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Soegaard K, Sig JR, Nielsen C, Verhaeghe S, Beeckman D, Biering-Sørensen F, Sørensen JA. "I am just trying to live a life!" -a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries. J Tissue Viability 2024; 33:50-59. [PMID: 38044163 DOI: 10.1016/j.jtv.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/22/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) are frequently reported in people with spinal cord injuries (SCI). Wound management in people with SCI involves relieving pressure on the affected area by means of immobilisation and bed rest. The healing time of a PU can vary, but often takes several months or even years, causing people to stay in bed for prolonged periods of time. OBJECTIVE This study aims to explore the perspectives and lived experiences of people with SCI who are affected by PUs. DESIGN and method: This study is a qualitative explorative study that employs individual semi-structured in-depth interviews to obtain the narratives of people with SCI and a pressure ulcer. We used a phenomenological-hermeneutic approach that was inspired by Ricoeur's theory of interpretation. The analysis was performed in three levels: Naïve reading, structural analysis and critical interpretation and discussion. PARTICIPANTS and setting: Ten people with SCI who were being treated in the Danish healthcare system for their PU participated in this study: six participants had experienced a complete traumatic SCI, three had an incomplete traumatic SCI, and one had a non-traumatic complete SCI. The study included nine men and one woman, aged 49-81 years (mean 64). Nine had a PU in the seating area, while one had the ulcer on the leg. RESULTS The analysis revealed three themes: 1. Struggling to balance prevention with an active, meaningful life, 2. Challenges and consequences of pressure relief protocols and bed rest, 3. Experiencing prolonged and incoherent treatment with varying levels of staff engagement and competencies. CONCLUSIONS People with SCI and a PU have difficulty balancing their active, redefined lives when subjected to a strict pressure relief protocol. The consequences of immobility caused by pressure relief include reduced social and community participation and decreased quality of life. PU treatment is experienced as incoherent and unnecessarily lengthy, leading to a deterioration in the wounds. Improving PU treatment for people with SCI is of utmost importance and has the potential to benefit not only the people with SCI but also the healthcare system and the economy.
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Affiliation(s)
- Knaerke Soegaard
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark.
| | | | - Charlotte Nielsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium; Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Fin Biering-Sørensen
- University of Copenhagen, Denmark; Department for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark
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MacKenzie J. Giving the terminally ill access to euthanasia is not discriminatory: a response to Reed. JOURNAL OF MEDICAL ETHICS 2024; 50:123. [PMID: 37979972 DOI: 10.1136/jme-2023-109553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/28/2023] [Indexed: 11/20/2023]
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Bloom J, McLennan V, Dorsett P. Results from phase one of an early intervention vocational rehabilitation trial for people with spinal cord injury conducted in Queensland, Australia. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The Back2Work Early Intervention Vocational Rehabilitation (EIVR) program was developed in response to the low employment rate of people with spinal cord injuries (SCI) and their lack of access to early, specialised vocational rehabilitation (VR). The program has been delivered by qualified rehabilitation counsellors to hospital patients with newly acquired SCI since 2016. OBJECTIVE: The objective of the study was to evaluate the effectiveness and consumer perspective of the Back2Work EIVR Program. METHODS: The program was evaluated using a mixed-methods, longitudinal, prospective design. RESULTS: Data analysis revealed a return to work rate (RTW) of 43% by 12 months post-discharge. Qualitative data indicated positive participant experiences with the program, emphasising the hopefulness brought about by early vocational support. CONCLUSIONS: The Back2Work program has a positive impact on participants’ RTW outcomes, through the provision of early specialist vocational rehabilitation interventions. This includes building a positive culture around RTW after SCI and engagement with employers to maximise the likelihood of timely and sustainable re-employment. The RTW outcomes and emergent themes will help inform service development in the field of early vocational rehabilitation after SCI.
