The relationship between pressure sores and psychosocial adjustment in persons with spinal cord injury.

Demonstrated a relationship between the occurrence of pressure sores during inpatient medical rehabilitation and scores on the Human Service Scale (HSS). 566 Ss with spinal cord injury who were 1–4 yrs postinjury participated. Results indicate that Ss who had developed pressure sores during inpatient rehabilitation scored lower on the HSS 1–4 yrs after discharge than did Ss who had not developed such sores. Possible explanations of this relationship are discussed with respect to activity repertoire, psychosocial adjustment, and compliance vs control. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being

OBJECTIVE: To assess the prevalence, severity, and correlates of chronic pain in a community-based sample of men with spinal cord injury (SCI). DESIGN: Survey. SETTING: Community. PARTICIPANTS: Seventy-seven men with SCI randomly selected from a sampling frame solicited from the community. METHOD: Participants completed standardized questionnaires assessing many areas of life, were interviewed in their homes, and underwent a physical examination at a hospital. There they were interviewed by an anesthesiologist regarding chronic pain, and a nurse administered objective pain measures. RESULTS: Seventy-five percent of the men reported chronic pain. Chronic pain was associated with more depressive symptoms, more perceived stress, and poorer self-assessed health. Greater intensity of pain was related to less paralytic impairment, violent etiology, and more perceived stress. Area of the body affected by pain was related to independence and mobility. CONCLUSIONS: Because of the high prevalence of chronic pain in the population with SCI and its relation to disability, handicap, and quality of life, health care providers need to give this issue the same priority given to other SCI health issues. Analysis of individual pain components provides better information than assessing overall pain. It is futile to treat SCI pain without giving full attention to subjective factors.     

Depressive symptomatology in persons with spinal cord injury who reside in the community

Depressive symptomatology was studied in a community-based sample of 100 men and 40 women with spinal cord injury. The mean for the Center for Epidemiologic Studies Depression Scale was higher than that reported previously for the general population, and the mean for women was higher than that for men. Findings from the Mobility dimension of the Craig Handicap Assessment and Reporting Technique (CHART) suggested that differences between men and women in degree of mobility within home and community partly mediate the gender difference in depressive symptomatology. Other CHART dimensions, Social Integration and Occupation, were inversely related with depression scores, although these dimensions did not differentiate men and women. A statistically significant relationship was not obtained between depression and disability, assessed by a self-report version of the Functional Independence Measure, or between depression and impairment, reflected by the ASIA Total Motor Index Score. Depression was not related with the presence of either pressure ulcers or presumptive evidence of urinary tract infection.     

Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury.

Objective: To examine associations between pain severity, psychological distress, catastrophizing, and indices of functional disability in a sample of persons with spinal cord injury (SCI). Catastrophizing was examined as a potential mediator of associations between pain severity, psychological distress, and functional disability. Design and Participants: Questionnaires assessing pain severity, psychological distress, catastrophizing, pain interference, and community integration were completed by 237 persons with SCI. Results: Psychological distress and pain severity were associated significantly with greater functional disability. Moreover, the association between pain severity and functional disability was strongest among persons with high psychological distress. Catastrophizing appeared to mediate the associations between pain severity, psychological distress, and functional disability. Conclusions: Pain severity and psychological distress have the potential for both direct and interactive effects on functional disability, possibly through the mediating effects of catastrophizing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between interpersonal schemas and depressive symptomatology.

Turkish university students (187 men and 191 women), 17–27 years old, participated in this study. They completed the Interpersonal Schema Questionnaire (C. Hill & J. Safran, 1994) and the Beck Depression Inventory (A. Beck, A. Rush, B. Shaw, and G. Emery, 1979). This study extended the research that was conducted by Hill and Safran (1994). The results of this study revealed that individuals in the high-depressive symptomatology group expected less complementary responses from significant others in friendly, dominant, and submissive situations. They expected more complementary responses from them in hostile situations. They also rated their expected responses from others as more undesirable than did individuals in the low-depressive symptomatology group. These findings seem to be congruent with cognitive and interpersonal theories of depression. (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)     

Self-disgust mediates the relationship between dysfunctional cognitions and depressive symptomatology.

Disgust has been linked to several psychopathologies, although a role in depression has been questioned. However, it has recently been proposed that rather than general disgust sensitivity, disgust directed toward the self (self-disgust) may influence the development of depression, providing a causal link between dysfunctional cognitions and depressive symptomatology. This possibility was examined by developing a scale to measure self-disgust (the Self-Disgust Scale; SDS) and then using mediator analysis to determine if self-disgust was able to explain the relationship between dysfunctional cognitions (measured with the use of the Dysfunctional Attitudes Scale) and depressive symptomatology (measured with the use of the Beck Depression Inventory and the Depression, Anxiety and Stress Scale). The developed SDS was found to exhibit a high level of internal consistency, test-retest reliability, and concurrent validity. Principal-components analysis revealed two factors to underlie responses to SDS items: the 'Disgusting self,' concerned with enduring, context independent aspects of the self, and 'Disgusting ways,' concerned with behavior. Self-disgust was found to mediate the relationship between dysfunctional cognitions and depressive symptomatology, demonstrating for the first time that self-disgust plays a role in depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of functional impairment and social support on depressive symptoms in persons with diabetes.

Tested the hypothesis that, among patients with higher levels of illness-related impairment, adequate social support would act as a buffer against depression. 158 Ss (aged 17–78 yrs) with insulin-dependent diabetes mellitus completed the Beck Depression Inventory, a health status measure, and 2 measures of social support. Depressive symptoms correlated positively with functional impairment and negatively with adequacy of social support. In addition, social support moderated depression in the face of greater impairment such that, among Ss who reported the most illness-related functional disabilities, adequate support provided a relative protection from depression. Individuals with inadequate support seem to be most at risk for depression when disability related to illness increases. (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.     

