Search

Purpose: We examined positive behavioral resources and characteristics that might distinguish resilient personality prototypes among persons with chronic spinal cord injury/disorder (SCID). Positive psychology variables with clear linkages to existing psychological interventions were examined as potential mediators of the resilience–well-being relationship. Research Method and Design: A cross-sectional, self-report study was conducted. Two hundred and ninety-eight consenting members of the Paralyzed Veterans of America (268 male; 236 self-identified as white) provided useable survey data for analysis (including 161 veterans with tetraplegia, 107 with paraplegia, 30 with cauda equina). Cluster analysis of Big Five personality traits identified resilient and nonresilient personality profiles. Tests of mean differences between resilient and nonresilient participants on behavioral resources and characteristics were performed. Path models predicting well-being and health-related quality of life (HRQL) were conducted. Results: One hundred and sixty-three respondents had resilient personality profiles and 135 had nonresilient profiles. Resilient individuals reported significantly more optimal scores on every positive psychology variable, and greater well-being and HRQL than nonresilient respondents. Path models found the relationship of resilience to well-being was explained through its beneficial associations with psychological flexibility, use of personal strengths, meaning in life (MIL), and gratitude. Psychological flexibility also mediated the resilience–HRQL relationship. Cauda equina was significantly associated with higher pain interference and lower HRQL. Conclusions: Higher gratitude, MIL, use of personal strengths, and psychological flexibility appear to characterize resilience and well-being among persons with chronic SCID. Further studies are needed to understand the impact of pain interference on HRQL among individuals with cauda equina. Impact and Implications: The present study documents several positive behavioral resources and characteristics that typify resilience among persons with chronic spinal cord injury/disorder. The results should prompt rehabilitation psychologists to consider further study of the positive psychology variables examined in this paper, and the potential use of the existing interventions associated with each one. [ABSTRACT FROM AUTHOR]

Objectives: Although many Iraq/Afghanistan warzone veterans report few problems with adjustment, a substantial proportion report debilitating mental health symptoms and functional impairment, suggesting the influence of personal factors that may promote adjustment. A significant minority also incur warzone-related traumatic brain injury (TBI), the majority of which are of mild severity (mTBI). We tested direct and indirect pathways through which a resilient personality prototype predicts adjustment of warzone veterans with and without mTBI over time. Method: A sample of 264 war veterans (181 men) completed measures of lifetime and warzone-related TBIs, personality traits, psychological adjustment, quality of life, and functional impairment. Social support, coping, and psychological flexibility were examined as mediators of the resilience-adjustment relationship. Instruments were administered at baseline, 4-, 8-, and 12-month assessments. Structural equation models accounted for combat exposure and response style. Results: Compared with a nonresilient personality prototype, a resilient prototype was directly associated with lower PTSD, depression, and functional disability, and higher quality of life at all time-points. Warzone mTBIs frequency was associated with higher scores on a measure of functional disability. Indirect effects via psychological flexibility were observed from personality to all outcomes, and from warzone-related mTBIs to PTSD, depression, and functional disability, at each time-point. Conclusions: Several characteristics differentiate veterans who are resilient from those who are less so. These findings reveal several factors through which a resilient personality prototype and the number of mTBIs may be associated with veteran adjustment. Psychological flexibility appears to be a critical modifiable factor in veteran adjustment. The present study indicates that the beneficial effects of a resilient personality prototype occur among warzone veterans with and without mTBI. Several of the characteristics associated with a resilient personality prototype can be addressed in psychological interventions to facilitate psychological adjustment of veterans who are experiencing difficulties with depression, posttraumatic stress symptoms, and quality of life. Of these characteristics, psychological flexibility appears to be a particularly important mechanism through which resilience promotes adjustment, and psychological flexibility is a central element of acceptance and commitment therapy. [ABSTRACT FROM AUTHOR]

