1
|
Mashola MK, Korkie E, Mothabeng DJ. Exploring the Experience of Living with Pain after Spinal Cord Injury: A Qualitative Study. Behav Neurol 2024; 2024:9081530. [PMID: 38343899 PMCID: PMC10857878 DOI: 10.1155/2024/9081530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
A spinal cord injury is a life-changing experience that results in functional limitations and an increased risk of secondary health conditions. People with spinal cord injury identify pain as the most devastating health problem following their injury that not only affects their social life but their mental well-being as well. This study is aimed at exploring the lived experience of living with pain by community-dwelling manual wheelchair users with spinal cord injuries. An explorative qualitative design was used to explore their experiences. In-depth interviews were recorded and transcribed, and the data were analysed using inductive thematic content analysis in the MAXQDA v2020. Fifteen manual wheelchair users with paraplegia participated in this study, and four themes were identified from their experience of living with pain: pain constantly lurks, pain is worse than the direct consequences of the SCI, pain is restrictive, and life continues despite the pain. Categories and subcategories included the participants being one with the pain; pain interfering with sleep; feelings of anger, isolation, and suicidal ideation; and uncertainties about what the future holds living with pain. Living with pain after SCI is a challenging feat, and effective management of pain is necessary to improve not only functioning and mobility but also mental health and life satisfaction.
Collapse
Affiliation(s)
- Mokgadi Kholofelo Mashola
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Diphale Joyce Mothabeng
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
2
|
Lee W, Jeong S, Lee BS, Lim JC, Kim O. Association between functional outcomes and psychological variables in persons with spinal cord injury. Sci Rep 2023; 13:23092. [PMID: 38155215 PMCID: PMC10754915 DOI: 10.1038/s41598-023-50252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
We aimed to explore the association of functional outcomes with psychological variables, including depression, anxiety, sleep quality, and suicide risk, in persons with spinal cord injuries (SCIs). The secondary aim was to determine specific functions related to the psychological variables. This retrospective study included 259 persons with SCIs who were admitted to the Korean National Rehabilitation Center between 2019 and 2021. The participants were interviewed by a psychiatrist and completed questionnaires, including the Korean Beck Depression Inventory II (K-BDI-II), Korean Beck Anxiety Index, Insomnia Severity Index, and Mini International Neuropsychiatric Interview. To assess functional outcomes, the Spinal Cord Independence Measure III (SCIM III) and Walking Index for Spinal Cord Injury were determined by a physical therapist. The findings revealed a negative correlation of SCIM III subdivisions 1 and 3 with K-BDI-II. Specifically, feeding and mobility in bed and actions to prevent pressure injuries were functional factors associated with all four psychological variables. Our findings can guide clinicians to focus on improving functional independence and activities of daily living during the management of persons with SCI to prevent psychological consequences. Developing devices that aid in improving functional independence is crucial and may improve psychological problems in such individuals.
Collapse
Affiliation(s)
- Wonha Lee
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea
| | - SangHyup Jeong
- Department of Neuropsychiatry, National Rehabilitation Center, Seoul, Republic of Korea
| | - Bum-Suk Lee
- Department of Rehabilitation Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
| | - Jin-Cheol Lim
- Department of Education Measurement and Evaluation, Sungkyunkwan University, Seoul, Korea
| | - Onyoo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea.
| |
Collapse
|
3
|
Han S, Kim W, Kim O. Risk Factors for Suicidality in Individuals With Spinal Cord Injury: A Focus on Physical and Functional Characteristics. Ann Rehabil Med 2023; 47:377-384. [PMID: 37907229 PMCID: PMC10620485 DOI: 10.5535/arm.23110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To demonstrate the association between the physical and functional characteristics of individuals with spinal cord injury (SCI) and suicidality, an area of research that is less understood than the association with demographic, social, and psychological characteristics. METHODS : A retrospective cross-sectional study was conducted with 259 patients with SCI admitted for rehabilitation at the National Rehabilitation Center, Seoul, between January 2019 and December 2021. Demographic, SCI-related, physical, and functional data were collected from their medical records. Suicide risk was assessed using the Mini International Neuropsychiatric Interview. RESULTS : The 259 participants had an average age of 49.1 years, and 75.7% were male. The analysis revealed a statistically significant negative correlation between age and suicidality. No significant differences were found for sex, education, occupation, or SCI-related factors. Lower upper extremity motor score (UEMS) was significantly associated with higher suicide risk. Regarding functional factors, the inability to perform independent rolling, come to sit, wheelchair propelling, and self-driving were associated with increased suicidality. In the multiple linear regression analysis, lower UEMS, limited shoulder joint motion, upper extremity spasticity, and dependent wheelchair propulsion were predictors of higher suicide risk. CONCLUSION : This study highlights the associations among physical status, functional dependency, and suicide risk in individuals with SCI. These findings emphasize the need to address psychological aspects and physical and functional factors in the management of individuals with SCI who are at a high risk of suicide.
