Coping with negative life events in old age: the role of tenacious goal pursuit and flexible goal adjustment

Stress and suicidal ideation in Korean baby boomers: the mediating effect of mindfulness and meaning in life

Stress has been shown to enhance elderly suicidal ideation. However, the effect of mindfulness and meaning in life on the relationship between stress and suicidal ideation in Korean baby boomers are still unknown. This study investigated (a) a significant correlation between the stress, suicidal ideation, mindfulness, and meaning in life, (b) the mediating effect of mindfulness in the association between stress and suicidal ideation, and (c) the serial mediating effect of mindfulness and then meaning in life on the relationship between stress and suicidal ideation. Data were collected from 200 baby boomers (born between 1955-1963) concerning their stress, mindfulness, meaning in life, and suicidal ideation. These findings suggest that if interventions directed at baby boomers can successfully improve their mindfulness and by extension raise their meaning in life, suicidal ideation will decrease within their population.

Accepting the Aging Body: Protective Factors of Body Acceptance in Persons of Advanced Age

Introduction: Physical attractiveness, productivity, religiosity, meaningfulness, and relationships are important characteristics of successful aging. To maintain psychological flexibility, acceptance and values-directed interventions have been effective in managing difficulties with aging. Objectives: The present paper aimed to investigate body acceptance and individual values in healthy individuals over the age of 50 living in Austria. Methods: In addition to sociodemographic variables, subjective age, attractiveness, and desire for body changes were assessed in our survey. The Austrian Value Questionnaire was used to record values, and the German Version of the Quality of Marriage scale assessed partnership quality. Data from 187 older adults were recruited via snowball sampling. Analyses were performed in SPSS and R, using a structural equation modeling approach. Results: The results indicate that as age increases and subjective attractiveness decreases, body acceptance declines. Materialism seems to support the desire for cosmetic surgery (β = .230, p = .016). A negative association between conservatism and changes in desires for body change (β = -.221, p = .044) suggests that greater value commitment and conservative attitudes are related to fewer change desires. Conclusion: These findings underpin the necessity for encouraging individuals early on to be in touch with their values to promote psychological flexibility.

Awareness of age-related change, future time perspective, and implications for goal adjustment in older adulthood

OBJECTIVES

How people adjust their goals is central to adaptation across the lifespan. However, little is known about individual difference characteristics that predict how and why people use different self-regulatory strategies. The present study investigated associations of perceived age-related gains and losses, and their interaction, as predictors of goal adjustment in older adulthood. Furthermore, we examined whether future time perspective (FTP) mediated relationships between awareness of age-related change (AARC) and goal adjustment.

METHOD

A community-based sample of 408 adults (aged 60-88 years) was recruited via an internet-based research platform. Participants completed questionnaire measures of AARC, FTP, goal disengagement, and goal re-engagement. A flexibility index reflecting tendencies toward use of both goal disengagement and goal re-engagement strategies was also analyzed.

RESULTS

Although AARC-losses was associated with lower goal re-engagement and goal flexibility, this association was weaker among those with higher AARC-gains, indicating AARC-gains may be protective in the relationship between AARC-losses and goal adjustment. The association between AARC and goal adjustment was also shown to be mediated by FTP. Higher AARC-gains was associated with more expansive FTP, which was associated with lower goal disengagement and higher goal re-engagement. On the other hand, higher AARC-losses was associated with more restricted FTP, which was associated with higher goal disengagement and lower goal re-engagement.

DISCUSSION

Results have implications for how we conceptualize the combined effects of age-related gains and losses on developmental outcomes relevant to adaptive aging. Furthermore, perceptions of future time with advancing age may be implicated in processes linking AARC with goal adjustment.

Students' Well-Being: The Mediating Roles of Grit and School Connectedness

A remarkable point in previous decades in every aspect of life is well-being which is also effective in academic settings, and it is consistent with positive psychology, in which one can recognize how to make everything pleasing. Moreover, grit is another noteworthy point in the process of learning, which is at the center of researchers’ attention in last years as a result of its long-term eminence. In addition, school connectedness is another important factor that was found to be positively related to students’ well-being. Therefore, the current review endeavors to emphasize the mediating role of these two constructs, grit and school connectedness on students’ well-being. Successively, some implications are proposed for educators, learners, teacher educators, and materials developers.