Objective: We examined the prospective influence of the resilient, undercontrolled, and overcontrolled personality prototypes on depression and posttraumatic stress disorder (PTSD) symptoms among Iraq/ Afghanistan war veterans. After accounting for the possible influence of combat exposure, we expected that the resilient prototype would predict lower depression and PTSD over time and would be associated with adaptive coping strategies, higher social support, lower psychological inflexibility, and higher self-reported resilience relative to overcontrolled and undercontrolled prototypes, independent of traumatic brain injury (TBI) status. Method: One hundred twenty-seven veterans (107 men, 20 women; average age = 37) participated in the study. Personality was assessed at baseline, and PTSD and depression symptoms were assessed 8 months later. Path analysis was used to test the direct and indirect effects of personality on distress. Results: No direct effects were observed from personality to distress. The resilient prototype did have significant indirect effects on PTSD and depression through its beneficial effects on social support, coping and psychological inflexibility. TBI also had direct effects on PTSD. Conclusions: A resilient personality prototype appears to influence veteran adjustment through its positive associations with greater social support and psychological flexibility, and lower use of avoidant coping. Low social support, avoidant coping, and psychological inflexibility are related to overcontrolled and undercontrolled personality prototypes, and these behaviors seem to characterize veterans who experience problems with depression and PTSD over time. A positive TBI status is directly and prospectively associated with PTSD symptomology independent of personality prototype. Implications for clinical interventions and future research are discussed. [ABSTRACT FROM AUTHOR]

Objective: Individuals who assume caregiving duties for a family member disabled in a traumatic injury often exhibit considerable distress, yet few studies have examined characteristics of those who may be resilient in the initial year of caregiving. Reasoning from the influential Pearlin model of caregiving (Pearlin & Aneshensel, 1994) and the resilience process model (Bonanno, 2005), we expected a significant minority of caregivers would be chronically distressed and another group would be resilient throughout the inaugural year of caregiving for a person with a traumatic spinal cord injury (SCI), and these groups would differ significantly in primary and secondary stress and in personal resources and mediators. Method: Twenty men and 108 women who identified as caregivers for a family member who incurred a traumatic SCI consented to complete measures during the inpatient rehabilitation and at 1 month, 6 months, and 12 months postdischarge. Results: Latent growth mixture modeling of depression symptoms over time revealed 3 groups of caregivers: chronic (24%), recovery (24%) and resilient (48%). The chronic group reported more anxiety, negative affect, and ill health than the other 2 groups throughout the year. The resilient group was best characterized by their enduring levels of positive affect and supportive social networks. Conclusions: A large percentage of individuals are resilient in the initial year of caregiving, and those who have problems adapting exhibit significant distress soon following the traumatic event. Early detection of and psychological interventions for individuals who have difficulty adjusting are indicated, as their distress is unlikely to abate untreated over the year. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to examine the use and quality of exploratory factor analysis (EFA) in articles published in Rehabilitation Psychology. Design : Trained raters examined 66 separate exploratory factor analyses in 47 articles published between 1999 and April 2014. The raters recorded the aim of the EFAs, the distributional statistics, sample size, factor retention method(s), extraction and rotation method(s), and whether the pattern coefficients, structure coefficients, and the matrix of association were reported. Results: The primary use of the EFAs was scale development, but the most widely used extraction and rotation method was principle component analysis, with varimax rotation. When determining how many factors to retain, multiple methods (e.g., scree plot, parallel analysis) were used most often. Many articles did not report enough information to allow for the duplication of their results. Conclusion: EFA relies on authors’ choices (e.g., factor retention rules extraction, rotation methods), and few articles adhered to all of the best practices. The current findings are compared to other empirical investigations into the use of EFA in published research. Recommendations for improving EFA reporting practices in rehabilitation psychology research are provided. [ABSTRACT FROM AUTHOR]

Objective: Intervention trials for stroke caregivers after the early poststroke period are lacking. To address this gap, we examined the effectiveness of a problem-solving intervention (PSI) for stroke caregivers who provided care for at least 6 months and who experienced significant strain in their role. Method: One hundred twenty-two family caregivers (age = 66.2 years, 77.9% female) were randomly allocated to a PSI or control group. The PSI was composed of 2 home visits and 18 telephone calls delivered over a 3-month intensive intervention and a 9-month maintenance period. PSI and control groups received monthly information letters in addition to usual care. Primary caregiver outcomes were depressive symptoms (measure: Center for Epidemiologic Studies-Depression Scale) and sense of competence (measure: Sense of Competence Questionnaire). Results: In covariance analyses, caregivers of the PSI group showed significantly lower levels of depressive symptoms after 3 months (p < .01, d = -.4 8 ) and after 12 months (p < .05, d = -.3 7 ), but no better sense of competence compared with the control group. Latent growth curve analyses revealed positive significant (p < .05) linear and quadratic effects of PSI on both primary outcomes. No effects, however, were found on caregiver social-problem-solving abilities. Conclusions: Although beneficial effects were observed among caregivers in the PSI group, the lack of effects on problem-solving abilities implies other characteristics of the intervention might account for these benefits. The relative intensity and therapeutic contact during the first 3 months of the intervention may be particularly helpful to caregivers of stroke survivors. [ABSTRACT FROM AUTHOR]

