Selected Abstracts from the 2006 SCI Conference
#107
Predicting Depression Among Family Caregivers
Timothy R. Elliott, Ph.D, ABPP, Laura E. Dreer, PhD, Richard Shewchuk, PhD, Jack W. Berry, PhD, and Patricia Rivera, PhD
Objectives:
- Participants will understand the necessity for applying diagnostic criteria in assessing depression among family caregivers.
- Participants will learn the observed percentage of family caregivers who are at risk for major depressive disorder.
- Participants will learn that caregivers at risk for a depressive episode may be providing to a person with a more severe injury and may possess a dysfunctional problem-solving style.
Introduction
Family members who assume a caregiver role for a person with a spinal cord injury (SCI) may experience heightened distress, and they are often considered at risk for depression. Self-report measures are often used to assess depressive symptoms among family caregivers, but these instruments provide an indicator of current distress and most were not designed to assess symptoms with criteria consistent with a depressive disorder.
Problem Statement: We do not know the percentage of family caregivers who may meet criteria for a major depressive disorder, and research to date has not determined the demographic or psychological characteristics of family caregivers who may meet these criteria.
Objectives: This study was conducted to determine the percentage of family caregivers at risk for 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.
Statement of Methods: Eighteen men and 103 women caregivers (M age of caregivers = 45.66, SD = 12.88) of individuals with SCI consented to participate in the study. Caregivers were interviewed by a PhD-level psychologist. The Inventory to Diagnose Depression was used to assess major depressive disorder (by DSM-III R criteria). A popular measure of social problem-solving abilities was used, as was the omnibus SF-36 questionnaire (to assess caregiver health). Correlational and logistic regression analyses were used to predict depression status.
Results and Data Supporting Hypotheses: Nineteen caregivers (15.7%) met criteria for a major depressive disorder. SCI severity and a dysfunctional problem-solving style were significantly predictive of caregiver depression, regardless of the physical health of the caregiver and caregiver demographic variables. The final predictive equation yielded an overall 80.8% accuracy of classification, with 77.8% of at-risk caregivers correctly classified and 81.4% of not-at-risk caregivers correctly classified.
Summary and Conclusions: The percentage of caregivers at risk for a depressive
disorder may parallel that observed among persons with SCI. Family caregivers with a dysfunctional problem-solving style and assisting individuals with more severe injuries may be particularly at risk to develop depressive symptoms characteristic of a major depressive disorder.
#308
The Role of Sports in Psychosocial Rehabilitation Following a Spinal Cord Injury
Keith Cavill, Nicholis Springer, and Jason Regier
Objectives:
- To understand the role of recreational activities in rehab following and SCI.
- To appreciate the gains achieved by athletes in organized/team sports
- To learn of the different team sports available to persons with SCI
The ultimate goal of rehabilitation for persons with spinal cord injuries has shifted over time from an extension of their life expectancy to attainment of an optimal level of independent living and quality of life. Increased fitness through physical exercise or sports is beneficial to a person with SCI and their longevity in life. People with SCI experience a dramatic change in the way their time is spent. They typically do not return to work right away and must adjust to sudden “forced leisure.” This often forces people with SCI to make sudden, radical lifestyle changes. Many persons need to learn new leisure skills, particularly those who did not value leisure time prior to their injury. Many people experience difficulty in making this leisure time adjustment. And turn to alcohol and substance abuse and a sedentary life style. One factor that has a serious negative effect on the quality of life for individuals with SCI is a deterioration of their physical fitness through “disuse” or physical de-conditioning. The normal aging process, combined with physical de-conditioning can significantly limit individual independence and activities of daily living. Participation is sports or exercise can not only increase the longevity of a person’s life, but it can make their everyday living style easier. Those who are in better physical shape can maneuver their wheelchair better than those who are not in good physical shape. They may experience less difficulty in negotiating curbs or hills and they may possess more confidence in handling their chair. While competition and winning are just as important to disabled athletes, participation in sports and physicalexercise provides lifetime benefits of sports training. The Special Olympics calls this “training for life.” Research shows that Special Olympics participation leads to higher social competence and better self-esteem among participating athletes. Exercise is good for everyone. The benefits from participating in sports are not any different for athletes with disabilities than for able-bodied athletes. Researchers have described physical, psychological, and social benefits from participating in sports:
Physical Benefits For persons with a disability who require the use of adaptive devices (walkers, crutches, wheelchair), being in good physical shape enables them to use their equipment more
effectively, with less fatigue after longer usage. In addition, they have less chance to become injured from the everyday strain on their joints due to the use of adaptive devices. Athletes have healthier body fat to muscle ratio, decreased obesity, improved cardio-pulmonary functioning, and increased muscular strength and endurance. They show improved mobility, balance, and endurance.
