The Impact of Spinal Cord Injury on the Couple Relationship: A Grounded Theory Exploration of the Adjustment Process

Adaptations to adult attachment and intimacy following spinal cord injury: a systematic review

PURPOSE

Experiencing spinal cord injury (SCI) can be life-changing for individuals and their families. Previous reviews have focused on coping and psychological adjustment, sexual function and sexuality, or factors facilitating or impeding interpersonal relationships after SCI. However, there is a very little synthesis of research focusing on changes to adult attachment and emotional intimacy post-SCI. This review aims to examine the mechanisms of change in adult attachment and intimacy in romantic relationships following SCI.

MATERIALS AND METHODS

Four online databases (Psycinfo, Medline, CINAHL, and Scopus) were searched for qualitative papers concerning romantic relationships, attachments, and intimacy post-SCI. Sixteen of the 692 papers met the inclusion criteria. These were quality assessed and analysed using meta-ethnography.

RESULTS

Three main themes emerged from the analysis: (a) strengthening and maintaining adult attachment; (b) changes in roles; and (c) changing views of intimacy.

CONCLUSION

Many couples face significant changes to adult attachment and intimacy following SCI. Systematic ethnographic analysis of their negotiations enabled the identification of underlying relational processes and adaptation strategies associated with changes to inter-dependence, communication, role revision, and re-definition of intimacy. The findings indicate that healthcare providers should assess and respond to challenges faced by couples post-SCI using evidence consistent with adult attachment theory.

Social disconnectedness and perceived social isolation in persons with spinal cord injury/dysfunction living in the community: A scoping review

Context: Persons with spinal cord injury/dysfunction (SCI/D) are particularly at risk for social disconnectedness and/or perceived social isolation, which are key components to overall well-being. However, there is limited evidence that aims to understand these phenomena in this population.Objective: To investigate what is known about social disconnectedness and perceived social isolation for adults with SCI/D living in the community.Methods: A scoping review was conducted. A computer assisted search of four online databases was completed on all articles published until May 18th, 2021. Gray literature and key agencies were also searched for relevant documents. Two key concepts (spinal cord injury/dysfunction and social disconnectedness/perceived social isolation) and associated terms were used. All articles were double screened for inclusion by two reviewers.Results: Following deduplication, title and abstract screening and full-text screening, 37 articles met the criteria for inclusion in this review. Most of the included articles were published in North America, used quantitative methods and a cross-sectional design. Articles identified several factors that influenced social disconnectedness and perceived social isolation including participant characteristics, social support, psychological well-being, participation in activities, the built environment and physical health.Conclusion: The current literature suggests that issues with social disconnectedness and perceived social isolation exist for persons living with SCI/D in the community. More work is needed to better understand the relationship between these constructs. A more nuanced understanding can inform targeted interventions to help mitigate the impact of these phenomena on the SCI/D population.

Body image and psychosocial well-being among UK military personnel and veterans who sustained appearance-altering conflict injuries

A modest but significant number of military personnel sustained injuries during deployments resulting in an altered-appearance (e.g., limb loss and/or scarring). Civilian research indicates that appearance-altering injuries can affect psychosocial wellbeing, yet little is known about the impact of such injuries among injured personnel. This study aimed to understand the psychosocial impact of appearance-altering injuries and possible support needs among UK military personnel and veterans. Semi-structured interviews with 23 military participants who sustained appearance-altering injuries during deployments or training since 1969 were conducted. The interviews were analyzed using reflexive thematic analysis, identifying six master themes. These themes indicate that in the context of broader recovery experiences, military personnel and veterans experience a variety of psychosocial difficulties related to their changed appearance. While some of these are consistent with evidence from civilians, military-related nuances in the challenges, protective experiences, coping approaches, and preferences for support are evident. Personnel and veterans with appearance-altering injuries may require specific support for adjusting to their changed appearance and related difficulties. However, barriers to acknowledging appearance concerns were identified. Implications for support provision and future research are discussed.

Psychosocial Consequences of Spinal Cord Injury: A Narrative Review

Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care.

Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers

Purpose of Review

Assessing and addressing the mental and behavioral health concerns of individuals with SCI during rehabilitation is crucial, as untreated mental health distress can lead to reduced gains in rehabilitation and poor overall health. This review provides an overview of the latest research on prevalence rates of common mental and behavioral health concerns in the SCI population, highlighting disability-specific factors that may impact traditional assessment and treatment of mental health concerns.

Recent Findings

While those with SCI are at a heightened risk for experiencing mental health distress, overall, the majority of those with SCI adapt well, and live a full and meaningful life.

Summary

Rehabilitation psychologists are a vital aspect of rehabilitation teams, as they can address behavioral health and mental health concerns that may impede patients achieving their rehabilitation goals.

Disability as an Interpersonal Experience: A Systematic Review on Dyadic Challenges and Dyadic Coping When One Partner Has a Chronic Physical or Sensory Impairment

Chronically disabling health impairments affect an increasing number of people worldwide. In close relationships, disability is an interpersonal experience. Psychological distress is thus common in patients as well as their spouses. Dyadic coping can alleviate stress and promote adjustment in couples who face disabling health impairments. Much research has focused on dyadic coping with cancer. However, other health problems such as physical and sensory impairments are also common and may strongly impact couple relationships. In order to promote couples' optimal adjustment to impaired health, the identification of disability-related relationship challenges is required. Furthermore, ways in which dyadic coping with these challenges may benefit couples could inform researchers and practitioners how to support couples in coping with health impairments. Accordingly, the aims of this study were to systematically review dyadic challenges and dyadic coping when one partner has a chronically disabling physical or sensory impairment. Out of 873 articles identified through database searches, 36 studies met inclusion criteria. The disability-related dyadic challenges identified in the review were changed roles and responsibilities within the couple, altered communication, compromised sexual intimacy, and reduced social participation. These challenges were reported to burden both partners and the couple relationship. Dyadic adjustment benefitted from a we-perspective, i.e., when couples viewed the disability as a shared challenge and engaged in conjoint dyadic coping. The results suggest that patient/care recipient and partner/caregiver roles should be de-emphasized and that disability should be recognized as an interpersonal experience.

The journey of sexuality after spinal cord injury: Implications for allied health professionals

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.