Objectives: We studied the predictive impact of family satisfaction, marital status, and functional impairment on the trajectories of life satisfaction over the first 5 years following medical treatment for traumatic spinal cord injury, bums, or interarticular fractures (total N = 662). It was anticipated that fewer functional impairments, being married, and greater family satisfaction would predict higher life satisfaction trajectories. Method: The Functional Independence Measure, the Family Satisfaction Scale, and the Life Satisfaction Index were administered 12, 24, 48, and 60 months postdischarge. Results: Trajectory modeling revealed that greater functional impairment significantly predicted lower life satisfaction, regardless of injury type. However, this association diminished when marital status and family satisfaction were entered into the models. Greater family satisfaction and being married predicted greater life satisfaction across time. Moreover, there was no evidence for increases in life satisfaction trajectories over time: Trajectories were stable across time for all injury groups. Conclusions: Results suggest that being married and greater family satisfaction promote life satisfaction among those who traumatically acquire disability, and these beneficial effects may be more salient than the degree of functional impairment imposed by the condition. [ABSTRACT FROM AUTHOR]

Objective: We examine the rates of major depressive disorder, single episode determined by the Inventory to Diagnose Depression (IDD) in a clinical sample of persons with recent-onset spinal cord injury (SCI; ⩽52 weeks) participating in an inpatient SCI rehabilitation program. We also analyzed the factor structure of the IDD measure in an attempt to replicate the factor structure reported by Frank et al. (1992), and we examined item endorsement patterns. Design: A retrospective chart review was conducted. Participants were 354 individuals (93 women, 261 men) in an inpatient SCI rehabilitation program. Results: Fifteen percent of the sample met criteria for a major depressive disorder (MDD). A higher rate of depression was observed among women. A "dysphoria" factor accounted for 24% of the variance in the final four-factor model. The four-factor solution explained a total of 35.5% of the variance, with an "anhedonia" factor contributing 4.6%, a "sleep" factor contributing 3.5%, and an "appetite" factor contributing 3.5%, respectively. Items assessing symptoms of insomnia, weight loss, worrying about health, and decreased energy had the highest percentage of endorsement to meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for clinical significance. Conclusions: The rate of single episodes of MDD determined by the IDD parallels the rate observed with the Patient Health Questionnaire-9 (PHQ-9). The factor structure of the IDD was similar to that reported by Frank et al. (1992). Information provided by the IDD about the presence and severity of MDD symptoms can inform interventions for persons with SCI. [ABSTRACT FROM AUTHOR]

We examined the rate of depression among 110 parents of children with disabilities and tested a model to determine the unique factors associated with parental depression. Consenting parents completed measures of depression, family satisfaction, physical health, problem-solving abilities, stress appraisals, and child functional impairment. Participants were categorized as depressed or nondepressed based on their responses to the Patient Health Questionnaire (PHQ9; Kroenke, Spitzer, & Williams, 2001). Nineteen percent of the parents met screening criteria for depression. Regression analyses revealed that threat appraisals, poorer physical health, and lower family satisfaction were uniquely associated with depression status with 83.3% accuracy. These findings highlight the importance of family satisfaction, problem solving ability, physical health, and the influence of appraisal processes on depression among parents of children with disabilities. [ABSTRACT FROM AUTHOR]

