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van Leeuwen CMC, Papazoglou E, van Eersel JHW, Stolwijk-Swüste JM, Post MWM. Associations between personality traits and depressive and anxiety symptoms among persons with spinal cord injury in first inpatient rehabilitation. Spinal Cord 2024; 62:178-182. [PMID: 38388760 DOI: 10.1038/s41393-024-00964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
STUDY DESIGN Retrospective analysis of medical records. OBJECTIVE To assess personality traits in persons with spinal cord injury (SCI) and compare these with the general population group. Moreover, to explore associations between personality traits and depressive and anxiety symptoms among persons with SCI in first inpatient rehabilitation. SETTING Specialized rehabilitation center in The Netherlands. METHODS Data were used from a routine psychological screening, administered in the first weeks of admission (N = 67). Measures included the Hospital Anxiety and Depression Scale and the Dutch Personality Questionnaire, which includes subscales measuring neuroticism, social inadequacy, rigidity, hostility, egoism, dominance, and self-esteem. Correlational and regression analyses were conducted. RESULTS Mean age of the participants was 58 (SD 17) years. The majority (63%) were male, and had a low lesion (57%). The participants scored significantly higher on dominance and lower on social inadequacy, hostility, and egoism in comparison with the general population. In the bivariate regression analyses, high neuroticism (β = 0.42 and β = 0.53) and low self-esteem (β = -0.25 and β = -0.29) were significantly associated with increased depressive and anxiety symptoms. In the hierarchical regression analyses, only high neuroticism was significantly associated with increased depressive (β = 0.42, p < 0.05) and anxiety (β = 0.55, p < 0.001) symptoms. CONCLUSIONS Personality traits are not the same between the SCI population and the general population. Assessment of personality traits early in inpatient rehabilitation can help to identify individuals at risk of mood problems and, thereby, facilitate interventions. Future research with a larger, representative SCI sample, is required to confirm these findings.
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Affiliation(s)
- Christel M C van Leeuwen
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Erika Papazoglou
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Janneke M Stolwijk-Swüste
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen, The Netherlands
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Parajuli B, Acharya K, Grooves CC, Dhakal R, Shrestha J, Shrestha R, Manandhar M. Post-traumatic stress disorder among individuals with traumatic spinal cord injury in Nepal: a cross-sectional study. Spinal Cord Ser Cases 2023; 9:13. [PMID: 37024460 PMCID: PMC10079656 DOI: 10.1038/s41394-023-00566-6] [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: 07/17/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
STUDY DESIGN Cross-sectional study OBJECTIVES: To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD. SETTING Spinal Injury Rehabilitation Center (SIRC) and Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Kavrepalanchowk, Nepal. METHODS Individuals above 18 years of age with TSCI of at least one month from trauma and admitted to SIRC and DH, KUH from June 2019 to May 2021 were included. The specific stress version of the PostTraumatic Stress Disorder Checklist (PCL), was utilized. To classify the neurological status of TSCI individuals, International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used. Hierarchical multiple regression analysis between independent variables and normalized PCL score was done to evaluate the predictors of PTSD. RESULTS Among 163 patients, the overall prevalence of PTSD was 27%, and the mean PCL score was 36 ± 13.9. Factors predictive of PTSD included gender, family type, ethnicity, and literacy rate. No significant association was found between the clinical characteristics and PTSD. CONCLUSIONS PTSD appears to be considerably prevalent among individuals with TSCI in Nepal. Females, individuals from nuclear families, individuals with lower literacy, and individuals from lower caste are significantly vulnerable to developing PTSD. However, clinical characteristics do not appear to be influential in the development of PTSD.
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Affiliation(s)
- Bikash Parajuli
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
| | - Khagendra Acharya
- Department of Management Informatics and Communication, School of Management, Kathmandu University, Dhulikhel, Nepal
| | - Christine C Grooves
- Spinal Injury Rehabilitation Centre, Sanga, Nepal
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Raju Dhakal
- Spinal Injury Rehabilitation Centre, Sanga, Nepal
| | | | - Rahul Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
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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.
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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
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Powers MB, Douglas ME, Driver S, Sikka S, Hamilton R, Swank C, Callender L, Ochoa C, Bennett M, Stewart N, Chauvin GV, Rothbaum BO, Warren AM. Prevention of posttraumatic stress during inpatient rehabilitation post spinal cord injury: Study protocol for a randomized controlled trial of Brief Prolonged Exposure Therapy (Brief PE). Contemp Clin Trials Commun 2022; 30:101030. [PMID: 36387992 PMCID: PMC9661669 DOI: 10.1016/j.conctc.2022.101030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Scant research has focused on posttraumatic stress disorder (PTSD) in the SCI population, despite high prevalence estimates. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. Our recent clinical trial showed that standard 12-session PE was effective for PTSD treatment among inpatients with SCI. Early intervention with brief PE (3-sessions) delivered in the emergency department has also been effective for PTSD prevention, but has not been tested among people post-SCI. Thus, we aim to conduct the first test of the Brief PE intervention to prevent PTSD among patients with SCI. Methods Adults who have experienced a SCI (N = 200) will be randomly assigned during inpatient rehabilitation to either: (a) 3 60-min sessions of Brief PE (intervention group) or (b) treatment as usual (control group). Results The primary outcome measure (PTSD symptoms measured by the PSSI-5) and secondary outcome measures (depression, anxiety, pain, quality of life, sleep disturbance, and resilience) will be assessed at baseline, 1-month, 3-months, and 6-months. Hierarchical linear modeling (HLM) will be used to evaluate the effectiveness of the PE intervention on PTSD and secondary outcomes. Descriptive statistics will examine feasibility and will include the number of participants enrolled, the number of sessions completed, fidelity of Brief PE delivery, and average scores for difficulty and helpfulness of the intervention scales for those randomized to intervention. Conclusions Successful completion of this study will provide an evidence-based program to alleviate posttraumatic distress post spinal cord injury and prevent long-term development of PTSD.