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Affiliation(s)
- Julia Bloom
- School of Health Sciences and Social Work, Griffith University, Queensland, QLD, Australia
- Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Vanette McLennan
- School of Health Sciences and Social Work, Griffith University, Queensland, QLD, Australia
- Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Pat Dorsett
- School of Health Sciences and Social Work, Griffith University, Queensland, QLD, Australia
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Effects of Scrambler Therapy in Patients with Failed Back Surgery Syndromes and Factors Associated with Depression Affecting Pain before and after the Therapy. Pain Res Manag 2020; 2020:9342865. [PMID: 32695247 PMCID: PMC7362307 DOI: 10.1155/2020/9342865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023]
Abstract
Objectives To report the effects of scrambler therapy in patients diagnosed with failed back surgery syndromes and to analyze the factors affecting pain before and after the therapy. Methods This study included 26 patients (12 males and 14 females). The Oswestry Disability Index (ODI) and Brief Pain Inventory (BPI) before and after scrambler therapy, Beck Depression Inventory (BDI) score before therapy, and residual pain after therapy were assessed. The changes in the ODI, BPI, and residual pain before and after the therapy were analyzed using the Wilcoxon signed rank test. Spearman correlation analysis and Fisher's exact test were used to confirm the correlation between BDI and other factors. Multiple regression analysis was used to identify independent factors predicting residual pain, posttherapy ODI, and posttherapy BPI. Results The ODI changed from 25.69 ± 7.98 to 21.80 ± 9.41 (p < 0.05), and the BPI changed from 68.96 ± 18.00 to 61.62 ± 20.27 after scrambler therapy (p < 0.05). In addition, residual pain changed from 100 to 76.15 (p < 0.05). The BDI was negatively correlated with the duration of scrambler therapy and positively correlated with the initial OPD and BPI. In multiple regression analysis, residual pain was significantly correlated with the BDI (p < 0.05). Conclusion Scrambler therapy can be used to change the total scores of the ODI and BPI after 5 sessions of treatment. Also, residual pain was significantly related to the BDI. Clinical significance of depression severity on pain should be further investigated via prospective studies.
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Titman R, Liang J, Craven BC. Diagnostic accuracy and feasibility of depression screening in spinal cord injury: A systematic review. J Spinal Cord Med 2019; 42:99-107. [PMID: 31573447 PMCID: PMC6781470 DOI: 10.1080/10790268.2019.1606556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Context: Individuals with spinal cord injury or disease (SCI/D) are at increased risk of depression, which is associated with poor short- and long-term outcomes. Accurate diagnosis is complicated by overlapping symptoms of both conditions, and a lack of consensus-derived guidelines specifying an appropriate depression screening tool. Objective: To conduct a systematic review to: (1) identify the diagnostic accuracy of established depression screening tools compared to clinical assessment; and, (2) to summarize factors that influence feasibility of clinical implementation among adults with SCI/D. Methods: A systematic search using MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane databases using the terms spinal cord injury, depression or mood disorder, and screening or diagnosis identified 1254 initial results. Following duplicate screening, five articles assessing eight screening tools met the final inclusion and exclusion criteria. Measures of diagnostic accuracy and feasibility of implementation were extracted. The Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2) was used to assess study quality. Results: The Patient Health Questionnaire-9 (PHQ-9) had the highest sensitivity (100%), and specificity (84%). The 2-item version, the PHQ-2, comprised the fewest questions, and six of the eight tools were available without cost. Utilizing the QUADAS-2 tool, risk of bias was rated as low or unclear risk for all studies; applicability of the results was rated as low concern. Conclusion: The PHQ-9 is an accurate and feasible tool for depression screening in the adult SCI/D population. Future studies should evaluate the implementation of screening tools and the impact of screening on access to mental health interventions.
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Affiliation(s)
- Rebecca Titman
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | - Jason Liang
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | - B. Catharine Craven
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
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Depressive mood in individuals with spinal cord injury (SCI) living in Greece. Spinal Cord 2018; 56:883-889. [PMID: 29581518 DOI: 10.1038/s41393-018-0093-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To provide data on depressive symptoms rates in the Greek SCI population and to investigate their association with demographic and clinical variables. SETTING Greek territory. METHODS One hundred and sixty-four individuals with SCI living in the community for at least 1 year after the completion of the primary inpatient rehabilitation program were included in the study. Our group of participants were enrolled from multiple rehabilitation centers throughout Greece and were evaluated for probable depression according to the Patient Health Questionnaire (PHQ-9). Univariable and multiple linear regression analyses were performed to assess the possible association of risk factors with the occurrence of depression. We had also examined the correlation between PHQ-9 and scales measuring social reintegration (Craig Handicap Assessment and Reporting Technique (CHART)), quality of life (World Health Organization Quality of Life BREF (WHOQOL-BREF)), and independence (Spinal Cord Independence Measure (SCIM)). RESULTS It was found that 18.2% of the sample had probable depression. The mean (SD) PHQ-9 score was 5.7 (4.9). The multiple linear regression analysis showed that high pain scores (P = 0.001) and suffering from both nociceptive and neuropathic pain (P = 0.005) were associated with depressive mood, while pressure ulcers had a significant effect (P = 0.049) only in the univariable analysis. Participant's PHQ-9 scores had also a negative correlation with almost all CHART, WHOQOL-BREF, and SCIM subscales' scores. CONCLUSIONS This study documents relatively low rates of probable depression among individuals with SCI in Greece. Severe pain and pressure ulcers were the main identified predictors of depressive mood.