Collapse
Affiliation(s)
- Sora Han
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Wooyeung Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Onyoo Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| |
Collapse
|
4
|
Khong CM, Chan J, Pasipanodya E, Dirlikov B, Shem K. Risk Factors Associated With Suicidal Ideation in Individuals With Spinal Cord Injury. Arch Rehabil Res Clin Transl 2023; 5:100284. [PMID: 37744203 PMCID: PMC10517356 DOI: 10.1016/j.arrct.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To assess the frequency of suicidal ideation (SI) among individuals with chronic spinal cord injury (SCI) and to identify risk factors associated with SI. Design Cross-sectional. Setting Community setting. Participants Two hundred and forty-six individuals with chronic SCI participating in the Spinal Cord Injury Model Systems at a Level 1 Trauma center. Interventions Not applicable. Main Outcome Measure SI, as assessed by question 9 of the Patient Health Questionnaire-9. Results Twenty-seven (11.0%) participants endorsed SI; 6 (22.2%) of whom endorsed active SI with a plan of self-harm. Participants who endorsed SI had significantly higher depressive symptoms, lower resilience, and lower satisfaction with life (all Ps<.001). They also had lower perceived health (P<.001), Craig Handicap Assessment & Reporting Technique Short Form (CHART-SF) physical independence (P=.013), and Spinal Cord Injury - Functional Index with Assistive Technology domains of basic mobility (P=.003), self-care (P=.042), and fine motor skills (P=.035). However, participants who endorsed SI were not significantly different in re-hospitalization rates and in other domains of CHART-SF and SCI-AT. Logistic regression, with a forward selection procedure, was used to identify significant predictors of endorsing SI in the context of multiple associated variables. Depressive symptoms (odds ratio [OR]=1.18, P=.020), resilience (OR=0.85, P=.003), and physical independence (OR=0.98, P=.019) remained significant predictors of SI. Conclusion Study findings suggest higher levels of SI among people with SCI, a substantial proportion of whom have active SI. Individuals with SCI who endorse SI have greater burden of poor physical and mental health, as well as poorer functional status and adaptation. Interventions targeting multiple dimensions of quality of life may help reduce risk of SI and suicide among individuals with SCI.
Collapse
Affiliation(s)
- Cria-May Khong
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA
| | - John Chan
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA
| | | | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA
| | - Kazuko Shem
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA
| |
Collapse
|
5
|
Usta Sağlam NG, Aksoy Poyraz C, Doğan D, Erhan B. Suicidal ideation, post-traumatic stress disorder, and depression in traumatic spinal cord injury: What resilience tells us. J Spinal Cord Med 2023; 46:309-316. [PMID: 35593735 PMCID: PMC9987751 DOI: 10.1080/10790268.2022.2039856] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Identification of unmet psychiatric needs, protective and risk factors for suicide are crucial for people with traumatic spinal cord injury (SCI). In this study, we aimed to explore depression, post-traumatic stress disorder (PTSD) status (non-PTSD, partial-PTSD, full-PTSD), resilience, suicidal ideation (SI) and to examine predictors and clinical correlates of current SI in traumatic SCI. METHOD Sixty-three individuals with traumatic SCI who were at least 3 months post-injury were included in the study. The participants were evaluated in terms of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), depression, SI, and resilience using the PCL-5, the Patient Health Questionnaire-9, the Brief Resilience Scale, and sociodemographic measures. RESULTS 33% of our sample (n = 21) had SI over the past two weeks. 71.4% of the patients with SI (n = 15) had depression. A total of 52.4% of the patients with SI (n = 11) were diagnosed with full PTSD. Resilience was found to be significantly lower in individuals with depression and individuals with SI. While depression predicted SI in traumatic SCI, resilience stands as a protective factor against SI. CONCLUSION SI is quite common in individuals with traumatic SCI and is accompanied by substantial psychiatric comorbidities such as depression and PTSD. Along with depression and PTSD, resilience - which has protective and predictive values and is inversely associated with SI - constitutes a significant psychotherapeutic intervention and screening area.