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Affiliation(s)
- Mark B. Powers
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Corresponding author. Baylor Scott & White Spinal Cord Injury Model System, USA.
| | - Megan E. Douglas
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Simon Driver
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Seema Sikka
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Rita Hamilton
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Chad Swank
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Librada Callender
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Christa Ochoa
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Monica Bennett
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Neil Stewart
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Gregory V. Chauvin
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Barbara O. Rothbaum
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Emory University School of Medicine, USA
| | - Ann Marie Warren
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
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Prevalence of Posttraumatic Stress Disorder Symptoms Following Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis. Harv Rev Psychiatry 2022; 30:271-282. [PMID: 36103682 DOI: 10.1097/hrp.0000000000000340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Limited evidence is currently available on the prevalence of posttraumatic stress disorder (PTSD) following traumatic spinal cord injury (SCI). This systematic review and meta-analysis aims to assess the prevalence and geographic distribution of PTSD symptoms after SCI. METHODS After a search in the MEDLINE, Embase, Scopus, and Web of Science databases, two reviewers independently summarized relevant studies published through 20 October 2021. Observational studies were included. The studies were eligible if they assessed PTSD symptoms using standard self-report or clinician-based instruments. Data and results were reported using the overall prevalence and the odds ratio (OR), with 95% confidence intervals (CIs). RESULTS 24 articles (5646 patients) met the inclusion criteria. The prevalence of PTSD symptoms ranged from 6.33% (95% CI, 2.73-13.97) to 61.76% (95% CI, 52.07-70.61). Pooled analysis demonstrated that the overall prevalence of PTSD symptoms in SCI patients was significantly higher in developing countries (41.64%; 95% CI, 31.11-52.55) than in developed countries (19.35%; 95% CI, 14.66-24.51) (OR = 1.24; 95% CI, 1.08-1.42; p = .003). The highest prevalence of PTSD symptoms was reported in South Africa (56.25%; 95% CI, 47.01-65.08), followed by Sri Lanka (45.71%; 95% CI, 30.47-61.81), and Greece (43.55%; 95% CI, 31.94-55.91). By contrast, Norway (6.33%; 95% CI, 2.73-13.97), Switzerland/Germany (8.65%; 95% CI, 4.8-13.42), and Denmark (10.71%; 95% CI, 6.89-16.30) were found to have the lowest prevalence of PTSD symptoms after SCI. CONCLUSION Many traumatic SCI patients suffer from PTSD symptoms, and their prevalence seems to be higher in developing countries than in developed countries. These findings underscore the need to consider the psychological aspects of traumatic SCI.
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Powers MB, Pogue JR, Curcio NE, Patel S, Wierzchowski A, Thomas EV, Warren AM, Adams M, Turner E, Carl E, Froehlich-Grobe K, Sikka S, Foreman M, Leonard K, Douglas M, Bennett M, Driver S. Prolonged exposure therapy for PTSD among spinal cord injury survivors: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2021; 22:100763. [PMID: 34013091 PMCID: PMC8113811 DOI: 10.1016/j.conctc.2021.100763] [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] [Received: 08/21/2020] [Revised: 01/28/2021] [Accepted: 03/26/2021] [Indexed: 10/28/2022] Open
Abstract
The National Spinal Cord Injury Statistical Center estimates 294,000 people in the US live with a spinal cord injury (SCI), with approximately 17,810 new cases each year. Although the physical outcomes associated with SCI have been widely studied, the psychological consequences of sustaining a SCI remain largely unexplored. Scant research has focused on posttraumatic stress disorder (PTSD) in this population, despite prevalence estimates suggesting that up to 60% of individuals with SCI experience PTSD post-injury, compared to only 7% of the general US population. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. However, no trauma focused exposure-based therapy for PTSD (e.g. PE) has not yet been tested in a SCI population. Thus, we aim to conduct the first test of an evidence-based intervention for PTSD among patients with SCI. Adults with SCI and PTSD (N = 60) will be randomly assigned to either: (1) 12-sessions of PE (2-3 sessions per week) or (2) a treatment as usual (TAU) control group who will receive the standard inpatient rehabilitation care for SCI patients. Primary outcomes will be assessed at 0, 6, 10, and 32 weeks.
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Affiliation(s)
- Mark B Powers
- Baylor University Medical Center, Dallas, TX, United States
| | - Jamie R Pogue
- Baylor University Medical Center, Dallas, TX, United States
| | | | - Sarita Patel
- Baylor University Medical Center, Dallas, TX, United States
| | | | | | | | - Maris Adams
- Baylor University Medical Center, Dallas, TX, United States
| | - Emma Turner
- Baylor University Medical Center, Dallas, TX, United States
| | - Emily Carl
- The University of Texas at Austin, Austin, TX, United States
| | | | - Seema Sikka
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | | | - Kiara Leonard
- Baylor University Medical Center, Dallas, TX, United States
| | - Megan Douglas
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
| | - Monica Bennett
- Baylor University Medical Center, Dallas, TX, United States
| | - Simon Driver
- Baylor Institute of Rehabilitation, Baylor Scott & White Health, Dallas, TX, United States
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Kuiper H, van Leeuwen CCM, Kopsky DJ, Stolwijk-Swüste JM, Post MWM. Post-traumatic stress disorder symptoms and pain intensity in persons with spinal cord injury. Spinal Cord 2021; 59:328-335. [PMID: 33495577 DOI: 10.1038/s41393-020-00599-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To examine the association between post-traumatic stress disorder (PTSD) symptoms and pain intensity, taking symptoms of anxiety and depression into account within persons with spinal cord injury (SCI). SETTING Persons with SCI, who visited a Dutch rehabilitation centre between 2005 and 2010, were invited to complete a survey. METHODS PTSD symptoms were measured with the Trauma Screening Questionnaire (TSQ), pain intensity with an 11-point Numerical Rating Scale (NRS), and symptoms of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). To determine associations between PTSD symptoms and pain intensity, linear regression analyses were performed. Confounding variables representing anxiety and depression were added to the final model. RESULTS In total, 175 participants (55.8% traumatic, 29.1% complete) were included (response rate of 31.7%). Of them, 11.4% had clinically relevant symptoms of probable PTSD (TSQ score ≥ 6) 69.8% experienced moderate to severe pain levels (NRS ≥ 4), 14.9% had symptoms of anxiety and 20.8% symptoms of depression (HADS scores ≥ 11). Levels of PTSD symptoms were strongly associated with symptoms of anxiety (0.54) and depression (0.49). Bivariate analyses showed a moderate significant association (0.30) between PTSD symptoms and pain intensity. This association became small (0.10) when anxiety and depression comorbidity were factored into the final regression model. CONCLUSIONS No independent association between PTSD symptoms and pain intensity was shown when adjusted for anxiety and depression. Results of this study suggest the usefulness of screening for PTSD in persons with SCI (regardless of injury cause or type/level) who score high on symptoms of anxiety/depression.