Psychological Benefits People with disabilities who participate in sports or regular exercise have been shown to handle pressure and stress, better than those persons who did not exercise. They also experienced less depression, confusion, tension and anger. Sports provide the disabled athlete the opportunity to develop a sense of mastery and set and achieve certain goals. Swimmers are reported to have a strong self-identity, strong competitive nature, and goal-oriented focus.
Social Benefits Through sports, persons with disabilities have the opportunity to experience peer interaction, acceptance, and recognition. Sports can be a vehicle to combat discrimination by providing the able-bodied athlete the opportunity to see the athletic ability of the disabled athlete.
#312
Personal Reflections Following Spinal Cord Injury: Self-Concept, Self Esteem, and Social Identity
Kathie J. Albright, PhD
Objectives:
- To better understand qualitative analytic approaches to interview data
- To learn about study findings concerning identity reconstruction by women with traumatic SCI and the connections between post-injury identity trajectories and rehabilitation outcomes.
- To consider implications of a focus on identity reconstruction for future research and clinical practice.
Introduction: Spinal cord injury (SCI), as a major biographical disruption, has profound implications for functioning, self-perception, social life, and adaptation, requiring a reconstruction of identity. The self-system, as an organizer of experience in the personality, including thoughts and feelings about the self and the self in relation to others, may be seen as an equilibrating factor in living with SCI.
Problem Statement: In relation to a study population of women living in the community with SCI, qualitative description and analysis may be integrated to demonstrate that living with SCI transforms the self-concept, self-esteem, and social identity of women experiencing physical disability and that said transformations matter greatly.
Objective and Methods: This descriptive, qualitative, cross-sectional study was designed to collect and analyze personal reflections by women following traumatic SCI concerning both change and stability in their self-concept, self-esteem, and social identity. 26 Caucasian and 24 African American women (N = 50), recruited from the community and rehabilitation hospital databases, were interviewed in depth. The interview protocol included specific, semi-structured questions focusing on the impact of SCI on sense of self, self-esteem, and social relatedness. Transcripts were analyzed using an a priori coding scheme and the constant comparison method with QSR N6 software. Coded data were scrutinized for themes and patterns across the sample.
Data Supporting Hypothesis: The interview data supported the expectation that experience of disability living with SCI demands identity reconstruction. Empowerment themes of personal growth and transcendence emerged prominently in the qualitative, thematic and pattern analysis, clustering positively for participants spontaneously describing positive adjustment and expressing satisfaction with their quality of life. With respect to interpersonal relatedness, a powerful theme of interdependent identity (or wego) also emerged.
Summary of Findings and Conclusions: On the basis of self-report data, unequivocal support is provided for the contention that identity, crafted across a lifespan, becomes rewoven into details of traumatic SCI, disability experience, rehabilitation, and community reintegration. The very personal reflections offered by study participants are a potent reminder that identity reconstruction is a powerful dimension in the adjustment and rehabilitation process, a dimension awaiting further systematic inquiry.
#313
Crisis and Complication: Narration as Data in the Research of Women with Spinal Cord Injury
Marcy Epstein, PhD
Objectives:
- Provide a forum for participants to consider multiple approaches to research data.
