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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.

Objectives: This study tested an a priori contextual model of the mediating effects of participation on the predictive relationships of functional impairment, family satisfaction, and pain to quality of life (QoL) following traumatic spinal cord injury (SCI)., Design: A longitudinal design was used to study 144 persons following discharge for traumatic SCI. Predictor variables included functional impairment and family satisfaction (at 12 months post-discharge) and the presence of pain (at 24 months), and mediating variables were two indicators of participation (assessed 48 months post-discharge). Life satisfaction and self-rated health status at 60 months post-discharge were the outcome variables., Methods: A path model tested hypothesized prospective effects of functional impairment, family satisfaction and pain on participation and the subsequent effects of participation on the QoL variables., Results: Greater functional impairment and pain were predictive of less participation, and participation significantly predicted both indicators of QoL. The two participation variables mediated the relationship of functional impairment and pain to life satisfaction over time. Family satisfaction had an indirect effect on QoL through its association with social integration., Conclusions: Participation appears to mediate the prospective influence of functional impairment, family satisfaction, and pain on QoL in the years following SCI. These findings provide insight into factors that can predict QoL post-SCI and support the use of contextual models to understand the temporal influence of disability and psychological variables on participation and subsequent QoL., Statement of Contribution: What is already known on this subject? Life satisfaction and self-rated health status are important aspects of quality of life following traumatic spinal cord injury. Functional impairment has been inconsistently predictive of these variables over time. Prospective research to date has not examined the mediating effects of participation in predicting quality of life. What does this study add? The results indicate that greater functional impairment and pain are prospectively predictive of lower participation. Greater participation, in turn, is prospectively predictive of greater quality of life. Participation appears to mediate the prospective influence of functional impairment, family satisfaction, and pain to quality of life., (© 2013 The British Psychological Society.)

Our objective was to examine the effectiveness of a brief individualized problem-solving intervention for family with caregivers of persons with recent-onset spinal cord injury (SCI). Family caregivers were randomly assigned to a usual care control group (N=30) or an intervention group (N=30) in which participants were to receive three face-to-face problem-solving training sessions (PST), educational materials, and telephone contacts as requested over the first year of caregiving. The participants included 60 caregivers (49 women, 11 men). The Social Problem-Solving Inventory-Revised, the Inventory to Diagnose Depression, and the SF-36 were administered at baseline, 6 months and 12 months. Caregivers in the intervention group reported a significant decrease in dysfunctional problem-solving styles scores over time; there were no observable effects for PST on caregiver depression. There was also some indication that the intervention had beneficial effects on caregiver social and physical functioning. An intervention for new caregivers featuring brief PST, education, and contact may be associated with lower dysfunctional problem-solving styles over time and may promote certain aspects of caregiver quality of life. We also discuss limitations and implications of the present study.

Objective: To examine the effectiveness of an individualized problem-solving intervention delivered in videoconferencing sessions with family caregivers of persons living with a spinal cord injury (SCI) and possible contagion effects on care recipients., Design: Family caregivers were randomly assigned to an education-only control group or an intervention group in which participants received problem-solving training (PST) in monthly videoconference session for a year., Participants: Sixty-one caregivers (54 women, 7 men) and their care recipients (40 men, 21 women) consented to participate., Main Outcome Measures: The Social Problem-Solving Inventory-Revised was administered to caregivers. Caregivers and care recipients completed the Inventory to Diagnose Depression, the SF-36 and the Satisfaction with Life scale at pre-treatment, 6 months and 12 months., Results: Twenty-eight caregivers discontinued the study and their follow-up data were unavailable at the final assessment. Older caregivers were more likely than younger caregivers to remain in the study. Intent-to-treat analyses projected a significant decrease in depression among caregivers receiving PST; efficacy analyses indicated this effect was pronounced at the 6th month assessment. ITT analyses and efficacy analyses revealed that care recipients of caregivers receiving PST reported gains in social functioning over time., Conclusions: Community-based, telehealth interventions may benefit family caregivers and their care recipients, but the mechanisms of these effects are unclear. Attrition and sample issues should be considered in future studies with these populations.

A sample of 199 persons with spinal cord injury (SCI) were assessed on Big Five personality dimensions using the NEO Five-Factor Inventory (NEO-FFI; Costa & McCrae, 1992) at admission to an inpatient medical rehabilitation program. A cluster analysis of the baseline NEO-FFI yielded 3 cluster prototypes that resemble resilient, undercontrolled, and overcontrolled prototypes identified in many previous studies of children and adult community samples. Compared with normative samples, this sample had significantly fewer resilient prototypes and significantly more overcontrolled and undercontrolled prototypes. Undercontrolled individuals were the modal prototype. The resilient and undercontrolled types were better adjusted than the overcontrolled types, showing lower levels of depression at admission and higher acceptance of disability at discharge. The resilient type at admission predicted the most effective reports of social problem-solving abilities at discharge and the overcontrolled type the least. We discuss the implications of these results for assessment and interventions in rehabilitation settings.

We studied the predictive impact of proxy 'outsider' reports, injury type, and functional independence on trajectories of happiness over the first 5 years following medical treatment for a traumatic spinal cord injury, brain injury, severe burns or inter-articular fractures (total N = 1,271). It was anticipated that lower functional independence and outsider status would predict lower happiness trajectories, with injury type having little effect over time. A measure of functional impairment and the life satisfaction index containing the items that assessed happiness were administered 12, 24, 48, and 60 months post-discharge. Trajectory modeling revealed that lower functional independence significantly predicted lower happiness, regardless of injury type. Outsider reports predicted significantly higher happiness scores than the insiders reported themselves. These differences persisted across time and injury type. Additional analyses found that insider/outsider status accounted for one percent of the variance in happiness scores and functional independence accounted for twenty percent of the variance. Moreover, for all injury groups, there was no evidence for changes in happiness trajectories over time. Outsider accounts differ significantly from insider estimations of variables of positive adjustment accounts but explain little variation in the reports of happiness overall and still have practical and clinical value as secondary sources of information about positive emotional experiences, particularly when reports from the 'insider' are not possible. [ABSTRACT FROM AUTHOR]

Objective: To determine the percentage of family caregivers of persons with spinal cord injury (SCI) with probable depression and to test the hypothesis that dysfunctional problem-solving abilities would be significantly predictive of risk status after taking into account important demographic characteristics and caregiver health. Design: Correlational and logistic regression analyses of data collected in a cross-sectional design. Participants: Eighteen men and 103 women caregivers (mean age of caregivers = 45.66 years, SD = 12.88) of individuals with SCI. Main Outcome Measure: The Inventory to Diagnose Depression. Results: Nineteen caregivers (15.7%) met criteria on the Inventory to Diagnose Depression for a major depressive disorder. A dysfunctional problem-solving style was significantly predictive of caregiver depression, regardless of the severity of physical impairment of the care recipient or the physical health of the caregiver and caregiver demographic variables. Conclusions: The percentage of caregivers with probable depressive disorder may parallel that observed among persons with SCI, using a more conservative self-report measure designed to assess symptoms associated with a depressive syndrome. Family caregivers with a dysfunctional problem-solving style and assisting individuals with more severe injuries may have probable depression. [ABSTRACT FROM AUTHOR]