Negative life events and self-harm among the elderly: Result from a survey of 7070 people aged≥60 in China

PURPOSES

Negative life events have been reported as a risk factor for elderly self-harm. The aim of this study was to examine the relationship between negative life events and self-harm in a large sample of people aged 60 and older, and explore the role of some previously identified influential factors in this relationship.

METHODS

Multi-stage stratified sampling method was used to select the elderly people over 60 years old in Shandong, China. Information were collected through face-to-face interviews. Univariate and multivariable logistic regression were used for initial analysis. Karlson-Holm-Breen (KHB) method was used for mediating effect analysis.

RESULTS

A total of 7070 participants were included in the study, 160 reported they had a history of self-harm (2.3%), 756 reported they had negative life event experience (10.7%). After model adjustment, the association between negative life events, loneliness, economic status and self-harm was still statistically significant. Mediation analysis showed that the association is explained by loneliness (proportion of mediation 48.86%), self-rated economic status (16.13%).

CONCLUSIONS

Negative life events, loneliness and economic status were associated with self-harm among the older adults. Loneliness and economic status may play an intermediary role in the relationship between negative life events and self-harm, especially loneliness. More psychological and social functions intervention strategies and prevention measures on the self-harm of the elderly should be provided for the elderly who have experienced negative life events.

Learning as an Important Privilege: A Life Span Perspective with Implications for Successful Aging

Research has demonstrated the cognitive and mental health benefits of learning new skills and content across the life span, enhancing knowledge as well as cognitive performance. We argue that the importance of this learning – which is not available equally to all – goes beyond the cognitive and mental health benefits. Learning is important for not only the maintenance, but also enhancement of functional independence in a dynamic environment, such as changes induced by the COVID-19 pandemic and technological advances. Learning difficult skills and content is a privilege because the opportunities for learning are neither guaranteed nor universal, and it requires personal and social engagement, time, motivation, and societal support. This paper highlights the importance of considering learning new skills and content as an <i>important privilege</i> across the life span and argues that this privilege becomes increasingly exclusionary as individuals age, when social and infrastructural support for learning decreases. We highlight research on the potential positive and negative impacts of retirement, when accessibility to learning opportunities may vary, and research on learning barriers due to low expectations and limited resources from poverty. We conclude that addressing barriers to lifelong learning would advance theories on life span cognitive development and raise the bar for successful aging. In doing so, our society might imagine and achieve previously unrealized gains in life span cognitive development, through late adulthood.

Coping processes that foster accommodation to loss in old age

Aim: Flexible adjustment or accommodation to loss is healthy; however, little is known about how it can be achieved in old age. We sought to identify and characterize effective coping processes for achieving accommodation at this stage of life. Our aim was to foster the activation of the psychological resources of those who must deal with significant losses to which they will inevitably need to adapt.Method: Qualitative study with a sample of men (n = 16) and women (n = 19) aged 60 years and up. Information was collected through observation and content analysis applied to 35 in-depth interviews, using Atlas-Ti (v7).Results: Eighteen coping processes implemented in response to loss were identified and characterized. Although no single process led to full adjustment by itself, the difference between the participants who accommodated and those who lacked accommodation was reflected in the predominance of certain processes. This approach enabled us to identify 13 effective processes, such as the search for meaning and the use of humor, which were generally used by participants who had achieved accommodation. The processes regarded as ineffective, such as avoidance and procrastination, were used more often by those who displayed insufficient accommodation.Conclusion: It was confirmed that accommodation to losses in old age not only results from "the passage of time"; rather, it can be fostered by people's active efforts. Knowledge of these practices can help practitioners orient mental health interventions for older adults who have difficulty coping in healthy ways and preserving their subjective well-being.

Tenacious Goal Pursuit, Flexible Goal Adjustment, and Life Satisfaction Among Chinese Older Adult Couples

We aimed to examine the roles of tenacious goal pursuit (TGP) and flexible goal adjustment (FGA), mediated by positive self-perceptions of aging (PSA), in Chinese older couples' life satisfaction. Using a cross-sectional design, 245 Chinese older couples (age range: 55-93 years) completed measures of TGP, FGA, PSA, and life satisfaction. The results showed that (a) spousal interrelations existed for TGP and FGA; (b) TGP and FGA had significant actor effects on life satisfaction, with FGA having a stronger effect; (c) although the partner effect of FGA did not differ between husbands and wives, husbands' TGP was positively associated with wives' life satisfaction, but not vice versa; and (d) PSA mediated the effects of TGP and FGA on life satisfaction at the actor and partner levels. These results have implications for developing couple-based interventions to enhance successful aging, with a focus on promoting both partners' accommodative coping and positive age beliefs.