How can psychologists aid in addressing current disparities in accessibility to meet the mental health needs of rural areas? In this paper, we discuss an innovative partnership created between community leaders in a rural county and an APA-accredited doctoral training program and its mental health clinic at a regional Federally Qualified Health Center (FQHC) to provide mental health services. We describe the efforts to build community capacity to develop the partnership and provide sustainable mental health services via teleconferencing to a remote site in a rural county. Also, to present initial evidence of the services' effectiveness in alleviating client distress, as well as meeting the expectations of referral sources and community stakeholders, we used the Patient Health Questionnaire (PHQ), the SF-12v.2, and a qualitative community survey. We examined data from a maximum of 68 clients (M age = 40.5, SD = 14.1; 48 females and 20 males); the number of available client data varied by analysis. We found that clients showed significant decreases in depressive symptoms (M decrease = 5.88, SD = 7.16, p < .001) and significant increases Mental Health Composite Scores (MCS; M increase = 11.39, SD = 7.94, p < .005). Results from the community survey revealed encouraging results as well as areas for improvement. Implications of developing community capacity for sustainable psychological services in rural areas are discussed. [ABSTRACT FROM AUTHOR]

The article discusses research study which determines the relationship between the intellectual disabilities (ID) of children and the reports of their caregivers on the status of their health among 1,108 participants in Texas. It focuses on the use of the information to predict the allowed number of hours for Medicaid Personal Care Services (PCS). It explains the application of structural equation modeling that linked ID to the PCS.

Although much is known about the risks to health and well-being that occur among family caregivers of children with disability, little is known about the unique group of caregivers of children with severe neurodisabilities who require varying degrees of respiratory care including ventilator support. This present study examined the psychological adjustment of caregivers in these situations, and tested the prediction that caregiver coping and problem-solving styles would be predictive of their physical and emotional health. Hierarchical regression analyses revealed that demographic characteristics and the severity of pulmonary condition were unrelated to caregiver adjustment. A coping style characterized by developing relationships, pursuing activities that promote self-worth and individuality, and a lower negative orientation toward solving problems were significantly predictive of caregiver distress. These data indicate that care- giver adjustment in these situations is influenced by cognitive-behavioral characteristics that could be addressed in educational and therapeutic programs provided in the clinic and in the community. [ABSTRACT FROM AUTHOR]

Objective: Although rehabilitation psychology is more focused on empirical evidence and clinical application than theory development, the authors argue for the primacy of theory and explain why theories are needed in and useful for rehabilitation psychology. Impediments to theory development are discussed, including the difficulties of applying psychological theories in multidisciplinary enterprises and the difficulties in developing a theory-driven research program. The authors offer suggestions by reviewing research settings, knowledge gained through controlled studies, grantsmanship, and then identify topical areas in which new theories are needed. Researcher-practitioners are reminded that rehabilitation psychology benefits from a judicious mix of scientific rigor and real-world vigor. Conclusions: The authors close by advocating for theory-driven research programs that embrace a methodological pluralism, which will, in turn, advance new theory, produce meaningful research programs that inform practice, and realize the goals of this special issue of Rehabilitation Psychology--advances in research and methodology. [ABSTRACT FROM AUTHOR]

As a potential indicator of program quality, publication counts are of interest to colleagues who are invested in this activity, generally, and ultimately of little use in evaluating doctoral training. Quality programs are inherently multidimensional and complex, as is our profession; therefore, determinations of quality must explicitly define the essential elements of doctoral training and improve upon existing evaluation systems. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

