mental health of elderly Chinese immigrants can be understood in light of their unique cultural values.     

Quality of life after spinal cord injury: A qualitative study.

ABSTRACT. Objective: To describe the subjective quality of life (QOL) of persons with a spinal cord injury (SCI). Study Design: Qualitative analysis of transcribed interviews. Participants: Forty community-dwellers with SCI. Results: Few participants could define QOL, but most could identify indicators of QOL and provided clear ratings of their own QOL. Individuals were grouped into three QOL ratings categories (excellent or very good, good or fair, less than satisfactory) and compared in terms of issues reported to affect QOL. Conclusions: Financial security, material assets, meaningful social roles, and a longer time since injury appear to be prerequisites for high-level QOL. Personal growth and positive value changes following SCI offset the economic and social disadvantages of persons in the intermediate QOL group. Financial stability, material resources, and emotional and spiritual "capital" were in short supply for many persons in the low QOL group. (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)     

Postinjury employment outcomes among African-American and White persons with spinal cord injury.

Investigated the postinjury employment status of 1,042 Whites and 196 Blacks enrolled in the National Spinal Cord Injury Statistical Center database to determine whether factors that influence re-employment differ for the 2 racial groups. These factors included age, education, and marital status at time of injury; gender; neurologic level and extent of injury; and vocational rehabilitation client status. Age and education were found to predict employment status for both Whites and Blacks, with education being an especially strong predictor for Blacks. Gender had an impact on re-employment only for Blacks, while neurologic level of injury was predictive only for Whites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in adjustment after spinal cord injury: A 20-year longitudinal study.

This study assessed the stability of multiple aspects of adaptation after spinal cord injury (SCI). One hundred fourteen participants with SCI completed the Life Situation Questionnaire on 4 separate occasions over a 20-year interval. Changes in the outcomes over time were measured. Time engaged in employment activities, sitting tolerance, and number of years of education increased, and the number of hospitalizations and total days hospitalized decreased. However, self-rated adjustment decreased over the same time period. The results indicate a divergence between changes in objective and subjective aspects of life over the 20-year period. These findings suggest that people with SCI generally do not feel more positive about their lives than they did 20 years prior, despite an increase in employment opportunities and a decrease in hospitalizations. (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)     

Inpatient hospital utilization among veterans with traumatic spinal cord injury

OBJECTIVE: To describe the pattern of inpatient hospital utilization, up to 15 years after injury, among a cohort of veterans with service-connected traumatic spinal cord injury (SCI). PATIENTS: A cohort of 1,250 male veterans, with traumatic SCI occurring between 1970 and 1986, who visited the VA within 1 year of injury, was assembled from VA administrative files; diagnosis was verified by examining hospital discharge summaries. DESIGN: Computerized record linkage among Department of Veterans Affairs (VA) administrative files was used to determine patterns of inpatient hospital utilization. MAIN OUTCOME MEASURE: Pattern of inpatient admissions and length of stay (LOS). RESULTS: Patients were typically white males injured in their mid-twenties. The initial VA hospitalization began approximately 6 weeks after injury and lasted 4 to 7 months, depending on injury level and completeness. Subsequent hospitalizations usually lasted approximately 10 days, but 22% of stays exceeded 1 months. Most hospitalizations took place in specialized SCI Centers. Comparing the 1980s with the 1970s, patients in the 1980s entered VA facilities sooner after injury, were more likely to visit SCI Centers, and had shorter initial stays. Rates for the incidence of rehospitalization decreased rapidly in years 2-5 after injury and declined less rapidly thereafter. Occupancy rates and proportion rehospitalized followed similar patterns. The incidence rate for persons with complete quadriplegia was approximately twice that of patients with incomplete paraplegia. Between 1970 and 1991, both the rehospitalization incidence rate and LOS decreased by approximately 20%. Only 10% of patients accounted for 46% of the total LOS. LOS during the first five years was predictive of later LOS. CONCLUSIONS: The pattern of rehospitalization in VA facilities was generally consistent with that of the Model Systems. Efforts toward preventing rehospitalization should target persons with previous high utilization.     

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)     

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)