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Affiliation(s)
- Heleen Kuiper
- Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen, The Netherlands
| | - Christel C M van Leeuwen
- Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - David J Kopsky
- Institute for Neuropathic Pain, Amsterdam, The Netherlands
| | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands. .,University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen, The Netherlands.
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Stigma associated with parental depression or cancer: Impact on spouse and offspring's cortisol levels and socioemotional functioning. Dev Psychopathol 2021; 32:1822-1837. [DOI: 10.1017/s0954579420001431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractStress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.
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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
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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
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Morton L, Cogan N, Kornfält S, Porter Z, Georgiadis E. Baring all: The impact of the hospital gown on patient well‐being. Br J Health Psychol 2020; 25:452-473. [DOI: 10.1111/bjhp.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Liza Morton
- School of Psychological Science and Health University of Strathclyde Glasgow UK
| | - Nicola Cogan
- School of Psychological Science and Health University of Strathclyde Glasgow UK
| | - Susanna Kornfält
- School of Psychological Science and Health University of Strathclyde Glasgow UK
| | - Zoe Porter
- School of Psychological Science and Health University of Strathclyde Glasgow UK
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McDonald SD, Mickens MN, Goldberg-Looney LD, Mutchler BJ, Ellwood MS, Castillo TA. Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries. J Spinal Cord Med 2018; 41:691-702. [PMID: 28287932 PMCID: PMC6217469 DOI: 10.1080/10790268.2017.1293868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. DESIGN Cross-sectional. SETTING A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. PARTICIPANTS/METHODS Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. RESULTS Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. CONCLUSIONS Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.
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Affiliation(s)
- Scott D. McDonald
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melody N. Mickens
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Brian J. Mutchler
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael S. Ellwood
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Teodoro A. Castillo
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Geard A, Kirkevold M, Løvstad M, Schanke AK. Exploring narratives of resilience among seven males living with spinal cord injury: a qualitative study. BMC Psychol 2018; 6:1. [PMID: 29301561 PMCID: PMC5755441 DOI: 10.1186/s40359-017-0211-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/14/2017] [Indexed: 12/04/2022] Open
Abstract
Background It is a challenge for both individuals and families when an illness or traumatic injury results in a severe spinal cord injury. The on-going physical impairments experienced by persons with spinal cord injury play themselves out over time. Few qualitative studies have explored how health, resilience and wellbeing interplay across time among persons living with the consequences of severe physical injuries. Thus, the aim of this study was to obtain a deeper understanding of how individuals with spinal cord injury reflect upon the efforts, strategies and agency they perform to sustain long term resilience and wellbeing. Methods In this exploratory qualitative study, we conducted a thematic analysis of in-depth interviews with seven men who had lived with spinal cord injury for 2–32 years and who previously had undergone medical rehabilitation. Results The efforts revealed by the participants in normalising life with a spinal cord injury required continued flexibility, persistency and solution-focused adjustment, interpreted as processes documenting resilience. The participants were marshalling personal resources to handle challenges over time. They explained that they succeeded in maintaining health and wellbeing by manoeuvring between different strategies such as being self-protective and flexible as well as staying active and maintaining a positive attitude. Further, support from relational resources were of utmost importance emotionally, socially and when in need of practical assistance. When harnessing relational resources when needed, the participants underlined that balancing dependence and autonomy to remain a part of ordinary life was essential in staying emotionally stable. Conclusions The findings of the present study show similarities to those of previous studies with regard to the participants’ attribution of their resilience and wellbeing to their innate personal abilities and strong connection to their family and friends. In addition, the current participants provide enlightening nuances and depth that expand our understanding of the construct of resilience by highlighting the importance of continuously exerting agency, willpower and strength through rational cognitive strategies to adjust and adapt to chronic and new challenges. Electronic supplementary material The online version of this article (10.1186/s40359-017-0211-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Geard
- Sunnaas, Rehabilitation Hospital, Bjørnemyrveien 11, 1450 Nesoddtangen, Nesodden, Norway.
| | - Marit Kirkevold
- Department of Nursing Science, University of Oslo, Postboks 1130 Blindern, 0318, Oslo, Norway
| | - Marianne Løvstad
- Sunnaas, Rehabilitation Hospital, Bjørnemyrveien 11, 1450 Nesoddtangen, Nesodden, Norway
| | - Anne-Kristine Schanke
- Sunnaas, Rehabilitation Hospital, Bjørnemyrveien 11, 1450 Nesoddtangen, Nesodden, Norway
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Etingen B, Locatelli SM, Miskevics S, LaVela SL. Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders. Disabil Rehabil 2017; 40:2637-2643. [PMID: 28743195 DOI: 10.1080/09638288.2017.1355938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder. METHODS A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder. RESULTS Veterans with (vs. without) post-traumatic stress disorder (n = 896) reported lower social participation (40.2 vs. 43.9, p < 0.0001). Multivariate analyses showed that longer duration of injury (OR = 0.98, 95% CI: 0.97-1.00, p = 0.04) and white race (OR = 0.62, 95% CI: 0.38-1.01, p = 0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR = 1.43, 95% CI: 1.25-1.64, p < 0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR = 0.94, 95% CI: 0.90-0.98, p = 0.003). CONCLUSIONS Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation. Implications for Rehabilitation Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences. Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder. Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.