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Hope, coping and psychosocial adjustment after spinal cord injury. Spinal Cord Ser Cases 2017; 3:17046. [PMID: 28944084 DOI: 10.1038/scsandc.2017.46] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The study was a prospective, longitudinal design. The purpose was to explore the role of hope in the coping and psychosocial adjustment process following a spinal cord injury. The study was conducted at Spinal cord injury rehabilitation units in Queensland, Australia and Christchurch, New Zealand. MATERIALS AND METHODS This was a longitudinal study conducted in two SCI rehabilitation centres, one in Australia and one in New Zealand. A total of 47 participants with newly acquired traumatic SCI were administered a survey consisting of the Adult Hope Scale; the Moorong Self-Efficacy Scale; the Centre for Epidemiology Studies-Depression Scale (CES-D); Life Satisfaction, Self-Rated Adjustment and Life Problems Subscales of the Life Situation Questionnaire and selected subscales from the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL-CSQ) and the COPE scales at 6 weeks post injury and 3 months post discharge. RESULTS Hope levels and coping strategies remained consistent over time. Hope levels significantly and positively correlated with life satisfaction and self-reported adjustment, and negatively correlated with life problems. Hope levels also positively correlated with positive coping styles, including positive reappraisal, planning, acceptance and fighting spirit. Finally, hope levels negatively correlated with the negative coping strategies behavioural disengagement and social reliance. DISCUSSION Hope and coping styles are likely to be determined by personality traits. The findings suggest that hope enhancing interventions should be explored as a means of improving outcomes for people with SCI.
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Cao Y, Li C, Gregory A, Charlifue S, Krause JS. Depressive symptomatology after spinal cord injury: A multi-center investigation of multiple racial-ethnic groups. J Spinal Cord Med 2017; 40:85-92. [PMID: 27844565 PMCID: PMC5376138 DOI: 10.1080/10790268.2016.1244314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To identify (1) racial-ethnic differences in depressive symptomatology after spinal cord injury (SCI) and (2) the relationship of multiple additional factors to depressive symptoms, including health behaviors, employment, fatigue, and pain interference. DESIGN Cross-sectional Setting: Data were collected at 3 specialty hospitals in different regions of the USA (Southeastern, Mountain, Western). PARTICIPANTS Participants (N = 1,063) were identified from outpatient records of the 3 hospitals with oversampling of racial-ethnic minority groups. INTERVENTIONS N/A Main Outcome Measure(s): The outcome, depressive symptomatology, was measured by the Older Adult Health and Mood Questionnaire (OAHMQ). Participant demographic and injury characteristics were measured as statistical controls, as well as other variables including health behavior factors, depression/stress relief medication usage, fatigue, and pain interference. The multivariate analyses were developed using OLS regression models and logistic regression models. RESULTS Employment was protective for depressive symptomatology, whereas fatigue, pain interference, and binge drinking were risk factors for higher OAHMQ scores. Although there were no bivariate racial-ethnic differences in depressive symptoms, fatigue and pain interference had suppression effects on the relationship between race-ethnicity and depressive symptomatology. After controlling for fatigue and pain interference, Hispanic participants had significantly lower OAHMQ scores and lower odds of probable major depression (PMD) than non-Hispanic Whites and Blacks. CONCLUSIONS Fatigue and pain interference are associated with both race-ethnicity and depressive symptomatology. Assuming the same level of fatigue and pain interference, Hispanics will have a lower risk of depressive symptoms than non-Hispanic Whites and Blacks.