Association of tenacious goal pursuit and flexible goal adjustment with out-of-home mobility among community-dwelling older people

BACKGROUND

As people age, functional losses may limit the potential to get outside the home and participate in desired activities and community life. Coping with age-related losses has been reported to be important for psychological well-being. Hitherto is not known whether active use of coping strategies also helps maintain out-of-home mobility.

AIMS

We investigated how two coping strategies, tenacious goal pursuit (TGP; persistency in reaching one's goals) and flexible goal adjustment (FGA; adjusting one's goals to changed circumstances), are associated with life-space mobility and perceived autonomy in participation outdoors among community-dwelling older people.

METHODS

Participants (n = 186) were aged 79-93 years. TGP and FGA were self-reported using separate scales. Perceived autonomy in participation was assessed with the Impact on Participation and Autonomy Outdoors-subscale, and life-space mobility with the Life-Space Assessment. Two-step cluster analysis was used to create data-driven coping profiles of TGP and FGA.

RESULTS

General linear model analyses showed that the profile including highly tenacious and flexible older people had the highest life-space mobility and perceived autonomy outdoors, whereas the profile including people with low TGP and low FGA showed the lowest scores. Depressive symptoms attenuated the associations.

CONCLUSIONS

Active use of both TGP and FGA is favorable for out-of-home mobility and enables more active participation in society in later life.

Assimilative and accommodative coping in older adults with and without sensory impairment: four-year change and prospective relations with affective well-being

Objectives: Sensory impaired older adults may be particularly dependent on coping strategies such as assimilation (or tenacious goal pursuit [TGP]) and accommodation (or flexible goal adjustment [FGA]) to secure high levels of well-being. We investigated if late-life changes in these coping strategies and prospective associations of TGP and FGA with affective well-being vary according to sensory impairment status. Method: Our study sample consisted of 387 adults aged 72-95 years (M = 82.50 years, SD =4.71 years) who were either visually impaired (VI; n = 121), hearing impaired (HI; n = 116), or sensory unimpaired (UI; n = 150). One hundred sixty-eight individuals were reassessed after approximately 4 years. Results: Both VI and HI revealed a decrease in TGP, whereas TGP remained stable in UI. For FGA, a significant increase in HI was observed, whereas a significant decline emerged in UI. Controlling for age, gender, and cognitive abilities, higher TGP at baseline was significantly associated with higher negative affect 4 years later in VI. Moreover, the positive association between baseline FGA and subsequent positive affect was stronger in HI than in UI older adults. Conclusion: Our findings suggest that older adults with sensory impairments reveal trajectories of assimilative and accommodative coping and associations of TGP and FGA with affective well-being that are different from sensory unimpaired individuals.

Pain Intensity, Disability, and Quality of Life in Patients with Chronic Low Back Pain: Does Age Matter?

Objective

Nonspecific chronic low back pain (CLBP) is a frequent medical condition among middle-aged and older adults. Its detrimental consequences for functional ability and quality of life are well known. However, less is known about associations of chronological age with disability and well-being among CLBP patients. Coping with pain may be harder with advancing age due to additional age-associated losses of physical, sensory, and other resources, resulting in higher disability and lower quality of life. Alternatively, older patients may feel less impaired and report higher quality of life than younger patients because the experience of chronic pain may be better anticipated and more “normative” in old age.

Methods

We investigated an age-heterogeneous sample of 228 CLBP patients (mean age = 59.1 years, SD = 10.2 years, range 41–82 years). Our outcomes were pain intensity, pain disability (as assessed by self-reported activity restrictions and performance-based tests), and measures of quality of life (health-related quality of life: SF-12 physical and mental health; well-being: anxiety, depression, perceived control over life, affective distress).

Results

Although older patients had higher performance-based disability, they scored higher on mental health and on most measures of well-being than younger patients.