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Affiliation(s)
- Bella Etingen
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sara M Locatelli
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Scott Miskevics
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sherri L LaVela
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA.,b Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
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15
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The association between injustice perception and psychological outcomes in an inpatient spinal cord injury sample: the mediating effects of anger. Spinal Cord 2017; 55:898-905. [DOI: 10.1038/sc.2017.39] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 03/16/2017] [Accepted: 03/19/2017] [Indexed: 12/28/2022]
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Pollock K, Dorstyn D, Butt L, Prentice S. Posttraumatic stress following spinal cord injury: a systematic review of risk and vulnerability factors. Spinal Cord 2017; 55:800-811. [PMID: 28485385 DOI: 10.1038/sc.2017.45] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To summarise quantitatively the available evidence relating to pretraumatic, peritraumatic and posttraumatic characteristics that may increase or decrease the risk of developing posttraumatic stress disorder (PTSD) following spinal cord injury (SCI). STUDY DESIGN Systematic review. METHODS Seventeen studies were identified from the PubMed, PsycInfo, Embase, Scopus, CINAHL, Web of Science and PILOTS databases. Effect size estimates (r) with associated 95% confidence intervals (CIs), P-values and fail-safe Ns were calculated. RESULTS Individual studies reported medium-to-large associations between factors that occurred before (psychiatric history r=0.48 (95% CI, 0.23-0.79) P=0.01) or at the time of injury (tetraplegia r=-0.36 (95% CI, -0.50 to -0.19) P<0.01). Postinjury factors had the strongest pooled effects: depressed mood (rw=0.64, (95% CI, 0.54-0.72)), negative appraisals (rw=0.63 (95% CI, 0.52-0.72)), distress (rw=0.57 (95% CI, 0.50-0.62)), anxiety (rw=0.56 (95% CI, 0.49-0.61)) and pain severity (rw=0.35 (95% CI, 0.27-0.43)) were consistently related to worsening PTSD symptoms (P<0.01). Level of injury significantly correlated with current PTSD severity for veteran populations (QB (1)=18.25, P<0.001), although this was based on limited data. CONCLUSION Combinations of peri- and post-injury factors appear to be influential in the development of PTSD among persons with SCI. Further studies are needed to extrapolate these findings to the broader spinal cord-injured population. More longitudinal research, driven by multicausal models of causation such as the diathesis-stress model, is also needed to determine the temporality of PTSD risk factors.
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Affiliation(s)
- K Pollock
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - D Dorstyn
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - L Butt
- Craig Hospital, Englewood, CO, USA
| | - S Prentice
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Tough H, Siegrist J, Fekete C. Social relationships, mental health and wellbeing in physical disability: a systematic review. BMC Public Health 2017; 17:414. [PMID: 28482878 PMCID: PMC5422915 DOI: 10.1186/s12889-017-4308-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 04/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Research has consistently found that favourable exchange with one's proximal social environment has positive effects on both mental health and wellbeing. Adults with physical disabilities may have fewer opportunities of favourable exchange, and therefore the effects on mental health and wellbeing may be less advantageous. The aim of this study is to systematically review quantitative studies exploring associations of social relationships with mental health and wellbeing in persons with physical disabilities. METHODS The databases PubMed, PsycINFO and Scopus were searched for relevant studies published between 1995 and 2016. Data was extracted on study and participants' characteristics, independent and dependent variables, used measures and effects sizes of associations between social relationships and mental health or wellbeing. A narrative review was performed to synthesize findings along the constructs social support, social networks, negative social interactions, family functioning and relationship quality. RESULTS Of the 63 included studies, 47 were cross-sectional and 16 longitudinal. Most studies included a measure of social support (n = 58), while other concepts were less often studied (social networks n = 6; negative social interaction n = 3; family functioning n = 2; relationship quality n = 1). Over half of studies included depression as outcome (n = 33), followed by wellbeing (n = 14), composite mental health measures (n = 10), anxiety (n = 8), psychological distress (n = 7), posttraumatic stress disorder (n = 3), and hopelessness (n = 1). Although trends for associations of social support with mental health and wellbeing were consistent, around a quarter of studies failed to report significant associations. Social networks were related to depression, but not to other mental health or wellbeing measures. Family functioning, negative social interactions and relationship quality showed consistent associations with mental health and wellbeing, however, only few studies were available. CONCLUSIONS This review indicates that social relationships play an important role in mental health and wellbeing in persons with disabilities, although findings are less consistent than in general populations and strength of associations vary between constructs. Integrating persons with disabilities into social networks seems not sufficient and rehabilitation professionals together with affected persons and their peers should ensure that high quality relationships and tailored support are available.
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Affiliation(s)
- Hannah Tough
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Lucerne, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, 6002 Lucerne, Switzerland
| | - Johannes Siegrist
- Senior Professorship ‘Work Stress Research’, Faculty of Medicine, University of Düsseldorf, Life-Science-Center, Merowingerplatz 1a, 40225 Düsseldorf, Germany
| | - Christine Fekete
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Lucerne, Switzerland
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18
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Zhou X, Song H, Hu M, Li X, Cai Y, Huang G, Li J, Kang L, Li J. Risk factors of severity of post-traumatic stress disorder among survivors with physical disabilities one year after the Wenchuan earthquake. Psychiatry Res 2015; 228:468-74. [PMID: 26163729 DOI: 10.1016/j.psychres.2015.05.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 05/11/2015] [Accepted: 05/20/2015] [Indexed: 02/05/2023]
Abstract
On May 12, 2008, a devastating earthquake measuring 8.0 on the Richter scale struck Wenchuan County and surrounding areas in China. This study aimed to assess post-traumatic stress disorder (PTSD) in the aftermath of the earthquake, and to evaluate factors of severity of PTSD symptoms among survivors with physical disabilities. We conducted a population-based cross-sectional survey and recruited 817 survivors with physical disabilities in three stricken areas. Assessment measures included the PTSD Checklist-Civilian Version (PCL-C) and the 12-item General Health Questionnaire (GHQ-12). Our study showed that 27.42% of the survivors with physical disabilities had PTSD symptoms one year after the Wenchuan earthquake. In the regression model, geographic location, female, suffering from paralysis following the earthquake, and going into a coma in the earthquake were associated with severe PTSD symptoms. Our findings suggest that a substantial proportion of physically disabled survivors of a big earthquake may have severe PTSD symptoms. The associated factors of PTSD identified in our study could inform the implementation of preventive programs for this population and give hint on the way to cope with this kind of disaster in the future.