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Affiliation(s)
- Yue Cao
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Chao Li
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Anne Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | | | - James S. Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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January AM, Zebracki K, Chlan KM, Vogel LC. Mental health and risk of secondary medical complications in adults with pediatric-onset spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:1-12. [PMID: 24574817 DOI: 10.1310/sci2001-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate mental health problems in adults with pediatric-onset spinal cord injury (SCI) and explore how these problems relate to the risk of negative outcomes over time. METHOD The study included 466 adults who sustained an SCI prior to age 19 years and had been injured for at least 1 year. Participants were interviewed on an approximately annual basis using a study-specific questionnaire and standardized measures of depression, anxiety, substance use, and community involvement. Generalized estimating equations were used to assess the risk of negative outcomes across time as a function of depression, anxiety, and substance misuse. RESULTS Of the participants who reported on each domain of mental health, 26% reported misuse of alcohol or drugs (122/466), 21% reported problems with depression (78/360), and 29% reported problems with anxiety (49/168). Depression was associated with increased odds of pressure ulcers, urinary tract infections, hospitalizations, pain, and smoking and lower levels of economic independence and mobility. Anxiety was associated with increased odds of hospitalization, pain, and smoking. Substance misuse predicted an increased risk of pressure ulcers, pain, and smoking and decreased odds of occupational involvement. When examining the effect of mental health with time, results showed that depression accelerated the risk of urinary tract infections, respiratory complications, and hospitalizations and anxiety and depression accelerated risk for lower occupational independence. CONCLUSIONS The added burden that mental health difficulties pose for medical and psychosocial outcomes highlight the importance of monitoring and treating mental health symptoms in pediatric-onset SCI.
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Affiliation(s)
- Alicia M January
- Shriners Hospitals for Children-Chicago , Chicago, Illinois ; Marquette University , Milwaukee, Wisconsin
| | - Kathy Zebracki
- Shriners Hospitals for Children-Chicago , Chicago, Illinois ; Loyola University Chicago , Chicago, Illinois
| | | | - Lawrence C Vogel
- Shriners Hospitals for Children-Chicago , Chicago, Illinois ; Rush Medical College , Chicago, Illinois
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January AM, Zebracki K, Chlan KM, Vogel LC. Symptoms of depression over time in adults with pediatric-onset spinal cord injury. Arch Phys Med Rehabil 2013; 95:447-54. [PMID: 24316327 DOI: 10.1016/j.apmr.2013.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/20/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the prevalence of depressive symptoms in adults with pediatric-onset spinal cord injury (SCI) and explore potential risk factors that may be associated with elevated symptoms. DESIGN Longitudinal, cohort survey over a period of 2 to 9 years. Follow-up occurred approximately every year, a total of 868 interviews were conducted, and most participants contributed to at least 3 waves of data (72%; range, 2-8; mean, 4.34±2.16). SETTING Community. PARTICIPANTS Adults (N=214; 133 men; mean age at first interview, 29.52±5.21y; range, 24-42y) who sustained an SCI prior to age 19 (mean age at injury, 13.93±4.37y; range, 0-18y). Participants tended to have complete injuries (71%) and tetraplegia (58%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed measures assessing psychosocial functioning, physical independence, participation, and depression at each time point. Multilevel growth modeling analyses were used to explore depression symptoms across time. RESULTS Depression symptoms at initial status were typically minimal (3.07±.24; 95% confidence interval, 2.6-3.54) but fluctuated significantly over time (P<.01). Several factors emerged as significant predictors of depressive symptoms in the final model, including less community participation (P<.01), incomplete injury (P=.02), hazardous drinking (P=.02), bladder incontinence (P=.01), and pain (P=.03). Within individuals, as bowel accidents (P<.01) and pain increased (P<.01), depression scores increased; however, marriage resulted in decreases in depression scores for individuals (P=.02). CONCLUSIONS These findings suggest that most patients with pediatric-onset SCI are psychologically resilient, but strategies to minimize secondary health complications and foster community participation and engagement should be considered.