- Improve knowledge concerning issues facing women with SCI.
- Enhance research skills of those wanting to contribute to the field of SCI.
Problem Statement: Personal account arguably describes the basis of qualitative methodology, but narration of textual data often eludes valid or reliable analysis.Particularly in the case of sensitive populations like women with spinal cord injury, the handling of qualitative data relies on interpretation of meaningful units and pattern
recognition of their arrangement in relation to one another. Qualitative findings can then be compared to quantitative findings. Employing a formulation of text in the study of women with SCI, much of the rich complexity of participant narratives may be processed and comprehended, a complexity that otherwise would be lost in translation to numerical value.
Goal: The goal of this study is to demonstrate the analysis of narratives by women with SCI, as well as how narrative analysis may be linked to other qualitative and quantitative modalities for handling data.
Methods: A qualitative instrument, the Narrative Form Index and Matrix (NFIM), will be explained in the case study of three study participants, all women with spinal cord injury living in Detroit.
Data Supporting Hypothesis: Descriptive textual analyses of two narrative forms-Crisis (Single-Variable) and Un/Raveling (Multi-Variable)-were used to establish a matrix of narratological and contextual references from the cases, wherein all participants identified crises as ubiquitous in their lives. Two of three women expressed constructive ways of unraveling crises; the remaining participant instead raveled in narrative, expressing negative ways of coping comparable to scores on quantitative measures of Ways of Coping and Satisfaction with Life.
Results: Participants narratives mirrored numerical data but provided additional factual, contextual, and subjective data about the structuring of life with SCI after crisis.
Conclusion: From narrative data, it is conclusive that these women narrate their post-SCI rehabilitation in order to organize and communicate complications of coping after crisis. Furthermore, complementing more traditional quantitative measurement with narrative analysis drew out significant context and detail about women’s complications after SCIrelated crisis, thus giving voice to these women and posing new strategies for researching life with SCI across a broad spectrum of experience.
P1
Influence of Religious Coping on Adjustment Following Traumatic Spinal Cord Injury
Shannon N. Smith, MS, Samuel T. Gontkovsky, PsyD, and Chad D. Vickery, PhD
Objectives:
- Increase understanding of psychosocial adjustment after SCI.
- Facilitate consideration of coping as one factor in the process of psychosocial adjustment after SCI.
- Acquire preliminary understanding of the role of religious coping in psychosocial adjustment after traumatic SCI.
Emotional distress is recognized as a common occurrence among individuals with spinal cord injury (SCI). Research has reported estimates of psychological disturbance as high as 40% in this population, with the greatest levels of distress generally taking place during the initial 2–3 weeks post-injury. Although individual reactions vary, emotional symptomatology is commonly manifested in the form of depression, anxiety, and/or anger. Individual psychological reactions to SCI are moderated, however, by a multitude of factors, one being the strategies used for coping with the associated sequelae of injury. For example, research has suggested that higher levels of acceptance coping predict decreased distress and increased positive morale following SCI, and elevated levels of social reliance coping predict heightened distress following SCI. Livneh also reported better psychosocial adaptation to SCI with the adoption of problem-solving/focusing styles of coping. Little is known about the manner in which religious coping strategies influence adjustment following SCI. This investigation examined the associations among religious coping and psychosocial outcomes in 37 individuals with traumatic SCI evaluated during acute inpatient rehabilitation hospitalization. Participants completed the Brief Religious Coping Scale, Satisfaction With Life Scale, and Rosenberg Self Esteem Scale. Correlational analyses revealed expected associations between negative religious coping and both satisfaction with life (r = -.30, p < .05) and self-esteem (r = -.60, p < .0005). Contrary to expectation, significant positive associations were not found between positive religious coping and these variables. Results provide preliminary evidence to suggest the important role of religious coping in acute psychosocial adjustment following traumatic SCI. Specifically, coping techniques that revolve around issues of abandonment by God or the church, punishment by God, and attribution of injury occurrence to the devil are associated with decreased satisfaction with life and self esteem. Primary limitations of this study include the cross-sectional nature of its design and the relatively small size of the sample. Additional research will be necessary to ascertain whether findings generalize to individuals in the chronic stages of recovery and those who sustained SCI by non-traumatic means.