Collapse
Affiliation(s)
- Nazife Gamze Usta Sağlam
- Department of Psychiatry, University of Health Sciences, Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, Istanbul, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Istanbul University- Cerrahpaşa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Deniz Doğan
- Physical Medicine and Rehabilitation Department, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Belgin Erhan
- Physical Medicine and Rehabilitation Department, İstanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
6
|
Pour-Rashidi A, Namvar M, Iranmehr A, Carpaneto A, Hanaei S, Rezaei N. Psychological and Psychiatric Aspects of Brain and Spinal Cord Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:673-687. [PMID: 37452958 DOI: 10.1007/978-3-031-23705-8_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Central nervous system (CNS) tumors are mainly diagnosed by physical symptoms such as paralysis, visual field defect, seizure, and loss of consciousness. The psychological and psychiatric background of CNS tumors, whether in preoperative or postoperative period, has long been a neglected topic; however, lately, many authors and researchers have paid more attention to these manifestations. Neurocognition is a subset of parameters, including attention, memory, mood, emotions, language production, personality, executive function, problem-solving, calculation, and spatial cognition, making up the patient's cognitive performance. Also, it is worthy to say that neurocognition is considered a parameter of quality of life (QoL). Currently, we know that neurocognitive disorders are a group of symptoms presenting by the patients. These symptoms may be the first picture of CNS lesions, which result in incorrect treatment, a higher financial burden on the patient and health system, and finally, poorer QoL and performance scale if they are not diagnosed early. Psychological and psychiatric problems such as depression, anxiety, and phobia following the CNS tumors have two aspects. These may present before any treatment resulting from the tumoral mass effect, peritumoral edema, or cerebral tissue disruption due to the space-occupying lesion. On the other hand, we can see these features after a kind of therapy such as surgery, medical therapy, or adjuvant therapy. Sometimes, the CNS tumors lead to psychosocial complications postoperatively. Indeed, considering tumor surgery complications, some patients may find various degrees of deficits that make the patient isolated either socially or professionally. Obviously, the improvement rate and outcome of this specific situation depend on the mechanism of occurrence and its causes. For instance, postoperative symptom relief would be expected when the symptoms are related to the tumoral mass effect. Getting familiar with this constellation of the symptoms, realizing them, and then localizing them to the correct area of the CNS are very crucial. Accordingly, because of their importance in QoL, their influence on patient's survival even more than the extent of resection of the tumor, and somehow their ignorance, we will discuss different neurocognitive manifestations related to CNS tumors in this chapter.
Collapse
Affiliation(s)
- Ahmad Pour-Rashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Mohamad Namvar
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Arad Iranmehr
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Allegra Carpaneto
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126, Turin, Italy
| | - Sara Hanaei
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| |
Collapse
|
7
|
Marlow NM, Xie Z, Tanner R, Jacobs M, Hogan MK, Joiner TE, Kirby AV. Association between functional disability type and suicide-related outcomes among U.S. adults with disabilities in the National Survey on Drug Use and Health, 2015-2019. J Psychiatr Res 2022; 153:213-222. [PMID: 35841817 PMCID: PMC9811968 DOI: 10.1016/j.jpsychires.2022.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/26/2022] [Accepted: 07/02/2022] [Indexed: 01/07/2023]
Abstract
While research on suicidal behavior for people with disability (PWD) suggests they experience higher risk than people without disability, less is known about variations among individuals with different disability types. This nationally representative, cross-sectional study compared differences in suicide-related outcomes (ideation, planning, attempts) among PWD by functional disability type (hearing, vision, cognitive, mobility, complex activity) and number. Secondary analysis of adult PWD in the 2015-2019 National Survey on Drug Use and Health (unweighted N = 35,544; representing 47,723,378 PWD, weighted) was used to estimate relationships between suicide-related outcomes and disability type and number. Most respondents were female (55.9%), and 36.0% were aged ≥65 years. Adjusted odds ratios (AORs) from multivariable logistic regression indicated that suicidal ideation and suicide attempt, respectively, were significantly more likely among individuals with cognitive (AOR = 1.71, 95% CI = 1.24-2.35; AOR = 2.54, 95% CI = 1.31-4.91), complex activity (AOR = 1.96, 95% CI = 1.37-2.81; AOR = 2.67, 95% CI = 1.32-5.41), and ≥2 limitations (AOR = 2.02, 95% CI = 1.52-2.69; AOR = 3.46, 95% CI = 1.84-6.50) than hearing limitation. Also, relative to other disability types, suicide-related outcomes were significantly more likely among individuals with cognitive limitation and complex activity limitation (p < 0.001). Additionally, suicide-related outcomes elevated in likelihood as the number of limitations increased, with the largest associations among those with ≥5 limitations for suicidal ideation (AOR = 2.31, 95% CI = 1.46-3.66), suicide planning (AOR = 3.34, 95% CI = 1.97-5.68), and suicide attempt (AOR = 6.37, 95% CI = 3.76-10.79). Subgroup analyses showed that presence of cognitive limitation and multiple limitations differentiated between suicidal ideators and suicide attempters. Further research is needed to identify causes of these risks and develop suicide prevention efforts for these particularly vulnerable groups.
Collapse
Affiliation(s)
- Nicole M Marlow
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Zhigang Xie
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Rebecca Tanner
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Molly Jacobs
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Michaela K Hogan
- Department of Family, Community and Health Systems Science, University of Florida, Gainesville, FL, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
8
|
Mohammadi F, Oshvandi K, Bijani M, Borzou SR, Khodaveisi M, Masoumi SZ. Perception of facing life's challenges in patients with spinal cord injury in Iran: a qualitative study. BMC Psychol 2022; 10:202. [PMID: 35971169 PMCID: PMC9376906 DOI: 10.1186/s40359-022-00909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is one of the most serious types of physical trauma and has become a major life-threatening condition in the recent decade. It is essential that the life perception and experiences of patients with SCI be studied and evaluated in different cultural contexts so that their needs and the challenges they face can be properly determined. The present study aims to explore the how patients with SCI in the south of Iran perceive facing life's challenges. METHODS The present study is a qualitative research with a descriptive phenomenological design. Participants were identified through purposive sampling of patients with spinal cord injury admitted to two state hospitals affiliated with a university of medical sciences in western Iran. The researchers collected data using semi-structured, in-depth interviews with 25 SCI patients conducted between August and October 2021. Data was analyzed according to Colaizzi's method using MAXQDA v. 2007. RESULTS Analysis of the data led to the emergence of three themes and nine sub-themes. The three main themes were emotional shock (crisis making and mental rumination, persistent depressive disorder, pitying behaviors, fear of the future), loss of dignity (poor self- care, sexual dysfunction, loss of job and educational status), and lack of effective support (lack of financial institutions and sponsors, lack of social support). CONCLUSION Patients with spinal cord injuries face various issues in their care and social lives. Attention to their psycho-emotional needs along with comprehensive health support play key roles in generating a sense of self efficacy and promoting the mental well-being and dignity of patients with spinal cord injuries. Accordingly, healthcare administrators and caregivers are recommended to provide more comprehensive health support to SCI patients to meet their needs more effectively.