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Affiliation(s)
- Xiaobo Zhou
- Mental Health Center, West China Hospital of Sichuan University, Chengdu City, Sichuan Province 610041, China
| | - Hui Song
- Department of Psychiatry, the Third People's Hospital of Mianyang City, Mianyang City, Sichuan Province 621000, China
| | - Min Hu
- Department of Psychiatry, the Fourth People's Hospital of Chengdu City, Chengdu City, Sichuan Province 610000, China
| | - Xiaolin Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu City, Sichuan Province 610041, China
| | - Ying Cai
- Mental Health Center, West China Hospital of Sichuan University, Chengdu City, Sichuan Province 610041, China
| | - Guoping Huang
- Department of Psychiatry, the Third People's Hospital of Mianyang City, Mianyang City, Sichuan Province 621000, China
| | - Jun Li
- Department of Psychiatry, the Demobilized Veterans' Hospital of Sichuan Province, Chongzhou City, Sichuan Province 611200, China
| | - Lin Kang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu City, Sichuan Province 610041, China
| | - Jing Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu City, Sichuan Province 610041, China.
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McMonagle C, Rasmussen S, Elliott MA, Dixon D. Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities. Disabil Rehabil 2015; 38:605-12. [DOI: 10.3109/09638288.2015.1055374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Craig A, Nicholson Perry K, Guest R, Tran Y, Middleton J. Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation. Br J Health Psychol 2015; 20:807-23. [PMID: 26037456 DOI: 10.1111/bjhp.12143] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. DESIGN Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (N = 88), at discharge from the inpatient phase (N = 81) and 6 months following discharge (N = 71). METHODS Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social re-integration or participation post-discharge after 6 months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge. RESULTS Six months after discharge, around 55% of the sample had difficulties with social participation. The odds against being employed for an adult with poor social participation was found to be 8.4 to 1. Factors that predicted social participation included a younger age, having less severe secondary medical complications like bladder and bowel dysfunction, having a higher cognitive capacity, perceiving one has control (self-efficacy) over one's life and environment, and having greater perceived social support. CONCLUSIONS These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation, affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation. Statement of contribution What is already known on this subject? Spinal cord injury (SCI) is associated with significant challenges to wellbeing, including a high risk of secondary chronic illnesses, risk of co-morbid mental health problems, financial insecurity and social isolation. Research has shown poor social participation can lead to problems in re-integration into society following discharge from inpatient rehabilitation. Research to date has examined various factors related to poor social participation, but the majority of this research has been survey based with convenience samples. What does this study add? This study adds results of prospective longitudinal research on adjustment following SCI, where adjustment was defined by the rate of social participation when living in the community. About one-third of SCI participants were found to have very poor social participation, and only one-third had found some form of employment 6 months after discharge. Multiple factors were found to predict and contribute to poor social participation, including older age when injured, more severe medical complications, cognitive deficits, poor perceptions of control or self-efficacy, and poor social support.
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Affiliation(s)
- Ashley Craig
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Kathryn Nicholson Perry
- Australian College of Applied Psychology, Sydney, New South Wales, Australia.,School of Social Sciences and Psychology, The University of Western Sydney, New South Wales, Australia
| | - Rebecca Guest
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Yvonne Tran
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia.,Key University Centre for Health Technologies, University of Technology, Sydney, New South Wales, Australia
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
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21
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Kisala PA, Victorson D, Pace N, Heinemann AW, Choi SW, Tulsky DS. Measuring psychological trauma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Psychological Trauma item bank and short form. J Spinal Cord Med 2015; 38:326-34. [PMID: 26010967 PMCID: PMC4445023 DOI: 10.1179/2045772315y.0000000022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the SCI-QOL Psychological Trauma item bank and short form. DESIGN Using a mixed-methods design, we developed and tested a Psychological Trauma item bank with patient and provider focus groups, cognitive interviews, and item response theory based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. SETTING We tested a 31-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Veterans Administration hospital. PARTICIPANTS A total of 716 individuals with SCI completed the trauma items RESULTS The 31 items fit a unidimensional model (CFI=0.952; RMSEA=0.061) and demonstrated good precision (theta range between 0.6 and 2.5). Nine items demonstrated negligible DIF with little impact on score estimates. The final calibrated item bank contains 19 items CONCLUSION The SCI-QOL Psychological Trauma item bank is a psychometrically robust measurement tool from which a short form and a computer adaptive test (CAT) version are available.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Natalie Pace
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - David S. Tulsky
- Correspondence to: David Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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22
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Arikan G, Stopa L, Carnelley KB, Karl A. The associations between adult attachment, posttraumatic symptoms, and posttraumatic growth. ANXIETY STRESS AND COPING 2015; 29:1-20. [DOI: 10.1080/10615806.2015.1009833] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Hiskey S, Ayres R, Andrews L, Troop N. Support for the location of negative posttraumatic cognitions in the diagnosis of posttraumatic stress disorder. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2014.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Krause JS, DiPiro ND, Saunders LL, Newman SD, Banik NL, Park S. Allostatic load and spinal cord injury: review of existing research and preliminary data. Top Spinal Cord Inj Rehabil 2014; 20:137-46. [PMID: 25477736 DOI: 10.1310/sci2002-137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To introduce allostatic load (AL) as a framework for measuring stress-related outcomes after spinal cord injury (SCI) by identifying the number and nature of biomarkers investigated in existing studies and by generating preliminary data on AL in 30 persons with traumatic SCI. METHODS This systematic review and pilot study were conducted at a medical university in the southeastern United States. A review of literature published between 1993 and 2012 identified studies using 2 or more of 5 classes of AL biomarkers. We then collected data on 11 biomarkers (n = 30) from self-selected participants using physical exams and blood and urine specimen collection. These included waist to hip ratio, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, dihydroepiandrosterone, glycosylated hemoglobin, C-reactive protein, interleukin-6, and cortisol, norepinephrine, and epinephrine normalized by 12-hour creatinine. RESULTS We were unable to identify any studies investigating AL biomarkers from each of the 5 areas or any studies specifically proposing to investigate AL. AL scores were relatively low, with metabolic indicators being the most elevated and neuroendocrine the least elevated. CONCLUSIONS AL is a promising, yet underutilized, construct that may be feasibly assessed after SCI.