P7
Development of Neuropathic Pain During the First Year Following Spinal Cord Injury
Margaret M. Schmitt, MA, Timothy Ness, MD, PhD, and J. Scott Richards, PhD
Objectives:
following spinal cord injury.
Background: Chronic pain is a common secondary condition in SCI. Extreme pain has been associated with significantly poorer mental functioning, physical functioning, and quality of life. Neuropathic pain is often reported to be more severe than other subtypes. Little is known, however, about the natural history of the development of neuropathic pain post-SCI. Understanding the natural course of development of neuropathic pain is important for evaluating new pre-emptive treatments.
Methodology: Participants were part of the University of Alabama at Birmingham’s Spinal Cord Injury System of Care. Interviews occurred at monthly intervals during the first year following injury. Initial interviews were in the hospital and follow-up was by phone or in person. Semi-structured interviews elicited details about the pain experience. Interviews were independently reviewed by an anesthesiologist and clinical psychologist, both of whom are familiar with pain subtypes, and coded for type of pain.
Analyses: Pain data were available at 1, 6, and 12 months post-injury for 20 individuals. Sample characteristics include: mean age 32.42; 76.9% male; 57.7% Caucasian, 42.3% African American; 50% paraplegia and 50% tetraplegia; and 53.8% with complete
lesions. Etiology of injury included: vehicular accidents (46.2%), acts of violence (26.9%), falls (19.2%), and other (7.6%). Pain was endorsed by 60% at month 1, 50% at month 6 and 45% at month 12. Musculoskeletal and neuropathic were most common at month 1 (N = 8 40% for both) and neuropathic was most common at month 6 (N = 8, 40%) and month 12 (N = 7, 35%).
Conclusions: Rates of neuropathic pain remained fairly constant. The data, however, reveal that some cases of neuropathic pain resolved during the study. Additionally, new individuals reported neuropathic pain at month 6 and at month 12. Although preliminary, these results suggest that there may be critical time periods for the development and resolution of neuropathic pain. Further research into the natural history of neuropathic pain is warranted. Psychologists can contribute to this line of research in areas including expertise in evaluating quality of life and the impact of pain on general functioning as well as expertise in measurement and qualitative methods.
P12
Employment and Caregivers of Persons with Spinal Cord Injury
Phyllis S. Ellenbogen, MSW, MBA, Nicole Abdul, BA, Michelle Meade, PhD, Njeri Jackson, PhD, and Kirsten Barrett, PhD
Objectives:
- Understand how employed caregivers of persons with SCI are different from other caregivers, such as those of the elderly.
- Understand what a small sample of caregivers in our study express as their concerns.
- Participants will understand what types of programs and services might help this group
Caregivers play key roles in assisting with the continued health and community integration of persons with SCI. Many of these individuals are employed full or parttime, for one of any number of reasons ncluding economic necessity, professional interests, or social need. Employment may add complexity to a potentially difficult and stressful situation or may be a way of maintaining balance and connections. While research is available on caregivers of individuals with SCI and plentiful on employment of caregivers of the frail elderly and those with Alzheimer’s, we could find no research focused on employment factors/issues of caregivers of persons with SCI. This project examines the issue of employment in caregivers, how individuals balance multiple roles, and what they describe as their needs and concerns. Multiple data types are used to examine this issue, including: (a) qualitative data from 9 caregivers interviewed either individually or as part of a focus group; and (b) quantitative data from a multimethod survey completed by over 500 persons with SCI and over 300 persons identifying themselves as caregivers. Quantitative data revealed that about half (53%) of the caregivers (N = 156) were employed at least 30 hours a week. 138 respondents answered yes to whether they provided any personal assistance. Of this group, 44% (N = 60) reported that their employment was limited because of the time spent providing personal care. Caregivers who were unemployed or partially employed expressed interest in several services at a higher rate then those fully employed, including assistance with transportation, financial assistance, assistance with lawyers, family support or counseling and help with bathing and dressing. Furthermore, fully employed caregivers reported statistically significant higher levels of health than those partially or unemployed (p = 001). Qualitative data provided information about the issues, concerns and challenges caregivers faced related to employment. Common themes included the need for flexible work schedules, problems with hired help in the home, and the lack of opportunity for social connections, leisure time and career advancement. Further research is needed tobetter understand the needs of employed caregivers of persons with SCI-who they are, what level of services they are providing, what can be done to provide support for them.