HIV medication adherence remains a challenge and limits the degree to which treatment benefit can be maximized. This study tested an explanatory model of HIV medication adherence using a social problem-solving (SPS) framework. Associations of SPS with adherence are hypothesized to be direct and/or indirect via psychological health. HIV+ adults were interviewed using validated measures of SPS, psychological health, and antiretroviral therapy (ART) medication adherence. Structural equation modeling (SEM) techniques were used to test hypothesized relationships and to evaluate overall fit of the model to the data. SEM supported an indirect association (but not direct) of SPS on adherence via psychological health among the 545 HIV+ adults included in the analyses. Overall, the findings resulted in a model of adherence that offered very good fit to the data and correctly classified 97% of the cases as adherent versus nonadherent. Results support the use of SPS as a conceptual framework for understanding adherence to ART. Findings offer rationale and direction for SPS interventions to enhance adherence by improving psychological health. Such approaches, if effective, have the potential to positively impact psychological well being and adherence, thereby maximizing clinical benefit from treatment, which is linked to lower mortality from AIDS. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that social problem-solving abilities of persons with recent-onset spinal cord injury (SCI) would be predictive of pressure sore occurrence in the 1st 3 years following discharge from initial inpatient rehabilitation, Design: Prospective study of persons with recently incurred SCI and their subsequent pressure sore evaluations over a 3-year period in annual clinic evaluations. Setting: Inpatient SCI rehabilitation center and outpatient clinic. Participants: 188 persons with recent-onset SCI approaching discharge from initial inpatient SCI rehabilitation, with outpatient pressure sore evaluations for those who returned for pressure sore evaluations. Main Outcome Measure: Pressure sore occurrence as determined in annual outpatient evaluations conducted over the 1st 3 years of SCI. Results: 2 separate statistical models indicated that social problem-solving abilities significantly contributed to the prediction of pressure sore occurrence. Conclusions: Social problem-solving abilities are implicated in the development of pressure sores. Persons with ineffective problem-solving abilities may be at risk for pressure sores; these individuals might require strategic monitoring and training from clinical programs. [ABSTRACT FROM AUTHOR]

Objective: To develop a conceptual framework to guide interpretation of the Rey Auditory Verbal Learning Test (A. Rey, 1958) and similar list-learning tasks across the adult life span for individuals with spinal cord injury (SCI). Study Design: Factor analysis with comparisons of sample-based and norm-based factor scores across age groups. Participants: 221 individuals with SCI undergoing inpatient rehabilitation. Results: The retained model consisted of 3 correlated factors: General Verbal Learning, Auditory Attention, and Inaccurate Recall. Cross-sectional age trends suggest decreased auditory attention and verbal learning with increasing age. The inverse pattern was observed for inaccurate recall. Conclusions: These factors are consistent with other models using similar methodology. The results offer a means of identifying barriers to meeting the educational and therapeutic goals of post-SCI rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Tested the relations of social problem-solving abilities to distress, depression, and well-being and impairment reported by persons participating in a low vision rehabilitation program. Study Design: Correlational and multiple regression analyses. Setting: Outpatient low vision rehabilitation clinic. Participants: 25 men (M = 73.88 years old, SD = 11.94 years) and 29 women (M = 68.79 years old, SD = 17.25 years) participating in a comprehensive admitting examination. Main Outcome Measures: Emotional distress specific to the condition, depressive behavior, satisfaction with life, and functional ability. Results: A negative problem orientation significantly predicted depression and emotional distress; rational problem-solving skills predicted life satisfaction. Conclusions: A negative problem orientation toward problem solving predicts poor emotional adjustment reported by persons with low vision, and proactive problem-solving skills appear to promote optimal adjustment. [ABSTRACT FROM AUTHOR]

Beatrice A. Wright's (1960) classic book, Physical Disability: A Psychological Approach is a landmark publication in rehabilitation psychology. The authors believe that Division 22's forthcoming 50th anniversary, the results of a recent survey on essential readings in rehabilitation psychology, and a public critique concerning the relevance of individuating language in psychology are compelling reasons for revisiting the influence of Physical Disability. After discussing these catalysts, the authors review the book's history, scholarly impact, and link to positive disciplinary directions. The authors conclude by encouraging rehabilitation psychologists and other members of the discipline to (re)acquaint themselves with this important book and the timeless concepts it espouses. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Study Design: Evaluative research review. Objective: Depression is a significant secondary complication of spinal cord injuries (SCI); this study applies the D. L. Sackett (1989) research criteria to evaluate the quality of intervention studies of the treatment of depression among persons with SCI. Method: An extensive range of peer-reviewed published research was identified through established databases, critical reviews, and published meta-analyses. Results: Nine studies met the inclusion criteria. One antidepressant study was rated above Level III; although the psychological intervention studies had control groups, these were not randomized. Conclusion: This review demonstrates the need for randomized clinical trials of psychological and pharmacological interventions for depression and distress among persons with SCI, so that informed decisions concerning cost-effective treatments can be made. [ABSTRACT FROM AUTHOR]

Examines the relation of social problem-solving abilities to trajectories of adjustment of family caregivers in initial year of their caregiver role. Hierarchical linear models showing effect of negative problem orientation; Implications for psychological interventions; Health policy concerning the needs of family caregivers and their care recipients.