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Affiliation(s)
- James S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
| | - Nicole D DiPiro
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
| | - Lee L Saunders
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
| | - Susan D Newman
- Department of Nursing, College of Nursing, Medical University of South Carolina , Charleston, South Carolina
| | - Narendra L Banik
- Department of Neurosciences, College of Medicine, Medical University of South Carolina , Charleston, South Carolina
| | - Sookyoung Park
- Department of Neurosciences, College of Medicine, Medical University of South Carolina , Charleston, South Carolina
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Liu S, Wang L, Cao C, Zhang J. The factor structure of posttraumatic stress disorder symptoms in patients with traumatic spinal cord injuries. Arch Psychiatr Nurs 2014; 28:301-4. [PMID: 25439970 DOI: 10.1016/j.apnu.2014.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/17/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
The current study investigated the factor structure of posttraumatic stress disorder (PTSD) symptoms in a sample of 256 patients with traumatic spinal cord injuries (SCI) in China. The confirmatory factor analysis results showed that a five-factor model composed of intrusion, avoidance, emotional numbing, dysphoric arousal, and anxious arousal fits the data significantly better than the tripartite DSM-IV model and the two well-supported four-factor models, and the C3 symptom (inability to recall important aspect of the trauma) loaded weakly on its corresponding factor. Implications and limitations for the results are discussed.
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Affiliation(s)
- Songhuai Liu
- Faculty of Rehabilitation Medicine, Capital Medical University, China; Department of Psychology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, China; Department of Clinical Psychology, Capital Medical University, China.
| | - Li Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
| | - Chengqi Cao
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
| | - Jianxin Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Huang CY, Chen WK, Lu CY, Tsai CC, Lai HL, Lin HY, Guo SE, Wu LM, Chen CI. Mediating effects of social support and self-concept on depressive symptoms in adults with spinal cord injury. Spinal Cord 2014; 53:413-6. [PMID: 25266700 DOI: 10.1038/sc.2014.158] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 08/20/2014] [Accepted: 08/27/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional, correlational design. OBJECTIVES To examine the effects of individual demographics, activities of daily living, social support, and self-concept on depressive symptoms in people with spinal cord injury (SCI). SETTING A convenience sample of 135 adults with SCI was recruited from medical and rehabilitation centres in Taiwan. METHODS Face-to-face, structured interviews were employed to collect information. Study questionnaires included a demographic sheet, the Barthel scale, the modified Social Support Inventory, the Huang self-concept scale and the Beck Depression Inventory. Data were analysed by structural equation modelling (SEM). RESULTS The average age of the participants was 43.3 years (±11.98), the mean duration of injury was 114 months (±93.78), and most were males. Emotional support (r=-0.173, P<0.05) and appraisal support (r=-0.261, P<0.01) were negatively correlated with depressive symptoms. The best fitted SEM model included individual demographics and physical function, social support and self-concept as significant predictors of depressive symptoms, with self-concept acting as a mediator in this relationship. Participants' characteristics and social support both contributed substantial indirect effects on depressive symptoms via self-concept. Self-concept also mediated the relationship between education, income, physical functioning and participants' depressive symptoms. CONCLUSION For this sample, the more negative that individuals perceived themselves, the more likely they were to report worsening depressive symptoms. The more social support that individuals have, the more likely they were to report less depressive symptoms. Further longitudinal research will help clarify the direction of these relationships.
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Affiliation(s)
- C-Y Huang
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - W-K Chen
- I-Shou University, Kaohsiung, Taiwan
| | - C-Y Lu
- Department of Nursing, I-Shou University, Kaohsiung, Taiwan
| | - C-C Tsai
- Department of Nursing, MeiHo University, Pingtung, Taiwan
| | - H-L Lai
- Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - H-Y Lin
- 1] I-Shou University, Kaohsiung, Taiwan [2] Department of Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - S-E Guo
- Department of Nursing, Chang Gung University of Science & Technology, Pu-tz, Chiayi, Taiwan
| | - L-M Wu
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C-I Chen
- I-Shou University, Kaohsiung, Taiwan
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Lusilla-Palacios P, Castellano-Tejedor C, Lucrecia-Ramírez-Garcerán, Navarro-Sanchís JA, Rodríguez-Urrutia A, Parramon-Puig G, Valero-Ventura S, Cuxart-Fina A. Training professionals’ communication and motivation skills to improve spinal cord injury patients’ satisfaction and clinical outcomes: Study protocol of the ESPELMA trial. J Health Psychol 2013; 20:1357-68. [DOI: 10.1177/1359105313512351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acute spinal cord injury leaves patients severely impaired and generates high levels of psychological distress among them and their families, which can cause a less active role in rehabilitation, worse functional recovery, and less perceived satisfaction with the results. Additionally, rehabilitation professionals who deal with this psychological distress could ultimately experience higher stress and more risk of burnout. This article presents the study protocol of the ESPELMA project, aimed to train rehabilitation professionals in the clinical management of acute spinal cord injury–associated psychological distress, and to measure the impact of this training on the patients’ perceived satisfaction with treatment.