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Affiliation(s)
- Alicia M January
- Shriners Hospitals for Children, Chicago, IL; Marquette University, Milwaukee, WI
| | - Kathy Zebracki
- Shriners Hospitals for Children, Chicago, IL; Loyola University, Chicago, IL.
| | | | - Lawrence C Vogel
- Shriners Hospitals for Children, Chicago, IL; Rush Medical College, Chicago, IL
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Migliorini C, Callaway L, New P. Preliminary investigation into subjective well-being, mental health, resilience, and spinal cord injury. J Spinal Cord Med 2013; 36:660-5. [PMID: 24090180 PMCID: PMC3831328 DOI: 10.1179/2045772313y.0000000100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To undertake a pilot investigation into whether individuals whose subjective well-being had returned to the normal homeostatic range after a spinal cord injury (SCI) may be more resilient and therefore, at less risk of emotional distress over time. To consider the relative stability of subjective well-being in individuals with chronic SCI whose subjective well-being had previously returned to the normative homeostatic range. STUDY DESIGN Longitudinal study: Time 1 (T1) 2004 and Time 2 (T2) 2009. SETTING Victoria, Australia. PARTICIPANTS Participants were adults living in the community with chronic SCI, who had no mental ill-health symptoms at T1. OUTCOME MEASURES Scales include: Comprehensive Quality of Life Scale - Adult v5 (COMQoL-A5) at T1, Personal Well-being Index (PWI - the successor to the COMQol-A5) at T2, and Depression, Anxiety & Stress Scale - short form (DASS-21) at T1 and T2. RESULTS Twenty-one adults participated at T1 and T2. Subjective well-being was stable for 57% of the cohort. However, 19% presented with symptoms of emotional distress by T2. There was no significant difference in age (P = 0.94) or time since injury (P = 0.51) between those reporting significant emotional symptoms and those without; nor was there any systematic change in health status. CONCLUSION This study yielded two important findings. First, individuals with chronic SCI may be vulnerable to mental health issues even after they have previously exhibited good resilience. Second, subjective well-being after SCI may not be as stable as suggested by the general quality of life literature that have examined genetic and personality connections to subjective well-being.
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Affiliation(s)
- Christine Migliorini
- Monash University, Melbourne, Victoria, Australia,Correspondence to: Christine Migliorini, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia.
| | | | - Peter New
- Spinal Rehabilitation Unit, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia; and Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, Victoria, Australia
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Krueger H, Noonan VK, Williams D, Trenaman LM, Rivers CS. The influence of depression on physical complications in spinal cord injury: behavioral mechanisms and health-care implications. Spinal Cord 2013; 51:260-6. [PMID: 23559028 DOI: 10.1038/sc.2013.3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This study is a literature review and a proposed conceptual model. OBJECTIVES The objective of this study is to develop a conceptual model to explore the relationship between the presence of depressive symptoms and secondary physical complications such as pressure ulcers, urinary tract infections and autonomic dysreflexia in spinal cord injury (SCI). SETTING Community setting for individuals with SCI. METHODS A conceptual model explaining the mechanism underlying the relationship between depression and secondary physical SCI complications was developed based on the International Classification of Functioning, Disability and Health (ICF). A literature review was conducted to develop the model and to identify potential mechanisms responsible for the association. RESULTS A conceptual model based on ICF was created, informed by the literature discussing the link between depression and secondary physical SCI complications. Evidence in the literature was located that supports both a causal connection between depression and increased physical complications and/or the potential mechanisms mediating that connection. CONCLUSION The proposed model can be utilized to encourage further research on the influence of depression on SCI outcomes and the importance of prompt and effective identification and treatment of depressive symptoms. Additional research is needed to assess the relationship between depression and secondary physical SCI complications, and to test the validity of the model.
