Coping and emotional attributions following spinal cord injury

The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.

Attachment Style, Social Support, and Coping as Psychosocial Correlates of Happiness in Persons With Spinal Cord Injuries

Objective: To examine the roles of attachment, social support, and coping as psychosocial correlates in predicting happiness in people with spinal cord injuries.

Design: Quantitative descriptive research design using multiple regression and correlation techniques.

Participants: 274 individuals with spinal cord injuries.

Outcome Measures: Happiness as measured by the Subjective Happiness Scale.

Results: Functional disability and psychosocial correlates including coping, attachment styles, and social support were found to be associated with happiness scores. Functional disability was found to have a large negative effect on happiness and the effect was significantly reduced after taking into consideration the effect of positive psychology factors.

Conclusion: Positive psychology variables are important for happiness and subjective well-being, and happiness in turn is related to better quality of life. The negative relationship between functional disability and happiness can be mediated by attachment, social support, and coping. Rehabilitation professionals should deemphasize negative characteristics related to poor psychological adjustment and focus on positive human traits and positive psychology interventions for people with disabilities.

The impact of perceptions of health control and coping modes on negative affect among individuals with spinal cord injuries

A wide range of demographic, medical, and personality and coping variables have been implicated as predictors of psychosocial outcomes following the onset of spinal cord injuries (SCI). The primary purpose of this study was to examine the role that perceptions of health control (internality, chance-determined, and other persons-determined) and coping strategies play in predicting respondents' negative affect, namely, reactions of depression and anxiety [i.e., posttraumatic stress disorder (PTSD)], as outcomes of psychosocial adaptation to disability. A second purpose was to investigate the potential role that time since injury (TSI) plays in moderating the influence of coping on psychosocial outcomes related to SCI. Ninety five survivors of SCI participated in the study by completing a battery of self-report measures. Two sets of multiple regression analyses were employed to address the study's goals. Findings indicated that after controlling the influence of gender, age, time since injury, and number of prior life traumas: (a) the use of disengagement coping successfully predicted both respondents' levels of depression and PTSD; (b) none of the perceptions of control of one's health significantly influenced psychosocial reactions to SCI, as indicated by depression and PTSD, although perceptions of chance control showed a moderate positive trend; and (c) time since injury did not moderate the relationships between coping and negative affect related to the onset of SCI. The implications of these findings to rehabilitation professionals are discussed.

A longitudinal analysis of emotional impact, coping strategies and post-traumatic psychological growth following spinal cord injury: A 10-year review

OBJECTIVES

To review emotional impact, psychological growth and coping strategies in a sample of traumatic spinal cord injured people from 12 weeks post-injury to 10 years post-hospital discharge.

DESIGN

Longitudinal, multiple wave panel design.

METHODS

Eighty-seven people with traumatically acquired spinal cord injuries were assessed at 12 weeks post-injury and followed up 10 years later (43% of the original sample responded). The Beck Depression Inventory, the State Anxiety Inventory, the COPE Scale, the Functional Independence Measure and the Social Support Inventory were completed on both occasions.

RESULTS

Rates of anxiety and depression had changed little over the 10-year period. Two-thirds of the sample showed no signs or symptoms of depression. Coping strategies remained relatively stable over time, statistically significant regression models (coping strategies at week 12 post-injury) predicted one-third of the variance in depression at year 10. Rates of post-traumatic psychological growth were associated with higher levels of psychological distress.

CONCLUSIONS

These results suggest that many people living with spinal cord injury manage the consequences of their disability without significant levels of psychopathology. However, the coping strategies they employ remain critical in accounting for this adjustment. The relationship between post-traumatic growth and psychological well-being was found to be complex, raising many questions for future research.

Posttraumatic stress disorder following accidental injury: rule or exception in Switzerland?

BACKGROUND

There is still marked variability in the findings concerning psychiatric disorders associated with traumatic injury. The aim of this study was to determine the incidence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following accidental injuries, and to predict the PTSD symptom level at 6 months, taking into particular consideration the role of pre-existing psychiatric morbidity and insufficient command of the local language.