P14
Occupation and Economic Self-Sufficiency in Individuals Post Spinal Cord Injury
Jerry M. Wright, BA, and Tamara Bushnik, PhD
Objectives:
- Describe the occupational status of individuals five years post SCI.
- Examine the psychometrics of the CHART Occupation and Economic subscales.
- Compare self reported occupational status with CHART subscale scores
The Craig Handicap Assessment and Reporting Technique (CHART) is an established instrument used to measure participation/handicap following injury. The psychometric properties of two subscales of the CHART (Occupation and Economic Self-Sufficiency (ESS)) were examined for individuals who were five years post-spinal cord injury(SCI). The scores from these subscales were also compared with the individuals self-reported occupational status (employed worker, homemaker, student, retired, and unemployed). It was hypothesized that workers would score higher on both subscales. Data were taken from 2,548 five-year post-injury interviews of individuals with SCI who are part of the NIDRR-funded SCI National Database. At five years, 23 of the individuals were workers, 2% homemakers, 15% students, 11% retired, and 49% unemployed. There was a significant differentiationbetween reported occupational categories and scores on the CHART Occupation subscale (p < .001) with workers scoring highest (M = 94.3 +/-16.3) and unemployed individuals lowest (M = 41.3 +/-34.7). There were significant differences among all categories other than students (M = 81.7 +/-25.7) and homemakers (M = 80.8 +/-28.4). Workers, students and homemakers all have issues with ceiling effects on the Occupation subscale, with the majority (>50%) of each group getting a maximum score. There was also a significant differentiation between occupational categories and scores on the CHART ESS subscale (p < .001) with workers (M = 89.6 +/-21.8) scoring significantly higher than other categories and unemployed individuals scoring significantly lower (M = 53.4 +/-33.7). Workers, homemakers and retirees have issues with ceiling effects with the majority getting a maximum score. While the Occupation and ESS subscales of the CHART appear to be accurately reflecting activity status at five years post-SCI, there should be a concern that the majority of the active classifications (worker, student homemaker) are reaching instrument ceilings. This finding may have been masked in the past due to the high number of unemployed individuals in this population.
P16
The Relationship of Perceived Independence to Societal Participation
Martin Forchheimer, MPP
Objectives:
participation.
Introduction: Perception of independence has been widely studied in other populations, findings consistently indicating strong positive impacts on depression, social engagement and compliance with health maintenance protocols. Several studies have reported successfully facilitating enhancement of perceived independence. Considering this promising research with other populations, the lack of study of perceived independence in the spinal cord injury (SCI) community is surprising. This study looks at the
relationship of perceived independence to the International Classification of Functioning, Disability, and Health’s (ICF) Participation construct, as appraised by the Craig Handicap Assessment and Reporting Technique (CHART).
Hypothesis: Perceived independence is a significant predictor of CHART scores, moderating the effects of indices of the ICF’s Body Function and Structure (BFS) and Activity.
Sample: One hundred and fourteen people with new traumatic SCI. The sample’s neurological composition was 40% tetraplegia American Spinal Injury Association (ASIA) Grades A, B, or C; 41% paraplegia ASIA Grades A, B, or C; and 19% ASIA Grade D at all injury levels.