Conclusions

Our findings provide evidence for a “paradoxical” pattern of age effects in CLBP patients and are thus in line with other studies based on nonclinical samples: Although disability in CLBP patients increases with advancing age, indicators of quality of life are equal or even higher in older patients.

Assimilative and Accommodative Coping and Older People's Leisure Activities

Objectives: Assimilative and accommodative coping strategies have hardly been studied in relation to leisure activities in old age. We investigated whether tenacious goal pursuit (TGP) and flexible goal adjustment (FGA) influence the association between physical performance and participation in leisure activities. Methods: A cross-sectional analysis was conducted among 187 community-dwelling people aged 79 to 93 years. TGP, FGA, and leisure activity participation were asked with questionnaires. Physical performance was assessed with the Short Physical Performance Battery (SPPB). Results: TGP moderated the relationship between physical performance and leisure activity participation. Despite low physical performance, people with high TGP had close to mean level of leisure activity participation, whereas low TGP was associated with very little activity. Most notably, people without high TGP had fewer outdoor activities and group activities outside home. Similar effects were not found for FGA. Discussion: Persistency, rather than flexibility, in goal pursuit appears to help older people be active in their leisure time.

Five-year change in morale is associated with negative life events in very old age

OBJECTIVES

The objectives were to study changes in morale in individuals 85 years and older, and to assess the effect of negative life events on morale over a five-year follow-up period.

METHOD

The present study is based on longitudinal data from the Umeå85+/GERDA-study, including individuals 85 years and older at baseline (n = 204). Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). Negative life events were assessed using an index including 13 negative life events occurring during the follow-up period. Linear regression was used for the multivariate analyses.

RESULTS

The majority of the sample (69.1%) had no significant changes in morale during the five-year follow-up. However, the accumulation of negative life events was significantly associated with a greater decrease in PGCMS. A higher baseline PGCMS score did not attenuate the adverse effect negative life events had on morale.

CONCLUSION

Morale seemed to be mainly stable in a five-year follow-up of very old people. It seems, nonetheless, that individuals are affected by negative life events, regardless of level of morale. Preventing negative life events and supporting individuals who experience multiple negative life events could have important implications for the care of very old people.

Coping Flexibility as Predictor of Distress in Persons With Spinal Cord Injury

OBJECTIVES

Examine whether coping flexibility at admission to first spinal cord injury (SCI) rehabilitation was predictive of distress 1 year after discharge.

DESIGN

Longitudinal inception cohort study.

SETTING

Rehabilitation center.

PARTICIPANTS

Of the 210 people admitted to their first inpatient SCI rehabilitation program, 188 met the inclusion criteria. n=150 (80%) agreed to participate; the data of participants (N=113) with a complete dataset were used in the statistical analysis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Coping flexibility was operationalized by (1) flexible goal adjustment (FGA) to given situational forces and constraints and (2) tenacious goal pursuit (TGP) as a way of actively adjusting circumstances to personal preference. The Assimilative-Accommodative Coping Scale was used to measure FGA and TGP. The Hospital Anxiety and Depression Scale was used to assess distress.

RESULTS

Scores on FGA and TGP measured at admission were negatively associated with the scales depression (r= -.33 and -.41, respectively) and anxiety (r= -.23 and -.30, respectively) 1 year after discharge. All demographic and injury-related variables at admission together explained a small percentage of the variance of depression and anxiety. FGA, TGP, and the interaction term together explained a significant additional 16% of the variance of depression and 10% of anxiety.

CONCLUSIONS

The tendency to pursue goals early postonset of the injury seems to have a protecting effect against distress 1 year after discharge. People with low TGP may experience protection against distress from high FGA.

Positive organizational behavior: Longitudinal effects on subjective well-being

Increasing individual subjective well-being has various positive outcomes, knowledge about its antecedents and the mediators of this relationship can therefore help to increase subjective well-being and the accompanying positive effects. The more future oriented facets of psychological capital, i.e. optimism, hope and self-efficacy have been shown in several studies to be positively related to subjective well-being and negatively to ill-being. Furthermore, recent studies suggest coping strategies as mediators for these relationships. In our study, we examined the longitudinal relation of optimism, hope and self-efficacy with subjective well-being and ill-being in a German panel dataset and tested the mediating effect of flexible goal adjustment in a path model. Our results show a statistically significant positive effect of self-efficacy and optimism on subjective well-being as well as a statistically significant negative effect of optimism on depression over three years. All three predictors show a statistically significant relation with flexible goal adjustment, but flexible goal adjustment did not mediate the effect on subjective well-being or depression.