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Affiliation(s)
- H Krueger
- UBC School of Population and Public Health, The Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Schönenberg M, Reimitz M, Jusyte A, Maier D, Badke A, Hautzinger M. Depression, Posttraumatic Stress, and Risk Factors Following Spinal Cord Injury. Int J Behav Med 2012. [DOI: 10.1007/s12529-012-9284-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Saunders LL, Krause JS, Focht KL. A longitudinal study of depression in survivors of spinal cord injury. Spinal Cord 2011; 50:72-7. [DOI: 10.1038/sc.2011.83] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Angel S, Kirkevold M, Pedersen BD. Getting on with life following a spinal cord injury: Regaining meaning through six phases. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620802393492] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Crisp R. Depression and occupational disability in five diagnostic groups: A review of recent research. Disabil Rehabil 2009; 29:267-79. [PMID: 17364777 DOI: 10.1080/09638280600835267] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the methodologies and results of research across five diagnostic groups in which there was expected to be a high prevalence of depression and occupational disability. METHOD A review of research published since 1994 was carried out concerning depression and occupational disability in five diagnostic groups: Major depressive disorder (MDD), spinal cord injuries (SCI), traumatic brain injuries (TBI), chronic back pain (CP) and myocardial infarction/coronary artery bypass grafting (MI/CABG). RESULTS Prospective longitudinal designs were mostly undertaken in MDD studies. Diagnostic interview schedules were utilized in most MDD studies whereas self-report inventories that tend to confound somatic and depressive symptoms were mostly used in CP, SCI, TBI and MI/CABG studies. In longitudinal MDD studies both depression and occupational disability were related to access to enhanced primary care treatment. On the other hand, CP research reported different results concerning the strength of depressive symptoms, cognitive and psychosocial factors in predicting occupational disability. Different trends across diagnostic groups were evident in relation to depression, occupational disability, co-morbidity, socio-demographic factors and psychosocial resources. CONCLUSIONS Co-morbid, socio-demographic and psychosocial factors provide a framework from which to identify those at greater risk of depression and occupational disability. However, more CP, SCI, TBI and MI/CABG studies with diagnostic schedules, prospective designs and longer follow-up are required.
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The battle between hoping and suffering: a conceptual model of hope within a context of spinal cord injury. ANS Adv Nurs Sci 2008; 31:237-48. [PMID: 18724113 DOI: 10.1097/01.ans.0000334287.19473.5c] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this longitudinal study was to explore 10 patients' experiences of the meaning they attribute to the substance of hope and the process of hoping during the first 3 to 4 years following a spinal cord injury. This qualitative study is a synthesis of three empirical studies of hope and the overall aim was to deepen the understanding of the phenomenon of hope, based on the text representing the main contextual findings, to develop a theoretical framework on hope within a context of spinal cord injury, illustrated in the conceptual model. In correspondence with Ricoeur, this conceptual model, which was developed from a new understanding, based on a new text of the phenomenon of hope, develops a new and deeper understanding of the meaning of hope. Findings revealed 9 themes: universal hope, uncertain hope, hope as a turning point, the power of hope, boundless creative and flexible hope, enduring hope, despairing hope, body-related hope, and existential hope. The conceptual model was derived from these themes, illustrated as The Battle between Hoping and Suffering and The Road of Hope. The interpretations also revealed a distinction between being in hope and having hope, and having a hope of improvements was the main focus at the early stage of rehabilitation, whereas being in hope as being just fine was the main focus after 3 to 4 years of rehabilitation.
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Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias N, Svenson LW, Schopflocher DP, Voaklander DC. Depression following Traumatic Spinal Cord Injury. Neuroepidemiology 2005; 25:55-61. [PMID: 15947491 DOI: 10.1159/000086284] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To describe the epidemiology of depression following traumatic spinal cord injury (SCI) and identify risk factors associated with depression. METHODS This population-based cohort study followed individuals from date of SCI to 6 years after injury. Administrative data from a Canadian province with a universal publicly funded health care system and centralized databases were used. A Cox proportional hazards model was developed to identify risk factors. RESULTS Of 201 patients with SCI, 58 (28.9%) were treated for depression. Individuals at highest risk were those with a pre-injury history of depression [hazard rate ratio (HRR) 1.6; 95% CI: 1.1-2.3], a history of substance abuse (HRR 1.6; 95% CI: 1.2-2.3) or permanent neurological deficit (HRR 1.6; 95% CI: 1.2-2.1). CONCLUSION Depression occurs commonly and early in persons who sustain an SCI. Both patient and injury factors are associated with the development of depression. These should be used to target patients for mental health assessment and services during initial hospitalization and following discharge into the community.
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Affiliation(s)
- Donna M Dryden
- British Columbia Rural and Remote Health Research Institute, University of Northern British Columbia, Prince George, BC, Canada.
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