Collapse
Affiliation(s)
- Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, Fasa University of Medical Sciences, Fasa, Iran.
| | - Seyed Reza Borzou
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Khodaveisi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Community Health Nursing, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
9
|
Betthauser LM, Hoffberg AS, Stearns-Yoder KA, Harmon M, Coons D, Brenner LA. A systematic review of suicidal ideation and behaviors among adults with spinal cord injury. J Spinal Cord Med 2022:1-12. [PMID: 35192444 DOI: 10.1080/10790268.2022.2029282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT Suicide is a public health crisis within the United States. Individuals with spinal cord injury (SCI) are vulnerable to negative outcomes such as suicide. OBJECTIVE This systematic review describes frequency of suicidal ideation (SI) and behaviors (suicide attempt [SA] and deaths) among samples of adults living with SCI. Associated risk and protective factors of SI and suicidal behaviors were also explored. METHODS On July 7, 2021, OVID Medline, EMBASE, OVID PsycINFO, Web of Science Core Collection, CINAHL, Cochrane Library, and Google Scholar databases were searched for SI, SA, and deaths by suicide among adults with a history of SCI. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Results were synthesized descriptively considering the likely impact of RoB. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting method was used. RESULTS Sixty-nine articles were included. Frequency of SI and SAs within study samples ranged from 4% to 67%, and 0% to approximately 66%, respectively. While assessment methods for SI and SA widely varied, suicide deaths data sources were more consistent. Studies assessing SI and SA generally had high RoB and the overall strength of evidence was low. Stronger observational study designs assessing death by suicide had low RoB and the overall strength of evidence was high. Very few studies examined protective factors. DISCUSSION Findings support previous work. Quality of evidence, and therefore confidence in the frequency of these outcomes, was impacted by the use of assessment measures without sufficient psychometric properties. The field will benefit from use of psychometrically sound measures to assess for SI, SA and suicide deaths. Furthermore, additional work is needed to elucidate risk and protective factors and to clearly characterize samples to increase generalizability of findings to the larger SCI community, including standardized reporting of SCI characteristics (e.g. use of American Spinal Injury Association classification system). Ultimately, improved suicide assessment and risk management is expected to prevent suicide among those living with SCI. REGISTRATION CRD42020164686.
Collapse
Affiliation(s)
- Lisa M Betthauser
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - Adam S Hoffberg
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kelly A Stearns-Yoder
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - Matthew Harmon
- Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - David Coons
- Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA.,Spinal Cord Injury/Disorder Clinic, RMR VAMC, Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA.,Departments of Psychiatry, & Neurology, University of Colorado, Aurora, Colorado, USA
| |
Collapse
|
10
|
Tchajkova N, Ethans K, Smith SD. Inside the lived perspective of life after spinal cord injury: a qualitative study of the desire to live and not live, including with assisted dying. Spinal Cord 2021; 59:485-492. [PMID: 33790424 DOI: 10.1038/s41393-021-00619-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Qualitative. OBJECTIVES The objective of this study was to examine whether individuals with a SCI would have considered Medical-Assistance-in-Dying (MAiD) following their SCI and whether these individuals felt they would have been able to make an informed decision about this potentially permanent option early in their experience. SETTING Manitoba, Canada. METHODS Participants with varying neurological levels of SCI and classification were included. The time since SCI ranged from <6 months to >50 years. A focus group of five individuals was conducted first to calibrate questions. Twenty-three participants were then individually interviewed. Participants' responses were transcribed and coded into themes. RESULTS Half of the participants reported having suicidal ideation within the first 2 years of experiencing a SCI. However, no participants thought that they would have been able to make an informed decision about MAiD during this time. Most participants reported that they were able to adapt and reframe their lives to alter their views. There was higher agreement that MAiD should be available for individuals who had experienced a reframed, informed view. CONCLUSION This study indicates that people with SCI do not feel that informed decision making about ending their life can be made early after SCI despite high levels of reported suicidal ideation in that early time frame. A reframing process helps to facilitate informed decisions about living with a SCI. The reframing process is correlated with opportunities of rehabilitation, peer mentor support, and re-integration into the community.