METHOD

A total of 255 accident survivors who were hospitalized for at least 2 consecutive nights at a Swiss university hospital for treatment of recently acquired physical injuries were interviewed within 2 weeks of the trauma and 6 months after the accident. Patients who did not have a good command of German but were fluent in Italian, Spanish, Portuguese, Serbo-Croatian or Albanian were assessed using interpreters. The main outcome measure was the Clinician-Administered PTSD Scale.

RESULTS

Ten patients (3.9%) were diagnosed as having ASD. At 6 months, 8 patients (3.1%) had PTSD. A regression model using 12 potential predictor variables explained 40% of the variance of PTSD symptoms; mild traumatic brain injury (p < 0.001), pain (p < 0.05), ASD symptom level (p < 0.001) and emotional coping (p = 0.001) predicted higher PTSD symptom levels, while high Sense of Coherence (p < 0.05) and perceived responsibility for the accident (p < 0.01) were associated with lower PTSD symptom levels at follow-up.

CONCLUSIONS

ASD and PTSD seem to occur less frequently following accidental injuries than previously reported in the literature. Pre-existing psychiatric morbidity and lack of proficiency in the locally spoken language do not appear to play an important role in the development of PTSD.

Masculine role variables and outcomes among men with spinal cord injury

PURPOSE

Few studies have considered the impact of masculine role variables on outcome and adjustment to SCI among men. The present study examined the relations among SCI, views of masculinity, psychological adjustment, and rehabilitation outcomes among men with SCI.

METHOD

The sample included 20 men with SCI receiving inpatient rehabilitation, with a mean age of 45 years. Data included demographic variables as well as Conformity to Masculine Norms Inventory (CMNI), Gender Role Conflict Scale (GRCS), Functional Independence Measure (FIM), and Satisfaction with Life Scale ratings, and change in marital status.

RESULTS

The findings revealed that satisfaction with life was positively related to scores on the CMNI Violence scale, FIM change from admission to discharge was positively related to the CMNI Emotional Control scale and negatively related to the CMNI Dominance scale. Change in marital status was inversely related to the CMNI Emotional Control and Primacy of Work scales and the GRCS Restricted Emotionality and Power, Success, and Competition scales.

CONCLUSIONS

The findings show that certain aspects of the traditional masculine role (i.e., ability to modulate strong emotions) may be adaptive in the rehabilitation process, whereas other aspects (i.e., a dominant interpersonal style) may present a barrier to effective rehabilitation.

Condition-related coping strategies in persons with spinal cord lesion: a cross-national validation of the Spinal Cord Lesion-related Coping Strategies Questionnaire in four community samples

STUDY DESIGN

Cross-sectional, questionnaire.

OBJECTIVES

Coping strategies employed to manage the consequences of a spinal cord lesion (SCL) have been found to be distinctly related to emotional well-being. However, research and clinical implications have been hampered by the lack of cross-validated measures that are directly related to the lesion and its consequences. This study investigates the psychometric performance of the SCL-related Coping Strategies Questionnaire in four different countries.

SETTING

Austria, Germany, Switzerland and UK.

METHODS

The study sample comprised 355 community residing persons with SCL. Multi-trait/multi-item analysis methods and non-parametric and parametric tests were used.

RESULTS

The Acceptance coping scale showed satisfactory psychometric qualities, whereas there were some problems in the Fighting spirit scale and greater problems in the Social reliance scale. Compared with the Swedish developmental sample, Acceptance was used more in the four study countries. Consistent with the original sample, Acceptance and Fighting spirit coping correlated with fewer signs of emotional distress, persons lesioned > or = 5 years tended to report more Acceptance than the newly lesioned and coping strategies were mainly unrelated to neurological status.