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Affiliation(s)
- Pilar Lusilla-Palacios
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Carmina Castellano-Tejedor
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
- Institut de Recerca Vall d’Hebron de Barcelona, Spain
| | - Lucrecia-Ramírez-Garcerán
- Universitat Autònoma de Barcelona, Spain
- Department of Rehabilitation and Traumatology, Hospital Universitari Vall d’Hebron, Spain
| | - José A Navarro-Sanchís
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Amanda Rodríguez-Urrutia
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Gemma Parramon-Puig
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Sergi Valero-Ventura
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
- Institut de Recerca Vall d’Hebron de Barcelona, Spain
| | - Ampar Cuxart-Fina
- Universitat Autònoma de Barcelona, Spain
- Department of Rehabilitation and Traumatology, Hospital Universitari Vall d’Hebron, Spain
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Abstract
This study examined the levels of posttraumatic stress disorder (PTSD) following asthma attack (post-asthma attack PTSD) and psychiatric co-morbidity among college students. It also investigated the association between these variables and alexithymia. One hundred and six college students participated in the study and completed an on-line survey comprising the Asthma Symptom Checklist, PTSD Checklist, General Health Questionnaire-28 and Toronto Alexithymia Scale. Ninety-one students without asthma and major illness formed the control group. 2 % met the diagnostic criteria for full-PTSD, while 42 and 56 % met the partial and no-PTSD criteria respectively. Compared with the control, the asthma group reported significantly more somatic problems, social dysfunction and depression and was five times more likely to have an elevated risk of developing a general psychiatric disorder. After adjusting age, marital status, asthma experience and symptoms, alexithymia did not predict PTSD, while difficulty identifying feelings predicted psychiatric co-morbidity. Mediational analyses showed that asthma symptoms partially mediated the link between difficulty identifying feelings and psychiatric co-morbidity. People can develop PTSD symptoms and other psychological difficulties following asthma attack. Alexithymia influenced general psychological difficulties independently of PTSD symptoms.
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Affiliation(s)
- Man Cheung Chung
- Natural Science and Public Health, Zayed University, PO Box 144534, Abu Dhabi, UAE.
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Moodley N, Pillay BJ. Post-traumatic stress disorder in patients with spinal-cord injuries. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.1177/0081246313486879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The majority of spinal-cord injuries result from traumatic incidents such as motor vehicle accidents, falls, and acts of violence such as stab and gunshot wounds. Given the traumatic and life-threatening nature of most spinal-cord injuries, especially in a country like South Africa, where there is a high level of violent crime, post-traumatic stress disorder can be a common consequence for many patients. Using a prospective design, a total of 112 traumatic spinal-cord-injured patients, drawn from government hospitals in the Durban (South Africa) metropolitan and surrounding areas, were assessed. The control group consisted of 79 patients who had amputations. Post-traumatic stress disorder was assessed using the Impact of Event Scale–Revised and Post-Traumatic Diagnostic Scale. In addition, a semi-structured interview was conducted and supplementary data were obtained from each patient’s file. The results indicated a high rate of post-traumatic stress disorder following traumatic spinal-cord injuries. Road traffic accidents were the most common cause of traumatic spinal-cord injuries. Single young males were found to be at greater risk of sustaining such injuries. The results and discussion emphasise the ubiquitous multicultural issues that influence outcomes. This study highlights the need for psychological intervention following traumatic spinal-cord injuries due to the high rate of post-traumatic stress disorder symptoms.
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Affiliation(s)
- Nancy Moodley
- University of KwaZulu-Natal, South Africa
- Provincial Spinal Rehabilitation Centre, South Africa
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30
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Schönenberg M, Reimitz M, Jusyte A, Maier D, Badke A, Hautzinger M. Depression, Posttraumatic Stress, and Risk Factors Following Spinal Cord Injury. Int J Behav Med 2012. [DOI: 10.1007/s12529-012-9284-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Kimble MO, Batterink L, Marks E, Ross C, Fleming K. Negative expectancies in posttraumatic stress disorder: neurophysiological (N400) and behavioral evidence. J Psychiatr Res 2012; 46:849-55. [PMID: 22595869 PMCID: PMC3936679 DOI: 10.1016/j.jpsychires.2012.03.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 03/26/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a disorder that theoretically and clinically is thought to be associated with persistent and exaggerated negative expectancies. This study used the N400 event-related potential (ERP) to investigate expectancies for threatening endings to ambiguous sentence stems. The N400 ERP is thought to reflect the amount of effort required to integrate a stimulus into a given context. In sentence reading tasks, the N400 is reliably larger when a word is unexpected. METHOD In this study, fifty-seven trauma survivors of various types (22 with PTSD and 35 without) read ambiguous sentence stems on a computer screen. These sentence stems were completed with either an expected ("The unfortunate man lost his…wallet"), unexpected ("The unfortunate man lost his…artist"), or threatening word endings ("The unfortunate man lost his…leg"). RESULTS Participants with PTSD, as compared to those without, showed significantly smaller N400s to threatening sentence endings suggesting enhanced expectancies for threat. Behavioral responses supported this conclusion. CONCLUSIONS These findings are consistent with the clinical presentation of hypervigilance and proposed revisions to the DSM-V that emphasize persistent and exaggerated negative expectations about one's self, others, or the world. Relative to earlier behavioral studies, this work further suggests that this expectancy bias occurs automatically and at the early stages of information processing. The discussion focuses on the potential impact of a negative expectancy bias in PTSD and the value of the ambiguous sentence paradigm for studying PTSD as well as other disorders.
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Hoffman JM, Dikmen S, Temkin N, Bell KR. Development of Posttraumatic Stress Disorder After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:287-92. [DOI: 10.1016/j.apmr.2011.08.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/31/2011] [Accepted: 08/31/2011] [Indexed: 11/25/2022]
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Abstract
STUDY DESIGN Review. OBJECTIVES To review literature on subjective well-being (SWB; mental health and life satisfaction) and on psychological and social support factors associated with these outcomes in people with spinal cord injury (SCI), in order to identify gaps in scientific knowledge and recommend research priorities. SETTING Non applicable. METHODS Narrative review of the SCI literature on life satisfaction and mental health (depression, anxiety, post-traumatic stress syndrome) outcomes in people with SCI. Further, reviews were performed of the SCI literature on psychological and social support variables associated with SWB and on psychosocial interventions aimed to improve SWB. RESULTS People with SCI experience, on average, higher levels of distress and lower levels of life satisfaction compared with the general population. Individual differences, however, are large, and most people with SCI adapt well to their condition. A set of psychological and social support factors is strongly related to SWB. Intervention studies on cognitive behavioural therapy or coping effectiveness training to improve SWB show promising results, but suffer from methodological weaknesses (for example, lack of randomization and small sample size). CONCLUSION There is a need for cohort studies with sufficient sample size, which include people early after onset of SCI in order to enhance our understanding of the course of mental health and well-being after SCI. Cohort studies could also identify which people are at risk for long-term impairment of SWB. Finally, intervention studies on psychosocial interventions are needed to identify which interventions may improve SWB of people with SCI.