Investigates the influence of goal instability on adjustment and health of disabled people in the United States. Lack of data on psychoanalytic constructs in the adjustment of individuals with physical disability; Determinants of optimal adjustment during life transitions; Significance of a flexible but durable goal orientation.

Presents information on a study which examined the reactions of psychologists to vignettes that describe a client who emitted either depressed or nondepressed behavior and who varied in terms of cancer prognosis. Samples and measures; Analyses and results; Implications.

The utility of different reality negotiation strategies among 57 persons who had traumatically acquired severe physical disabilities was examined. It was predicted that a sense of goal-directed determination ("agency"; Snyder, 1989) would predict lower depression and psychosocial impairment scores soon after injury. To meet the demands of rehabilitation and social integration, however, it was hypothesized that a sense of ability to find ways to meet goals ("pathways") would predict lower depression and psychosocial impairment among persons who had been disabled for a longer period. The expected interaction was significant in the prediction of psychosocial impairment but not of depression. The sense of pathways was predictive of impairment and depression regardless of the time since injury. Results suggest that in the reality negotiation process the different components of hope as defined by Snyder have salient effects on perceptions of ability to function in social capacities. [ABSTRACT FROM AUTHOR]

Reports that a positive problem orientation wards off negative affect and promotes positive affect to enhance problem solving. Positive problem orientation's association with greater positive and lower negative affect; Mediation by trait affectivity.

Reflects on the 51st volume of the journal "Rehabilitation Psychology" in 2006. Factors that influence the elevated the status and relevance of research into the health and welfare of persons living with disabling conditions; Topics that will be addressed by the journal; Position of the journal on the development and refinement of psychometric instrumentation.

Purpose/Objective: The present study examines associations between levels of limb loss (partial hand vs. higher levels of limb loss) and eight clinically relevant measures of functional impairment, psychological well-being, and substance use. Research Method/Design: A cross-sectional, multisite study conducted at seven prosthetic rehabilitation centers across the United States. A total of 305 participants with upper limb loss (Mage = 44.28, SD = 15.45; 68.5% male; 70.5% white) completed orally administered self-assessments of pain interference, perceived activity restrictions, posttraumatic stress disorder (PTSD), depression, emotional reaction to their physical condition, problematic alcohol use, prescription medication overuse, and illicit drug use. Results: Results showed individuals with partial hand loss were at significantly greater odds of endorsing pain interference and screening positive for PTSD. Results also showed level of limb loss was significantly associated with emotional reaction to their physical condition, such that participants with partial hand loss scored significantly above those with higher level limb loss. Conclusions/Implication: The current study highlights level of limb loss as an important correlate of several functional impairments and psychological measures among individuals with upper limb loss. These findings may inform clinicians and occupational therapists in their development of treatment and rehabilitation. In particular, practitioners should be cognizant of their patient's level of limb loss, as individuals with partial hand loss may be more susceptible to greater emotional reactions to their physical condition and increased psychological distress due to pain interfering with their work and elevated posttraumatic stress symptoms. [ABSTRACT FROM AUTHOR]

Objective: Depressive symptoms are a common problem among family caregivers of stroke survivors. The purpose of this study was to examine the association between care recipient's impairment and caregiver depression, and determine the possible mediating effects of caregiver negative problem-orientation, mastery, and leisure time satisfaction. The evaluated model was derived from Pearlin's stress process model of caregiver adjustment. Method: We analyzed baseline data from 122 strained family members who were assisting stroke survivors in Germany for a minimum of 6 months and who consented to participate in a randomized clinical trial. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. The cross-sectional data were analyzed using path analysis. Results: The results show an adequate fit of the model to the data, χ2(1, N = 122) = 0.17, p = .68; comparative fit index = 1.00; root mean square error of approximation: p < .01; standardized root mean square residual = 0.01. The model explained 49% of the variance in the caregiver depressive symptoms. Results indicate that caregivers at risk for depression reported a negative problem orientation, low caregiving mastery, and low leisure time satisfaction. The situation is particularly affected by the frequency of stroke survivor problematic behavior, and by the degree of their impairments in activities of daily living. Conclusion: The findings provide empirical support for the Pearlin's stress model and emphasize how important it is to target these mediators in health promotion interventions for family caregivers of stroke survivors. [ABSTRACT FROM AUTHOR]