CONCLUSION

The English and German language versions of the Acceptance coping scale were valid and reliable, whereas some translated items in the Fighting spirit scale need to be revised. Translations of the Social reliance scale need to be thoroughly revised and retested. The results add further evidence to the literature on the stability of the link between adapting life priorities (ie Acceptance) and emotional well-being.

Coping with serious accidental injury: a one-year follow-up study

BACKGROUND

The aim of this study was to analyze changes of coping strategies in severely injured accident victims over time and to compare patients with high and low posttraumatic stress disorder (PTSD) symptom levels with regard to their coping patterns and accident-related cognitions.

METHODS

106 consecutive patients with severe accidental injuries admitted to a trauma surgery intensive care unit (ICU) were assessed within 1 month after the trauma and 6 and 12 months later. Assessments included a clinical interview, the Freiburg Questionnaire of Coping with Illness, the patients' accident-related cognitions, the Clinician-Administered PTSD Scale, the 90-item revised Symptom Checklist (SCL-90-R), and the Sense of Coherence Questionnaire (SOC). Patients who met the criteria for either full or subsyndromal PTSD at least once over the observation period (36 subjects; 34.0%) were assigned to a highly symptomatic group (HSG), the remainder (70 subjects; 66.0%) to a less symptomatic group.

RESULTS

Overall, active problem-focused coping was predominant immediately after the accident and declined over time, with a stronger decrease in the HSG. Patients in the HSG scored higher on the SCL Global Severity Index and lower on the SOC. The patients' subjective appraisal of accident severity was higher in the HSG, whereas there was no group difference with regard to accident-related variables such as type of accident, injury severity and mild to moderate traumatic brain injury.

CONCLUSIONS

Active problem-focused coping, although utilized most frequently and often regarded as protective, might be an inadequate strategy in face of acute stress following a severe accident. Clinicians should not expect their patients to cope very actively in the acute ICU phase. In the subsequent rehabilitation, active coping seems to be more adaptive.

Predictors of Psychosocial Adaptation Among People With Spinal Cord Injury or Disorder

OBJECTIVE

To examine the influence of disability-related medical and psychologic variables on psychosocial adaptation to spinal cord injury or disorder (SCI/D).

DESIGN

A structural equation modeling design linking 3 sets of predictive variables to an outcome measure of adaptation.

SETTING

Two outpatient SCI clinics (1 veteran, 1 civilian) in Texas.

PARTICIPANTS

Veterans (n=181) and civilians (n=132) with SCI/D.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The adaptation outcome was measured by 2 subscales (acknowledgment, adjustment) of the Reactions to Impairment and Disability Inventory (RIDI) and by the Quality of Life Scale. The predictive variables were measured by a demographic questionnaire, 3 subscales (intrusion, re-experiencing, hyperarousal) of the Purdue Posttraumatic Stress Disorder-Revised scale, the McMordie-Templer Death Anxiety Scale, and 3 subscales (anxiety, depression, denial) of the RIDI.

RESULTS

Goodness-of-fit indices suggested that a revised model of adaptation was a moderately good fit to the data. The revised model of adaptation indicated that there were medium total effects (direct plus indirect) on psychosocial adaptation by 2 latent variables (disability severity and impact, negative affectivity) and small total effects on psychosocial adaptation by disengagement coping. The latent factor of disengagement coping had the strongest direct effect on adaptation (although not statistically significant). Disability severity and impact had medium indirect effects and negative affectivity had small indirect effects on psychosocial adaptation. All of the aforementioned effects had a negative coefficient.

CONCLUSIONS

Negative emotional responses (eg, depression, anxiety) to SCI/D, disengagement-type coping (eg, disability denial, avoidance), and the severity and impact of disability were related to lower levels of adaptation to SCI/D.

The impact of coping on emotional adjustment to spinal cord injury (SCI): review of the literature and application of a stress appraisal and coping formulation

OBJECTIVES

This article reviews literature examining the psychological adjustment to Spinal Cord Injury (SCI) and illustrates the applicability of a Stress Appraisal and Coping model (SAC) for rehabilitation of this population.