Methods: A set of five hierarchical linear regression were conducted with all of the CHART’s scales except Economic Self-Sufficiency used as dependent variables, the Economic scale excluded due to extensive missing data. Demographic variables included first, followed by neurological status and Functional Independence Measure (FIM) Motor Scores. Scores on the Personal Independence Profile (PIP), a ten-item measure of perceived independence were added last.
Results: The combination of neurological status and FIM scores added significantly to the explanation scores on all the CHART scales except Social Integration, with adjusted R2 ranging from .09 (Occupation) to .61 (Physical Independence). Inclusion of the PIP added significantly to the explanation of the CHART’s Mobility, Occupation, and Social Integration scales, with increases ranging from .13 to .17. Subsequent to its addition, neurological status and FIM scores were not significant predictors of Occupation.
Conclusion: Interventions aimed at enhancing perceived independence may bolster community participation among people with SCI, thereby promoting overall well-being.
P17
Initial Evaluation of a Spinal Cord Injury Peer-Mentoring Program: So Far, So Good
Jack E. Sherman, PhD, Teresa A.Pellino, RN, PhD, Kristine L. Kravik, CTRS, BS
Objectives:
- To describe the basic administrative structure of a peer-mentoring program for individuals with SCI.
- To describe the frequency of contacts between mentee and mentor, the primary issues that are likely to be addressed, and mentee satisfaction with mentors along several relevant dimensions.
- To discuss the utility of brief assessment measures in documenting outcome as well as program evaluation.
Research suggests peer-mentoring for individuals with newly acquired SCI facilitates adjustment to disability. We established a hospital-based peermentoring program approximately 18 months ago. Here, we briefly describe our program and findings.
Participants/Methods: Mentors were recruited by rehab staff based on their success in adjusting to their SCI. All mentors completed formal screening required of hospital volunteers and completed additional training on confidentiality, boundaries, communication, crisis management, and community resources. Of 40 formal invitations to participate, 11 mentors were successfully recruited and retained.
Demographics of mentors: 6 men, 5 women; 5 tetraplegics and 6 paraplegics; 72% employed; mean years post SCI = 10.6, and mean age of 36.5 years. Mentees (n = 19) consisted of all consenting, serially admitted acute rehabilitation patients with traumatically acquired SCI; 3 declined to participate. Mentors and mentees were matched based on level of injury, gender and age. Staff arranged the first visit; mentees and mentors the remaining.
Mentors were given a $5 lunch voucher and $10 for each visit.
Results: During the mentee s acute hospitalization, they met an average of 2.8 times for approximately 70 minutes/contact. Based on contact logs completed by mentor and mentee, the five topics most commonly discussed in order of descending frequency were:
medical issues, housing, general adjustment, driving, and recreation. Average satisfaction of mentees (1 = very dissatisfied to 7 = very satisfied) with information, emotional support, relationship and progress toward goals provided by mentor were: 6.25, 6.25, 6.50, and 5.79, respectively. Prior to matching, compared to mentors, mentees had statistically significant (t-tests, p < .05): higher negative affect and lower positive affect (PANAS), greater depressive symptoms (BDI-FS), and lower current adjustment (Ladder of Adjustment Scale). The groups did not differ on life satisfaction (SWLS), perceived social support (ISEL), or one year projected adjustment.
Conclusions: As anticipated, mentors reported less distress/greater adjustment than mentees. Medical and concrete practical issues were most frequently discussed. Despite relatively few contacts, mentees consistently reported high levels of satisfaction with their mentors along several relevant dimensions. Thus far, peer mentoring appears to be an efficient and useful adjunctive clinical intervention to facilitate adjustment.