Objective: The authors examined depression and health-related quality of life among individuals with self-reported sensory impairments living in a health professional shortage area. Research Method: Health surveys of residents were conducted in 2006 and 2010. Responses were analyzed by groups of residents reporting vision loss, hearing loss, dual hearing and vision loss, and no sensory loss. In 2006, the total sample size was n = 2,591, and in 2010, it was n = 3,955. Main Outcome Measures: The CESD-5 scale (Shrout & Yager, 1989) was included in 2006, and the PHQ-9 (Kroenke, Spitzer, & Williams, 2001) was included in 2010. Rates of depression on the CESD-5 were determined by the recommended cut-off scores and on the PHQ-9 by the recommended algorithm. The Centers for Disease Control (CDC) Healthy Days instrument (Moriarty, Zack, & Kobau, 2003) was used in both surveys to assess health-related quality of life. Results: In both surveys, individuals who reported sensory loss had higher rates of depression and lower health-related quality of life than individuals with no reported sensory loss. Conclusions: Individuals reporting sensory loss had high rates of depression and a compromised quality of life compared to respondents without these impairments. These data imply strategic community-based health care services, including mental health initiatives, may be indicated for individuals with sensory loss living in underserved regions. Implications for rehabilitation psychology research, service, and policy are discussed as innovations in these areas are needed to better understand and address the disparities that may compromise the overall well-being of residents of underserved communities. [ABSTRACT FROM AUTHOR]