METHOD

Articles concerning psychological adjustment to SCI from the previous three decades have been reviewed and critiqued. When possible the articles have been discussed in a SAC framework.

RESULTS

The literature indicates that psychological adjustment to SCI is largely predictable from psychological variables including coping, appraisal and psychosocial resources. Recent literature has suggested psychological intervention can promote positive psychological adjustment following SCI for those individuals at risk of developing clinical levels of depression.

CONCLUSION

The SAC model provides a comprehensive formulation to incorporate the heterogeneity of populations with SCI. Suggestions for future research include developing assessment and treatment regimes specifically tailored to the strengths and weaknesses of an individual as highlighted in the model.

Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up

The objective of this study was to assess the prevalence of posttraumatic stress disorder (PTSD) and symptoms of depression and anxiety in severely injured accident victims 1 yr posttrauma and to predict psychiatric morbidity by means of variables assessed shortly after the accident. The sample consisted of 106 consecutive patients with accidental injuries (mean Injury Severity Score = 21.9, mean Glasgow Coma Scale score = 14.4) admitted to the intensive care unit of a University Hospital. Patients with severe head injuries, suicide attempters, and victims of physical assault were excluded. At 1-yr follow-up, two patients (1.9%) had PTSD, and 13 (12.3%) had subsyndromal PTSD. Eighteen patients (17%) had clinically relevant symptoms of anxiety, and nine (8.5%) were depressed. Overall, 27 patients (25.5%) showed some form of psychiatric morbidity (full or subsyndromal PTSD and/or anxiety and/or depression). Logistic regression analysis, using 1-yr psychiatric morbidity status as the dependent variable, allowed correct classification of 83.8% of patients 12 mo postaccident (specificity 91.8%, sensitivity 61.5%). Biographical risk factors and a sense of death threat contributed significantly to the predictive model. We conclude that a substantial proportion of severely injured accident victims develop some form of psychiatric morbidity that can be predicted to some degree by mainly psychosocial variables.

Differentielle Profile der Belastungsbewältigung und Wohlbefinden

Zusammenfassung: In einer Stichprobe erwerbstätiger Personen (n = 137) wurden differentielle Profile der Belastungsverarbeitung und deren Zusammenhänge mit Indikatoren des psychischen und physischen (Wohl-)Befindens untersucht. Als Erhebungsinstrumente wurden eine Kurzform des Streßverarbeitungsfragebogen (SVF, Janke, Erdmann & Kallus, 1984 ), die deutschsprachige Version des Profile of Mood States ( Biehl, Dangel & Reiser, 1986 ) sowie Ratingskalen zur Einschätzung von Belastungen und Bewältigungskompetenzen eingesetzt. Die Coping-Skalen wurden einer hierarchischen Clusteranalyse nach Ward mit anschließender iterativer Partionierung nach dem “k-means”-Algorithmus unterzogen. Es resultierte eine Aufteilung in drei Cluster: (1) “aktiv-flexibles Coping” (n = 53), (2) “rigid-instrumentelles Coping” (n = 40) und (3) “resigniert-distanziertes Coping” (n = 44). Die Reliabilität dieser Clusterlösung konnte durch mehrere Tests auf innere Konsistenz sowie auch bei Wiederholungsmessung nach drei Monaten bestätigt werden. Ferner erwies sich die Clusterzugehörigkeit als unabhängig sowohl von soziodemographischen Basisvariablen als auch von der Häufigkeit perzipierter beruflicher und privater Belastungen. Multivariate Varianzanalysen zeigten Unterschiede im Befinden zwischen den drei Clustern unter der Bedingung hoher subjektiver Belastung. Forschungsarbeiten zur Effektivität von Bewältigung sollten zukünftig anstelle von einzelnen Bewältigungsstrategien verstärkt differentielle Profile der Bewältigung evaluieren.