Longitudinal Patterns of Stability and Change in Tenacious Goal Pursuit and Flexible Goal Adjustment among Older People over a 9-Year Period

Using the dual-process model of assimilative-tenacity (TGP) and accommodative-flexibility (FGA), the study aims to identify trajectories of TGP and FGA over five time points within a 9-year period, explore the relationships between the trajectories of TGP and FGA, and explore if participants from distinct TGP and FGA trajectories differed in indicators of well-being and depression. Latent class growth analysis was used in a five-wave longitudinal design among an older population of 747 participants over 65 years. Results highlight (1) emergence of four trajectories for flexibility (low and increasing, moderate and increasing, moderately high and stable, and high and stable trajectories) and three trajectories for tenacity (low and stable, moderate and stable, and high and decreasing trajectories), (2) that older people belonging to particular trajectories of FGA are not more likely to belong to particular trajectories of TGP, and (3) that participants from the high and decreasing TGP and high or moderately high and stable FGA trajectories were characterized by high score of perceived health, satisfaction with life, and self-esteem and low score of depression moods. These results highlight that the heterogeneity in longitudinal TGP and FGA scores throughout the life span needs to be accounted for in future research.

Mastery and Depressive Symptoms: How Does Mastery Influence the Impact of Stressors From Midlife to Old Age?

OBJECTIVE

The objective of this research is to study depressive symptoms (DS) among adults aged 40 to 79 years and examine how mastery influences the impact of sociodemographic, socioeconomic, and health factors on DS.

METHOD

We used a sample of the Norwegian Life Course, Generation, and Gender (LOGG) study ( N = 6,879) and analyzed how mastery influences the independent variables on DS via regression analyses.

RESULTS

Mastery affected DS directly and influenced the effects of sociodemographic, socioeconomic, and health factors on DS. There was a stronger relationship between stressors and DS among respondents with low than high mastery. DS were most prevalent among people aged 70 to 79 years. When mastery was also controlled for, the oldest group (70-79 years) had significantly fewer DS than those aged 40 to 49 years.

DISCUSSION

The influence of mastery and stressors on DS seems to vary along the life span. The result that mastery was a relatively stronger buffer against DS in midlife than in old age is discussed.

Grit, Basic Needs Satisfaction, and Subjective Well-Being

Abstract. In this study, we investigated how grit is related to the satisfaction of the basic needs and subjective well-being. Grit means dedication to long-term goals with enthusiasm, which is closely related to success in objective terms. Thus, we expected that grit would be positively related to satisfying the autonomy and competence needs, which would lead to greater subjective well-being (i.e., higher life satisfaction and lower depression). A survey of young adults (N = 455) revealed that grit is strongly related to both the autonomy and competence needs, and these needs mediated the effect of grit on subjective well-being. Grit, did not directly increase life satisfaction but weakly decreased depression. Further, the two basic needs played different roles in enhancing subjective well-being. Autonomy reduced depression, and competence increased life satisfaction.

Life resources and personal goals in old age

It has been theorized that life resources influence goal engagement. The aim of the present study was to examine whether personal characteristics, and socio-economic, social and health resources are associated with personal goal content in old age. The participants were 824 community-dwelling people aged 75-90 from the Life-Space Mobility in Old Age project. Personal goals were elicited using a revised version of the Personal Project Analysis in a structured interview. Cross-sectional bi- and multivariate analyses using logistic regression modelling were conducted. The results showed that the most commonly reported goals were health maintenance related. People with better health resources were more likely to report goals related to leisure-time, social and physical activities and less likely to report goals related to recovery of health. Those with poor social resources were at risk for having no personal goals in their lives. The results are in line with theorizing on the influence of life resources on goal setting in old age. Further longitudinal studies are needed on whether resource loss precedes goal modification, and how goal setting strategies influence both mental and physical well-being in old age.

Psychological Approaches to Coping with Pain in Later Life

A psychological model of coping with the demands of aging is outlined. Chronic pain is conceptualized as a challenge to normal aging, because it threatens identity, risks affective disorder (depression), and interferes with action. The sparse evidence for psychological interventions is reviewed, and a case is made for the types of interventions that should be developed to address the specific presentation of geriatric pain management.