Objective: To examine whether an individualized problem-solving intervention provided to family caregivers of persons with severe disabilities provides benefits to both caregivers and their care recipients. Design: Family caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year. Participants: Family caregivers (129 women, 18 men) and their care recipients (81 women, 66 men) consented to participate. Main Outcome Measures: Caregivers completed the Social Problem-Solving Inventory-Revised, the Center for Epidemiological Studies-Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in 3 additional assessments throughout the year. Care recipient depression was assessed with a short form of the Hamilton Depression Scale. Results: Latent growth modeling was used to analyze data from the dyads. Caregivers who received PST reported a significant decrease in depression over time, and they also displayed gains in constructive problem- solving abilities and decreases in dysfunctional problem-solving abilities. Care recipients displayed significant decreases in depression over time, and these decreases were significantly associated with decreases in caregiver depression in response to training. Conclusions: PST significantly improved the problem-solving skills of community-residing caregivers and also lessened their depressive symptoms. Care recipients in the PST group also had reductions in depression over time, and it appears that decreases in caregiver depression may account for this effect. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate possible determinants of parent wellbeing using a contextual model of parent adjustment. Method: One hundred forty parents of children with various disabilities (i.e., autism, intellectual disabilities, and other health impairments) participated in this investigation. Parents completed a survey consisting of basic demographic characteristics of the parent, child-disability characteristics, parent problem solving ability, access to information and resources, environmental/social supports, appraisals of threat and growth, and measures of life satisfaction and physical/mental health. Structural equation modeling was conducted to test a hypothesized contextual model of parent wellbeing. Results: Results indicated strong fit to the a priori model. After controlling for the contribution of parent demographic variables, the largest contributors to the prediction of parent wellbeing were parent problem solving ability, access to resources, environmental/social supports, and parent appraisals of threat. Child functional impairment was not significantly associated with parent wellbeing. Conclusions: Access to resources and environmental/social supports have a greater direct effect on parent wellbeing than parent and child demographic variables and disability severity. Threat appraisals have direct and mediating effects on parent wellbeing. Implications related to the importance of resources and environmental/social supports, appraisals of threat and growth, and problem solving abilities on the wellbeing of parents of children with disabilities are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Examined the influence of functional impairment, stable marital status, and family satisfaction on life satisfaction trajectories for 609 individuals (435 men, 174 women) over the first 5 years after traumatic brain injury (TBI). Measures: Participants completed the Family Satisfaction Scale (FSS), Functional Independence Measure (FIM), and the Life Satisfaction Index (LSI) at years 1, 2, 4, and 5 after sustaining a TBI. Results: Trajectory modeling revealed that higher family satisfaction was associated with increases in life satisfaction for individuals with less functional impairment. Stable marital status was not significantly associated with life satisfaction trajectories. Implications: Family satisfaction appears to have pronounced beneficial effects on life satisfaction for persons with less functional impairment after TBI regardless of marital status. In contrast, a stable marriage appears to have no apparent benefits to self-reported life satisfaction over the first 5 years post-TBI. Theoretical and clinical implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Objective: To test hypothesized relations between hope and self-efficacy for rehabilitation to depression and functional ability reported by individuals receiving joint replacement surgery. Study Design: Community-dwelling older adults (N = 100) from an orthopaedic clinic were administered measures of hope, self-efficacy for rehabilitation, pain, depression, body mass index (BDI), and mental status 1 month prior to their joint replacement surgery. These measures were completed by 62 participants 6 weeks after surgery. Demographic, health information, and functional outcome measures were obtained by medical personnel pre- and postsurgery. Main Outcome Measures: Functional outcome measures (Harris Hip and Knee Society Scores) and depressive symptomatology. Results: Hope was significantly predictive of presurgery depression, but it was not predictive of depression or functional ability after surgery. Higher levels of self-efficacy were predictive of lower postsurgery depression scores. Conclusions: Results imply that social-cognitive constructs may have utility in the prediction of emotional adjustment before and after joint surgery, but they may have limited value in anticipating functional abilities following these surgeries. Theoretical and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: Examined appraisals of interference and personal tolerance in the prediction of distress among women experiencing urinary incontinence (UI). Design: Interviewed women volunteering for a behavioral treatment for UI. Women were interviewed at baseline; follow-up assessments were conducted 6 weeks and 6 months later. Measures of perceived interference, tolerance, condition-specific emotional distress, symptom severity, general intelligence, and depressive symptoms were administered. Participants: 131 women (mean age = 66.6 years, SD = 8.4; range 55-90) with reported involuntary loss of urine at least once a week prior to participation. Main Outcome Measure: Emotional distress attributed to UI. Results: Path analyses indicated that greater tolerance was associated with less interference imposed by UI. Greater tolerance was also associated with less distress. Symptom severity (frequency of UI episodes, nocturia, and objectively determined fluid loss) indirectly influenced emotional distress through perceived interference. Cognitive appraisals of interference and tolerance were stable over time. Conclusions: These data indicate that appraisals of personal ability to tolerate the condition and interference of the condition on goal-directed behavior and expected activities have greater influence on emotional distress than does severity of condition-specific symptom. [ABSTRACT FROM AUTHOR]

Positive psychology explores factors that make life worth living and the human strengths that enable individuals to confront challenges, appreciate others, and regard daily experiences as meaningful. This nascent area' s focus can inform the direction of future research and practice in rehabilitation psychology. The authors discuss rehabilitation psychology's positive core strengths, identify positive psychology's levels of analysis and the implications for rehabilitation psychology, review subjective experiences following disability to illustrate positive rehabilitation psychology, consider some integrative positive models for research and practice, and recommend positive resources for rehabilitation psychologists. On the basis of existing strengths and emerging perspectives, the authors conclude that the prospects for a positive psychology of rehabilitation are excellent. [ABSTRACT FROM AUTHOR]

Objective: To examine characteristics that best predict family caregivers of stroke survivors at risk for depression. Survivor and caregiver demographic variables and caregiver general health, problem-solving skills, social support, satisfaction with rehabilitation health care services, preparedness, and burden were examined. Design: A correlational design. Participants: Seventy-tour family caregivers of individuals receiving inpatient stroke rehabilitation were interviewed 1-2 days prior to their relative's discharge. Main Outcome Measure: The Center for Epidemiologic Studies Depression Scale (L. S. Radloff, 1977). Results: Caregivers at risk for depression had a negative orientation toward solving problems, a lack of caregiver preparedness, and impaired social functioning secondary to their own health. Conclusions: Rehabilitation psychologists should be aware that these variables are important in predicting family caregivers of stroke survivors at risk for depression. [ABSTRACT FROM AUTHOR]