The relationship between level of disability, psychological problems, social activity, and social networks.

Objective: To test a theoretical model on the relationship between level of disability, psychological problems, social activity, and social networks. Study Design: A repeated cross-sectional study included in 2 representative studies in the general population in Norway. Structural equation modeling was applied to test different models. Results: Activity limitations contribute to the prediction of psychological problems and level of social activity over time, whereas the reverse effects were not demonstrated. However, cross-sectional associations between psychosocial variables and activity limitations were found. Conclusions: The study confirms that activity limitations predict level of psychosocial problems. Although the reverse longitudinal effect from psychosocial problems on activity limitations was not demonstrated, short-term effects cannot be ruled out with the current study design. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reliability of a self-reported measure of disease, impairment, and function in persons with spinal cord dysfunction

OBJECTIVE: To develop a self-report instrument that would provide information about the different levels of the disablement process, and that (1) was suitable for persons with spinal cord disease (SCD), (2) could be completed quickly, (3) could be mailed, (4) had acceptable reliability, and (5) would be clinically useful. STUDY DESIGN: Test-retest using a convenience sample. METHODS: Review of the literature and an expert panel were used to develop the instrument. It was mailed to 49,458 individuals in June 1995 and a second mailing was done in August 1995. A subset of 725 individuals who responded to both mailings was used to examine the instrument's test-retest reliability. RESULTS: The instrument has a 4th grade reading level and has questions on causal disease, disease severity, impairment, activities of daily living (including a self-reported version of the Functional Independence Measure, the SRFM), and resource utilization. Individual item test-retest reliability was high for a mailed questionnaire; all kappa coefficients were near or above .60 and most were over .70. Intraclass correlation coefficient for the SRFM was .90 and internal consistency (Chronbach's alpha) was .96. CONCLUSION: This instrument provides a new, rapid way to obtain information relative to the differing levels of the disablement process.     

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)     

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)     

Comparing two measures of depression in spinal cord injury.

Compared 2 measures of depression, the Zung Self-Rating Depression Scale (SRDS) and the Brief Symptom Inventory (BSI), and discussed their use with (1) 162 spinal cord injury (SCI) outpatients and (2) 30 SCI inpatients. Sample 2 was used to study the predictor validity of the tests based on clinicians' ratings of Ss' depression status. Results indicate a fair degree of correlation between these tests. Fairly good test reliability was also found. The SRDS was more clearly delineated into distinct conceptual factors than the BSI. An analysis of predictive validities of the 2 tests using test scores and independent clinician ratings suggests that the BSI and the SRDS were the most useful predictors of depression among SCI Ss. However, the SRDS was superior for identifying SCI persons at risk of being depressed during or after rehabilitation hospitalization. (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)     

The effect of prolonged spinal cord compression on the extent of morphological changes in experimental spinal cord injury in rabbits

The analysis of early spinal cord decompression influence on the extent of morphological and microvascular changes after traumatic cord injury was the subject of this study, carried out on Polish-breed rabbits divided into two groups. Microvascular changes were evaluated in the first group of 20 animals and morphological changes in the second group of 36 rabbits. The injury causing paraplegia was performed at D9-D10 level by Allen method modified. Every group was subdivided into 4 subgroups depending on the duration of cord compression 2, 4, 6 and 12 hours. Fragments of cord were taken for examination 12 hours after decompression, from sites 0.5, 1.0 and 1.5 cm distant from the injury level. Histopathological analysis was performed by light and electron microscopy and for the analysis of microcirculation with microangiography the Górkiewicz method was used. Great changes were found in nerve fibres, vascular endothelium and microcirculation. The most pronounced lesions were found in the subgroup with 6-hour compression, in the form of haemorrhage, central necrosis and oedema within and around axona as well as destruction of myelin sheaths. Early decompression (within 6 hours) can reduce the extent of morphological and vascular changes.     

The relations between observer-rating and self-report of depressive symptomatology.

Sources of discrepancy between the Hamilton Rating Scale for Depression (HRSD) and the Beck Depression Inventory (BDI) were investigated in 114 depressed inpatients treated with ECT. Three previously reported observations were found to occur within the same sample: (1) There was only a moderate baseline correlation between the measures; (2) this correlation improved markedly at later assessment; (3) the HRSD had a greater effect size for change. The modest baseline correlation was largely due to patients who rated themselves as substantially less depressed than clinicians had rated them. Improvement in the correlation with repeated assessment was due to the representation of clinical responders. The larger effect size with the HRSD was mainly attributable to a small subgroup that showed marked deterioration on the BDI, a phenomenon not observed with clinical evaluation. (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)     

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 relationship between coping and adjustment after spinal cord injury: A 5-year follow-up study.

Investigated the relationship between coping and adjustment (including psychological distress, acceptance of disability, vocational hours, and medical status) 5 to 6 yrs after spinal cord injury. 28 people who had provided coping data during acute rehabilitation (AR) completed various measures including the SCL-90 (Revised). Results indicate that coping strategies during AR were not associated with long-term adjustment. However, at 5-yr follow-up, cognitive restructuring was positively associated and wish-fulfilling fantasy was negatively associated with acceptance of disability. Self-blame was related to psychological distress during AR but not at 5-yr follow-up. These results suggest that the importance of specific coping strategies to adjustment changes over time and support the belief that coping is a dynamic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)