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Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review. Spinal Cord 2011; 50:174-87. [DOI: 10.1038/sc.2011.120] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Müller R, Peter C, Cieza A, Geyh S. The role of social support and social skills in people with spinal cord injury—a systematic review of the literature. Spinal Cord 2011; 50:94-106. [DOI: 10.1038/sc.2011.116] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wu D, Yin H, Xu S, Zhao Y. Risk factors for posttraumatic stress reactions among Chinese students following exposure to a snowstorm disaster. BMC Public Health 2011; 11:96. [PMID: 21314959 PMCID: PMC3047427 DOI: 10.1186/1471-2458-11-96] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 02/12/2011] [Indexed: 12/04/2022] Open
Abstract
Background It is important to understand which factors increase the risk of posttraumatic stress disorder (PTSD) in adolescents. Previous studies have shown that the most important risk factors for PTSD include the type, severity, and duration of exposure to the traumatic events. Methods A cross-sectional survey was used to investigate the psychological symptoms associated with the aftermath of a snowstorm disaster in the Hunan province of China in January 2008. Students living in Hunan were surveyed at a three-month follow-up after the disaster. The questionnaire battery included the Impact of Event Scale-Revised (IES-R, trauma and symptoms associated with PTSD), the Chinese version of the Life Orientation Test-Revised (LOT-R, optimism and pessimism), the Chinese version of the Eysenck Personality Questionnaire (EPQ, neuroticism and extraversion), the Chinese Trait Coping Style Questionnaire (TCSQ, positive and negative coping styles), and a range of questions addressing social demographic characteristics and factors relating to the snowstorm. The survey was administered in school, and 968 students completed and returned the questionnaires. Results The results showed that 14.5% of the students had a total IES-R score ≥20. Students with greater school-to-home distances showed higher levels of posttraumatic stress symptoms than students who lived shorter distances from school. Students with emotional support from their teachers reported higher levels of posttraumatic stress symptoms (21.20%) than students without a teacher's emotional support (11.07%). The IES-R total and subscale scores correlated with all variables except extraversion. The binary logistic regression analysis results showed that the teacher's emotional support [odds ratio (OR) = 1.72, 95% confidence interval (CI) = 1.13-2.62], school-to-home distance (OR = 1.01, 95% CI = 1.00-1.01), negative coping (OR = 1.05; 95% CI = 1.02-1.08), and neuroticism (OR = 1.04, 95% CI = 1.02-1.06) were risk factors that predicted PTSD frequency and severity (percentage correct = 85.5%). Conclusions The risk factors that significantly impacted the onset of posttraumatic stress reactions in students living in Hunan, China following a snowstorm disaster were the school-to-home distance, negative coping, neuroticism, and teacher's emotional support.
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Affiliation(s)
- Daxing Wu
- The Medical Psychological Research Institute, Second Xiangya Hospital of Central South University, Changsha, China.
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Zatzick DF, Rivara FP, Jurkovich GJ, Hoge CW, Wang J, Fan MY, Russo J, Trusz SG, Nathens A, Mackenzie EJ. Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impairments. ACTA ACUST UNITED AC 2011; 67:1291-300. [PMID: 21135329 DOI: 10.1001/archgenpsychiatry.2010.158] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). OBJECTIVES To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. DESIGN Multisite US prospective cohort study. SETTING Eighteen level I trauma centers and 51 non-trauma center hospitals. PATIENTS A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. MAIN OUTCOME MEASURES Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. RESULTS At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. CONCLUSIONS More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.
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Affiliation(s)
- Douglas F Zatzick
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, 98104, USA.
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Posttraumatic stress disorder and spinal cord injury. Arch Phys Med Rehabil 2010; 91:1182-7. [PMID: 20684898 DOI: 10.1016/j.apmr.2010.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 05/20/2010] [Accepted: 05/27/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify the prevalence of posttraumatic stress disorder (PTSD) after spinal cord injury (SCI) in a sample averaging over 2 decades postinjury at assessment. Related objectives are to confirm the factor structure, compare subscales with those reported in a nonclinical sample, and identify the relationship of PTSD with depression. DESIGN Survey. SETTING A medical university in the Southeastern United States. PARTICIPANTS Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States. A cohort of adults (N=927) with traumatic SCI of at least 1 year duration at enrollment in 2002 to 2003 and a minimum of 7 years at the time of assessment completed the study materials. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES PTSD was measured by the Purdue Posttraumatic Stress Disorder Scale-Revised, and depression was measured by the Patient Health Questionnaire 9-item. RESULTS PTSD was reported by less than 10% of the participants. Item endorsement decreased as a function of years postinjury, primarily because of low rates of endorsement among those 21 or more years postinjury. Confirmatory factor analysis did not result in an acceptable fit for subscales, item sets, or factors previously reported in the literature. Participants scored higher than a nonclinical sample (reported in the literature) on the arousal and avoidance subscales but lower on the re-experiencing subscale. Item endorsement were lower for the first set of items that relate directly to the SCI itself, with the highest item endorsement for "have difficulty remembering important aspects of event." PTSD rarely occurred in the absence of a depressive disorder. CONCLUSIONS PTSD does not appear to be highly prevalent in long-term SCI survivors, and endorsement of items related to re-experiencing and even recalling the injury are rare. Because SCI often is accompanied by mild traumatic brain injury, difficulty recalling the event may have an organic rather than psychologic component.
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