Collapse
Affiliation(s)
- Natalja Tchajkova
- Section of Physical Medicine and Rehabilitation, Department of Medicine, University of Manitoba, Winnipeg, Canada. .,Section of Physical Medicine and Rehabilitation, Royal Inland Hospital, University of British Columbia, Vancouver, Canada.
| | - Karen Ethans
- Section of Physical Medicine and Rehabilitation, Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Stephen D Smith
- University of Winnipeg Psychology Department, Winnipeg, Canada
| |
Collapse
|
11
|
Lerman SF, Sylvester S, Hultman CS, Caffrey JA. Suicidality After Burn Injuries: A Systematic Review. J Burn Care Res 2021; 42:357-364. [PMID: 33482003 DOI: 10.1093/jbcr/irab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Burn survivors may be at increased risk for suicide due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as evaluate risk and protective factors. PubMed, EMBASE, CINAHL, Cochrane, PsycINFO, and Web Science databases were searched using search terms regarding suicide, suicidality, and burn. Fourteen full-text manuscripts and two published abstracts were included in the review. Overall, burn survivors demonstrate elevated suicidal ideations and a higher lifetime prevalence of suicide attempts compared to the general population. There is mixed evidence as to rates of completed suicide postburn injury, though rates appear to be relatively low. Risk factors include pain at discharge, perceived level of disfigurement, premorbid psychiatric comorbidities, and past suicide attempts. Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors, which is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, posttraumatic stress disorder, social isolation, and depression which are linked to suicidality in the general population. Suicide risk screening should be included as an integral part of burn survivors' care, and more research is needed to better understand the magnitude of this phenomenon and offer targeted interventions to vulnerable individuals.
Collapse
Affiliation(s)
- Sheera F Lerman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Scott Sylvester
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie A Caffrey
- Department of Plastic and Reconstructive Surgery, Division of Burn Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
12
|
Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
13
|
Awan N, DiSanto D, Juengst SB, Kumar RG, Bertisch H, Niemeier J, Fann JR, Kesinger MR, Sperry J, Wagner AK. Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation Following Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:E18-E29. [PMID: 32769828 PMCID: PMC10280901 DOI: 10.1097/htr.0000000000000588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI). DESIGN Prospective cohort study. SETTING Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States. PARTICIPANTS Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377). MAIN OUTCOME MEASURE Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury. RESULTS Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI. CONCLUSIONS Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
Collapse
Affiliation(s)
- Nabil Awan
- Departments of Physical Medicine and Rehabilitation (Messrs Awan and DiSanto and Dr Wagner), Biostatistics (Mr Awan), Surgery (Dr Sperry), and Neuroscience (Dr Wagner), University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Neuroscience (Dr Wagner), Safar Center of Resuscitation Research (Dr Wagner), School of Medicine (Mr Kesinger), and Clinical and Translational Science Institute (Dr Wagner), University of Pittsburgh, Pittsburgh, Pennsylvania; Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (Mr Awan); Departments of Physical Medicine & Rehabilitation (Dr Juengst) and Rehabilitation Counseling (Dr Juengst), University of Texas-Southwestern Medical Center, Dallas; Department of Rehabilitation Medicine, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Kumar); Department of Psychology, NYU Rusk Rehabilitation, Brooklyn (Dr Bertisch); Department of Physical Medicine & Rehabilitation, UAB Spain Rehabilitation Center, Birmingham, Alabama (Dr Niemeier); and Departments of Psychiatry and Behavioral Sciences (Dr Fann), Epidemiology (Dr Fann), and Rehabilitation Medicine (Dr Fann), University of Washington, Seattle
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
15
|
Morozowski M, Roughley RA. The journey of sexuality after spinal cord injury: Implications for allied health professionals. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2020. [DOI: 10.3138/cjhs.2020-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this phenomenological study, which reflected the lived experiences of seven individuals living in Alberta with spinal cord injury (SCI), was to gain insights into how individuals with SCI (a) are ill-equipped after injury with respect to post-injury sexual function education, (b) explore their sexuality after injury, (c) learn about the importance of role models and friends living with similar injuries, and (d) explain barriers to access reasonable care surrounding sexual health and counselling reflective of intersectionality of sexuality and disability, among other factors. The intent is also to provide a basis for others living with SCI to be aware that they are not alone in their experiences as well as inform others, including professionals working in the area of SCI, of what some experiences of living with SCI are. This study uncovered real lived experiences of individuals with SCI and their experience of sexuality and relationships after injury. Recommendations are highlighted with the intention of informing professionals, including counselling psychologists and other health related professionals.
