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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. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.)

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.

Family caregivers of persons following neurotrauma function as de facto extensions of our health care system. Their challenges may result in negative consequences for their physical and mental health, which directly impacts the well-being of their care-recipient. In this paper, we survey current practices in providing caregiver support, outline considerations for developing collaborative interventions, and make recommendations for assessing intervention effectiveness consistent with the nature of the adjustment processes among caregivers and care recipients.

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: 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]

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: 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]

Background/objectives: The relationship of social problem solving abilities, health locus of control beliefs, and psychosocial impairment were examined among individuals with spinal cord injuries who were hospitalized following surgical repair of severe pressure sores. Methods: Individuals were approached after surgical repair and completed measures of problem solving, health locus of control beliefs, and psychosocial impairment after admission to the rehabilitation hospital. Results: The sample reported greater psychosocial impairment than observed in comparative data, but they did not differ from another sample in terms of health locus of control beliefs. Correlational analyses revealed that a negative orientation toward problem solving was significantly predictive of psychosocial impairment, consistent with prior research. However, a second study found persons assigned to a brief problem solving intervention did not differ on any measure from participants in a control group. Discussion: Implications of these results are discussed from theoretical and clinical perspectives. Although social problem solving abilities were predictive of psychosocial impairment in a predicted direction, the lack of effects for the intervention suggests greater precision is needed to understand individual needs and to develop individualized intervention protocols. [ABSTRACT FROM AUTHOR]

Although many persons with spinal cord injuries (SCI) are at risk for preventable complications, very little research has examined the health behaviors of these individuals. In this study, we examined self-reported health behaviors of persons with recent-onset SCI. We also studied the association between health behaviors and social problem-solving abilities. The results indicated that positive problem-solving characteristics were associated with more adaptive wellness and accident prevention behaviors. A negative orientation toward problem solving and avoidant and impulsive/careless styles was associated with increased traffic and substance risk taking. Implications are discussed in terms of health education, research, and prevention programs. [ABSTRACT FROM AUTHOR]

The current study employed a case-control design to examine the impact of marital status on adjustment among individuals with spinal cord injury (SCI) 1 year post-injury. Two groups of 53 individuals (i.e., single versus married individuals) were matched case-for-case on age (i.e., within 10 years), education, gender, race, and lesion level. Although not specifically matched, etiology of SCI, and number of rehospitalizations and days rehospitalized during the past year were not significantly different between groups. Outcome measures included the Satisfaction With Life Scale, the Craig Handicap Assessment and Reporting Technique (CHART), and the SF-12. Results indicated that overall self-reported QOL was significantly lower among single individuals as compared to their matched married counterparts. Similarly, self-reported handicap was significantly higher among single individuals, particularly in the areas of social integration and economic self-sufficiency. In contrast, overall physical and mental health were not different across groups. [ABSTRACT FROM AUTHOR]

The article presents a study, which examined the correlates of unrealistic beliefs about spinal cord injury (SCI), denial tendencies, and defensiveness over the first year following injury onset. In the study, individuals were interviewed at three different times after their return to the community. Specific overly optimistic beliefs about SCI were not associated with any index of adjustment at the first two assessments, however, these beliefs were associated with greater distress and perceived handicap one year following return to the community. Greater denial and defensiveness were consistently associated with less distress, hostility, and perceived handicap at each assessment. No self-report variables were associated with the occurrence of preventable secondary complications diagnosed one year following discharge from the rehabilitation unit. Conclusively, results are discussed as they pertain to models of reality negotiation and adjustment to the onset of severe physical disability.

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]