Tenacious goal pursuit and flexible goal adjustment in older people over 5 years: a latent profile transition analysis

BACKGROUND

previous research has shown that tendencies to tenaciously pursue goals (TGP) and flexibly adapt goals (FGA) relate to well-being of older people.

OBJECTIVES

this study aimed to identify subpopulations of elderly people with different coping profiles, describe change in participants' profiles over time and determine the influence of coping profiles on well-being over a 5-year period.

METHODS

latent profile transition analysis (LPTA) was used in a three-wave longitudinal data collection measuring flexibility, tenacity, depression, self-rated health and life satisfaction among an elderly population over 65 years old.

RESULTS

three coping profiles were identified. Profile 1 was characterised by participants with high flexibility and tenacity scores, Profile 2 with moderate flexibility and low tenacity scores and Profile 3 with low flexibility and moderate tenacity scores. Results indicate stability of these profiles over time, with Profile 1 being the most adaptive in terms of ageing well.

CONCLUSION

high flexibility and tenacity in older people is a stable coping profile that is associated with successful ageing.

Does flexible goal adjustment predict life satisfaction in older adults? A six-year longitudinal study

OBJECTIVE

The aim of the present study was to investigate the relationship between flexible goal adjustment and life satisfaction (as an enduring component of subjective well-being) using six-year longitudinal data from a sample of older adults.

METHODS

The study included 704 participants aged 63-97 years assessed four times over a six-year period. Simultaneous and lagged models were specified and estimated using structural equation modeling.

RESULTS

Both simultaneous and lagged coefficients indicated that a high score on flexible goal adjustment significantly predicted subsequent levels of life satisfaction.

CONCLUSION

In line with successful aging theory, our findings support the view that the ability to adjust personal goals flexibly is a central resource when unattainable goals are encountered and it contributes to well-being in old age.

Goal pursuit, goal adjustment, and affective well-being following lower limb amputation

OBJECTIVES

This study examined the relationships between tenacious goal pursuit (TGP), flexible goal adjustment (FGA), and affective well-being in a sample of individuals with lower limb amputations.

DESIGN

Cross-sectional, quantitative.

METHODS

Ninety-eight patients recently admitted to a primary prosthetic rehabilitation programme completed measures of TGP, FGA, positive affect, and negative affect.

RESULTS

Hierarchical regression analyses revealed that TGP and FGA accounted for a significant proportion of the variance in both positive and negative affect, controlling for sociodemographic and clinical characteristics. TGP was significantly positively associated with positive affect, while FGA was significantly negatively associated with negative affect. Moderated regression analyses indicated that the beneficial effect of FGA on negative affect was strongest at high levels of amputation-related pain intensity and low levels of TGP.

DISCUSSION

TGP and FGA appear to influence subjective well-being in different ways, with TGP promoting the experience of positive affect and FGA buffering against negative affect. TGP and FGA may prove useful in identifying individuals at risk of poor affective outcomes following lower limb amputation and represent important targets for intervention in this patient group.

STATEMENT OF CONTRIBUTION

What is already known on this subject? The loss of a limb has a significant impact on several important life domains. Although some individuals experience emotional distress following amputation, the majority adjust well to their limb loss, with some achieving positive change or growth as a result of their experiences. Theories of self-regulation propose that disruptions in goal attainment have negative affective consequences. The physical, social, and psychological upheaval caused by limb loss is likely to threaten the attainment of valued goals, which may leave individuals vulnerable to negative psychosocial outcomes if they do not regulate their goals in response to these challenges. According to the dual-process model of adaptive self-regulation, individuals manage discrepancies between perceived and desired goal attainment by either modifying their life situation or behaviour to fit their goals (tenacious goal pursuit [TGP]) or adjusting their goals to situational constraints (flexible goal adjustment [FGA]). Examining psychosocial adjustment to amputation from this perspective may offer some insight into the diversity of affective outcomes observed. What does this study add? Contributes to our understanding of the mechanisms underlying adjustment to acquired disability. Offers a theory-based explanation for the diversity of psychosocial outcomes observed post-amputation. Identifies important targets for interventions to enhance adjustment in this population.