Collapse
Affiliation(s)
- Makrina Morozowski
- School of Arts and Sciences, City University of Seattle in Canada, Calgary, AB
| | - Robert A. Roughley
- School of Arts and Sciences, City University of Seattle in Canada, Calgary, AB
| |
Collapse
|
16
|
Brakel K, Aceves AR, Aceves M, Hierholzer A, Nguyen QN, Hook MA. Depression-like behavior corresponds with cardiac changes in a rodent model of spinal cord injury. Exp Neurol 2019; 320:112969. [PMID: 31158357 DOI: 10.1016/j.expneurol.2019.112969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/08/2019] [Accepted: 05/30/2019] [Indexed: 12/28/2022]
Abstract
In previous studies we have shown that approximately 1/3 of male Sprague Dawley rats develop symptoms of depression following a spinal cord injury (SCI). Using established behavioral tests to measure depression in rodents, we found that after SCI, subjects characterized as depressed had decreased sucrose preference, open field activity, social exploration, and burrowing behavior. As some of these tests of depression could be affected by the compromised motor function inherent to the SCI condition, the current study examined whether non-subjective, physiological differences in heart rate and heart rate variability were also associated with depression, as seen in humans. Male Sprague Dawley rats were implanted with radiotelemetry devices and either received a moderate contusion injury or remained intact. The implanted telemetry devices recorded home cage activity, body temperature, heart rate, and heart rate variability for 5 min/h throughout a 30-day post-injury assessment period. Depression behavior was evaluated using a battery of tests conducted on days 9-10 and 19-20 post-injury. Locomotor recovery and pain reactivity were also examined. Hierarchical clustering, based on the behavioral scores collected on the tests of depression, revealed that 28% of the SCI subjects displayed symptoms of depression, relative to the remaining 72% of SCI subjects. The subjects characterized as depressed had significantly lower social interaction and burrowing activity than the group that was not depressed. Interestingly, the subjects behaviorally characterized as depressed also had significantly lower heart rate variability than the not-depressed intact group. There was no difference between not-depressed SCI and intact rats on this measure. Therefore, in addition to behavior, depressed and not-depressed rats differ on measures of physiological function that are associated with depression in humans. These physiological differences further validate the rodent model of depression after SCI.
Collapse
Affiliation(s)
- Kiralyn Brakel
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Interdisciplinary Life Sciences Building, Texas A&M University, Rm 3148, 3474 TAMU, College Station, TX, United States.
| | - Alejandro R Aceves
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States
| | - Miriam Aceves
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Interdisciplinary Life Sciences Building, Texas A&M University, Rm 3148, 3474 TAMU, College Station, TX, United States
| | - Ashton Hierholzer
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States
| | - Quynh-Nhu Nguyen
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States
| | - Michelle A Hook
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Medical Research and Education Building, Texas A&M University, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Interdisciplinary Life Sciences Building, Texas A&M University, Rm 3148, 3474 TAMU, College Station, TX, United States
| |
Collapse
|
17
|
Khazem LR, Anestis MD. Do physical disabilities differentiate between suicidal ideation and attempts? An examination within the lens of the ideation to action framework of suicide. J Clin Psychol 2018; 75:681-695. [DOI: 10.1002/jclp.22735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Lauren R. Khazem
- Department of Psychology, The University of Southern Mississippi; Hattiesburg Mississippi
| | - Michael D. Anestis
- Department of Psychology, The University of Southern Mississippi; Hattiesburg Mississippi
| |
Collapse
|
18
|
Roddy C, Rickard N, Tamplin J, Baker FA. Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury: A case series analysis. J Spinal Cord Med 2018; 41:435-443. [PMID: 28835174 PMCID: PMC6055979 DOI: 10.1080/10790268.2017.1364559] [Citation(s) in RCA: 7] [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: 01/07/2023] Open
Abstract
CONTEXT/OBJECTIVE Spinal Cord Injury (SCI) patients face unique identity challenges associated with physical limitations, higher comorbid depression, increased suicidality and reduced subjective well-being. Post-injury identity is often unaddressed in subacute rehabilitation environments where critical physical and functional rehabilitation goals are prioritized. Therapeutic songwriting has demonstrated prior efficacy in promoting healthy adjustment and as a means of expression for post-injury narratives. The current study sought to examine the identity narratives of therapeutic songwriting participants. DESIGN Case-series analysis of the individual identity trajectories of eight individuals. SETTING Subacute rehabilitation facility, Victoria, Australia. PARTICIPANTS Eight individuals with an SCI; 7 males and 1 female. INTERVENTION Six-week therapeutic songwriting intervention facilitated by a music therapist to promote identity rehabilitation. OUTCOME MEASURES Identity, subjective well-being and distress, emotional state. RESULTS Three participants demonstrated positive trajectories and a further three showed negative trajectories; remaining participants were ambiguous in their response. Injury severity differentiated those with positive trajectories from those with negative trajectories, with greater injury severity apparent for those showing negative trends. Self-concept also improved more in those with positive trajectories. Core demographic variables did not however meaningfully predict the direction of change in core identity or wellbeing indices. CONCLUSION Identity-focused songwriting holds promise as a means of promoting healthy identity reintegration. Further research on benefits for those with less severe spinal injuries is warranted.