P26
Verbal Learning Deficits Following Traumatic SCI: Association with Severity of PTSD Symptomatology
Rushina Bhatt Robbins, MA, Samuel T. Gontkovsky, PsyD, and Chad D. Vickery, PhD
Objectives:
Research has revealed deficiencies of cognition among individuals with spinal cord injury (SCI). The presence of such deficits likely does not represent the direct sequelae of SCI but rather the presence of secondary complicating factors, such as comorbid traumatic brain injury (TBI), emotional distress, and/or increasing age. Although deficits
have been reported across various domains of cognition, reduced performances on measures of verbal learning/memory, as assessed by the Rey Auditory Verbal Learning Test, have been noted most commonly. The purpose of this study was to determine if deficiencies in verbal learning/memory would be detected in a sample of individuals with SCI using a less complex list learning measure than has been used in previous investigations and to explore whether performances on this test would be associated with severity of Posttraumatic Stress Disorder (PTSD) symptomatology. Participants were 21 individuals admitted for acute inpatient rehabilitation following traumatic SCI. None were documented as having conclusively sustained a comorbid TBI. Participants completed the Hopkins Verbal Learning Test and Davidson Trauma Scale within 48 hours of hospital admission. Participant performance on the Hopkins Verbal Learning Test was evaluated against the measure’s normative sample using age-derived T scores for comparison. One-sample t-tests revealed significantly reduced performances among individuals with SCI relative to the test’s normative sample on scores of total recall (M = 38.29, t(20) = -4.28, p < .0005), delayed recall (M = 40.71, t(20) = -3.75, p < .001), and recognition discrimination (M = 41.95, t(20) = -2.81, p < .05); performance was not significantly reduced on the retention percentage score. Bivariable correlations between severity of PTSD symptomatology and verbal learning/memory performances disclosed an unexpected positive association between severity of intrusion symptoms and total recall of verbal information (r = .49, p < .05). A significant positive association in the expected direction also was found between severity of hyperarousal symptoms and frequency of semantically-unrelated false-positive errors (r = .50, p < .05). Results
support previous findings that suggest deficits in verbal learning/memory following traumatic SCI and indicate deficiencies do not appear to be a primary function of TBI, severity of PTSD symptomatology, or age.
P27
Abuse and Health in Men and Women with Spinal Cord Injury/Disorder
Dena S. Hassouneh-Phillips, PhD, RN, ANP, Elizabeth McNeff, MPA-HA, and Roxie Choroser, MS
Objectives:
This presentation will review findings from an ongoing study of abuse and health in individuals with SCI/D. The aims of the study were to: 1) estimate the percentage of men and women with SCI/D who experience abuse; 2) explore predictors of abuse in men and women with SCI/D; and 3) explore the impact of abuse on health in men and women with SCI/D. The learning goals of this presentation correspond to these 3 aims. No significant differences between men and women in the reporting of any type of abuse with the exception of physical abuse was found, with men being significantly more likely to report current physical abuse than women. To address aim 2, separate logistic regressions for each predictor including gender and the gender-predictor interactions were run todetermine if the effect of the predictor on current abuse (e.g. abuse occurring within the past year) was different depending on gender. The only significant interaction was physical dependency-gender (p = .009). In the final model physical dependency was more
strongly associated with current abuse for women than for men. Past adult abuse was also a significant predictor of current abuse (OR 69.85). To address aim 3, one-way ANCOVA using planned contrasts were conducted to investigate whether participants reporting no abuse had better health outcomes than participants who reported current or past adult abuse controlling for age, gender, and physical dependency. Neither gender nor the interaction gender-abuse were significant predictors. In the final model individuals reporting past or current adult abuse were significantly more likely to experience depressive and post-traumatic symptoms (PTSD) than individuals who reported no past
adult abuse (p = 007 and p < .001 for depressive symptoms; p < .001 for PTSD in both groups). Individuals reporting current abuse were also significantly less likely to engage in health promoting behaviors such as healthy eating, exercise, and accessing preventative health care than individuals who reported no past abuse history (p = .046). To our knowledge, these findings are the first to quantitatively identify factors that place individuals with SCI/D at risk for abuse and demonstrate the significant negative health outcomes associated with abuse in this population.