Collapse
Affiliation(s)
- Chantal Roddy
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Nikki Rickard
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Centre for Positive Psychology, Graduate School of Education, University of Melbourne, Parkville, VIC, Australia
| | - Jeanette Tamplin
- Faculty of VCA & MCM, University of Melbourne, Southbank, VIC, Australia
- Royal Talbot Rehabilitation Centre, Austin Health, Kew, VIC, Australia
| | | |
Collapse
|
19
|
Chuang CH, Chen CH, Bai CH, Chen PC, Wu SC, Liu CH. Risk factors associated with newly psychiatric disorder in spinal cord injury: A retrospective cohort study. J Clin Nurs 2017; 27:e1038-e1047. [PMID: 29076624 DOI: 10.1111/jocn.14139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/17/2022]
Abstract
AIM AND OBJECTIVES To predict the risk factors related to newly diagnosed psychiatric disorders resulting from spinal cord injuries (SCIs). BACKGROUND SCIs are a common result of devastating accidents; they can have an essential negative impact on the psychological health of those so afflicted. Psychiatric disorders commonly occur worldwide and are often associated with pain and disability; however, few studies have investigated the risk factors of psychiatric disorders among persons with SCIs. DESIGN A retrospective cohort study design with data obtained from the Taiwan Health Insurance Research Database (THIRD). THIRD involves the claims data on recipients recorded in the Taiwan National Health Insurance (TNHI), which was set up in 1995 and covers about 99% of the 23 million persons in Taiwan. METHODS We used THIRD to predict the risk factors related to newly diagnosed psychiatric disorders among victims of spinal cord injury. RESULTS The majority of persons with SCI were men (51.2%), and their average age was 52.8 years. All 5,828 newly diagnosed psychiatric disorders were included from 1997-2009 in 64,907 SCI in the THIRD data set. These results demonstrated notable differences in hazard risk (HR); the injured persons were inspected for the level of SCI, age, hypertension and chronic obstructive pulmonary disease (HR: 1.637, 95% CI: 1.452-1.844, p < .0001; HR: 1.005, 95% CI: 1.002-1.009, p = .0019; HR: 0.724, 95% CI: 0.642-0.816; HR: 1.267, 95% CI: 1.105-1.454, p = .0007; HR: 1.368, 95% CI: 1.183-1.582, p < .0001, respectively); the persons with SCI exhibited significant independent associations with psychiatric disorders. CONCLUSIONS The results revealed that the level of SCI, female gender and age, respectively, affects the incidence of newly diagnosed psychiatric disorder related to SCI. RELEVANCE TO CLINICAL PRACTICE This study showed that psychiatric disorders may be associated with the development of SCI, and that this risk was more predominant in females with SCI. Our results are of direct clinical relevance as they are meant to assist clinical assessment, counselling, guidance of symptomatic monitoring and early clinical intervention.
Collapse
Affiliation(s)
- Ching-Hui Chuang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Niaosong, Kaohsiung, Taiwan
| | - Chung-Hey Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Chung Wu
- Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Chun-Hao Liu
- Department of Psychiatry, Chang Gung Memorial Hospital-Taoyuan Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
20
|
Khazem LR. Physical disability and suicide: recent advancements in understanding and future directions for consideration. Curr Opin Psychol 2017; 22:18-22. [PMID: 30122272 DOI: 10.1016/j.copsyc.2017.07.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
Recent research indicates a heightened risk of suicide in this population, a concern given that suicide may be more accepted for those with physical disabilities than for those without such disabilities. The relationship between physical disability and suicide has begun to be examined within empirically supported frameworks of suicide and indicates that interpersonal factors (e.g. perceived burdensomeness) and pain are mechanisms contributing to this heightened risk of suicide. The suicide rate after acquiring a physical disability, such as a spinal cord injury, and the greater odds of suicide after reporting having a disability further support the association between physical disability and suicide. The multifaceted nature of physical disability is reflected in its relationship with suicidal ideation and behaviors.
Collapse
Affiliation(s)
- Lauren R Khazem
- The University of Southern Mississippi, 118 College Dr., #5025 Hattiesburg, MS, United States.
| |
Collapse
|
21
|
Self-harm and suicide before and after spinal cord injury: a systematic review. Spinal Cord 2016; 55:2-7. [DOI: 10.1038/sc.2016.135] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 01/05/2023]
|
22
|
Reed KS, Meade MA, Krause JS. Impact of Health Behaviors and Health Management on Employment After SCI: Psychological Health and Health Management. Top Spinal Cord Inj Rehabil 2016; 22:111-120. [PMID: 29339853 DOI: 10.1310/sci2202-111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: The purpose of this study was to examine the relationship between employment and psychological health and health management as described by individuals with spinal cord injury (SCI) who were employed at least once following injury. Methods: A qualitative approach used 6 focus groups at 2 sites with 44 participants who were at least 10 years post SCI. All had been employed at some point since injury. Heterogeneous and homogeneous groups were delineated based on specific characteristics, such as education, gender, or race. Group sessions followed a semi-structured interview format with questions about personal, environmental, and policy related factors influencing employment following SCI. All group sessions were recorded, transcribed, and coded into conceptual categories to identify topics, themes, and patterns. Inferences were drawn about their meaning. NVivo 10 software using the constant comparative method was used for data analysis. Results: Narratives discussed the relationship between employment and psychological and emotional health and health management. Four themes were identified: (1) adjustment and dealing with emotional reactions, (2) gaining self-confidence, (3) preventing burnout, and (4) attitudes and perspectives. Most themes reflected issues that varied based on severity of injury as well as stage of employment. Conclusions: Individuals with SCI who are successful in working following injury must determine how to perform the behaviors necessary to manage their health and prevent emotional or physical complications. The emotional consequences of SCI must be recognized and addressed and specific behaviors enacted in order to optimize employment outcomes.
Collapse
Affiliation(s)
- Karla S Reed
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| | - Michelle A Meade
- Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor
| | - James S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| |
Collapse
|
23
|
Acute Trauma Factor Associations With Suicidality Across the First 5 Years After Traumatic Brain Injury. Arch Phys Med Rehabil 2016; 97:1301-8. [PMID: 26987622 DOI: 10.1016/j.apmr.2016.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether severity of head and extracranial injuries (ECI) is associated with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI). DESIGN Factors associated with SI and SA were assessed in this inception cohort study using data collected 1, 2, and 5 years post-TBI from the National Trauma Data Bank and Traumatic Brain Injury Model Systems (TBIMS) databases. SETTING Level I trauma centers, inpatient rehabilitation centers, and the community. PARTICIPANTS Participants with TBI from 15 TBIMS Centers with linked National Trauma Data Bank trauma data (N=3575). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES SI was measured via the Patient Health Questionnaire 9 (question 9). SA in the last year was assessed via interview. ECI was measured by the Injury Severity Scale (nonhead) and categorized as none, mild, moderate, or severe. RESULTS There were 293 (8.2%) participants who had SI without SA and 109 (3.0%) who had SA at least once in the first 5 years postinjury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe (odds ratio=2.73; 95% confidence interval, 1.55-4.82; P=.001). Drug use at time of injury was also associated with SI (odds ratio=1.69; 95% confidence interval, 1.11-2.86; P=.015). Severity of ECI was not associated with SA. CONCLUSIONS Severe ECI carried a nearly 3-fold increase in the odds of SI after TBI, but it was not related to SA. Head injury severity and less severe ECI were not associated with SI or SA. These findings warrant additional work to identify factors associated with severe ECI that make individuals more susceptible to SI after TBI.
Collapse
|
24
|
Maldonado-Bouchard S, Peters K, Woller SA, Madahian B, Faghihi U, Patel S, Bake S, Hook MA. Inflammation is increased with anxiety- and depression-like signs in a rat model of spinal cord injury. Brain Behav Immun 2016; 51:176-195. [PMID: 26296565 PMCID: PMC4679693 DOI: 10.1016/j.bbi.2015.08.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/28/2015] [Accepted: 08/07/2015] [Indexed: 02/07/2023] Open
Abstract
Spinal cord injury (SCI) leads to increased anxiety and depression in as many as 60% of patients. Yet, despite extensive clinical research focused on understanding the variables influencing psychological well-being following SCI, risk factors that decrease it remain unclear. We hypothesized that excitation of the immune system, inherent to SCI, may contribute to the decrease in psychological well-being. To test this hypothesis, we used a battery of established behavioral tests to assess depression and anxiety in spinally contused rats. The behavioral tests, and subsequent statistical analyses, revealed three cohorts of subjects that displayed behavioral characteristics of (1) depression, (2) depression and anxiety, or (3) no signs of decreased psychological well-being. Subsequent molecular analyses demonstrated that the psychological cohorts differed not only in behavioral symptoms, but also in peripheral (serum) and central (hippocampi and spinal cord) levels of pro-inflammatory cytokines. Subjects exhibiting a purely depression-like profile showed higher levels of pro-inflammatory cytokines peripherally, whereas subjects exhibiting a depression- and anxiety-like profile showed higher levels of pro-inflammatory cytokines centrally (hippocampi and spinal cord). These changes in inflammation were not associated with injury severity; suggesting that the association between inflammation and the expression of behaviors characteristic of decreased psychological well-being was not confounded by differential impairments in motor ability. These data support the hypothesis that inflammatory changes are associated with decreased psychological well-being following SCI.
Collapse
Affiliation(s)
- Sioui Maldonado-Bouchard
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center, Bryan, TX, USA; Department of Psychology, McGill University, Montréal, Québec, Canada.
| | - Kelsey Peters
- Department of Psychology, Texas A&M University, College Station,
Texas, USA
| | - Sarah A. Woller
- Anesthesiology, University of California San Diego, San Diego,
California, USA
| | - Behrouz Madahian
- Department of Mathematical Sciences, University of Memphis,
Tennessee, USA
| | - Usef Faghihi
- Department of Mathematics & Computer Science, University of
Indianapolis, Indianapolis, USA
| | - Shivani Patel
- Department of Psychology, Texas A&M University, College Station,
Texas, USA
| | - Shameena Bake
- Department of Neuroscience and Experimental Therapeutics, Texas
A&M Health Science Center, Bryan, Texas
| | - Michelle A Hook
- Department of Neuroscience and Experimental Therapeutics, Texas
A&M Health Science Center, Bryan, Texas
| |
Collapse
|