Spinal cord injury, posttraumatic stress, and locus of control among the elderly: a comparison with young and middle-aged patients

Geriatric spine fractures - Demography, changing trends, challenges and special considerations: A narrative review

The aim of this manuscript was to summarize the demography and changing trends of geriatric spinal injuries and to enumerate the challenges and special considerations in the care of geriatric spinal injuries. PubMed, Scopus and Embase databases were searched for literature on geriatric spine fractures using MeSH terms 'aged', 'aged, 80 and over', 'elderly', 'spinal fracture/epidemiology', spinal fracture/therapy∗' and keywords pertaining to the same. The search results were screened for appropriate articles and reviewed. There is a high community prevalence of elderly vertebral fractures ranging from 18% to as high as 51%. The proportion of older patients among the spinal injured is rising as well. There is a higher chance of missing spinal injuries in the elderly and clinical guidelines may not be applicable to this patient group. Classification and surgical treatment are different from younger adult counterparts as the elderly osteoporotic spine behaves differently biomechanically. There is a high incidence of respiratory complications both for surgically and conservatively managed groups. Older age generally is associated with a higher complication rate including mortality.

Prevalence of Posttraumatic Stress Disorder Symptoms Following Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis

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.

Risk factors for PTSD of Shidu parents who lost the only child in a rapid aging process: a cross-sectional study

BACKGROUND

The elderly population is rising globally, especially in China where a large population base causes the largest number of older adults in the world. Notably, Shidu people who are over the age of 60 and have lost their only child have drawn great public attentions as they become more elderly, medically unstable and worse mentally unhealthy. Posttraumatic stress disorder (PTSD) is one of the most common consequences resulted from the loss of the only child. However, few previous studies have examined PTSD in Shidu older aldults, and the risk factors are a relatively understudied area. Our study aims to estimate the prevalence and potential risk factors of PTSD and improve the possibility of early identifying the high-risk Shidu parents with PTSD, and successively provide timely and effective interventions.

METHOD

Based on the register of population statistic information provided by the health family planning commission, 149 participants were enrolled randomly. Data was collected by interviews and questionnaires. Socio-demographic and bereavement-related information and physical health outcomes were obtained. PTSD Checklist-Civilian Version was used to screen for bereavement-related PTSD.

RESULT

The morbidity of PTSD reached 30.9%, while in the group of age over 60 the morbidity reached 31.6%. Stratified by potential demographic risk factors, SDPs have significant between-group differences of PTSD. Specially, being women, higher income, losing the single child at older age, more serious medical conditions and being Shidu for a shorter period indicated higher severity of PTSD in SDPs. The single child dying at a older age and from accidence were also significant indicators. Regression analysis showed the gender of SDPs, hospital visits, and the cause of child death significantly predicted the severity of PTSD.

CONCLUSION

With the accelerate process of aging, especially in China, Shidu older adults become a group deserved more attentions. PTSD is clearly a possible reaction to the loss of the only child. The gender and hospital visits of the Shidu older adults and the causes of their child's death significantly related to the prevalence of PTSD, which could help to improve the possibility of early intervening.

Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Syrian Refugees of Different Ages: the Role of Trauma Centrality

It has been documented that trauma centrality is associated with posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. Whether age would influence the levels of the above constructs and the association between trauma centrality and distress outcomes is unclear. This study compared age differences in 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees. One thousand one hundred and ninety-seven refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28. Age groups were divided into young, middle-aged adults and adults of 45 or above. No significant group differences were found in the proportion of refugees meeting the diagnostic criteria for PTSD. Controlling for demographic variables, all subscales of trauma centrality and psychiatric co-morbidity were significantly different between groups. Young adults reported significantly less trauma centrality and psychiatric co-morbidity than the other groups. Multiple-indicator multiple-cause modelling showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity. Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model. To conclude, age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults' sense of self and other psychological problems than those who were older. The way in which young and middle-aged adults responded to distress varied depending on environment and personal characteristics.

Disclosure of Diagnosis in Early Recognition of Psychosis

There is a debate concerning risks and benefits of early intervention in psychosis, especially concerning diagnosis disclosure. The present study reports preliminary findings on self-reported locus of control and psychological distress after the disclosure of diagnosis in an early recognition center. We compared the ratings of the locus of control and psychological distress before and after communication of diagnosis. The study included individuals with an at-risk mental state (ARMS) (n = 10), schizophrenia (n = 9), and other psychiatric disorders (n = 11). Results indicate greater endorsement of the internal locus of control in individuals with ARMS after communication of diagnosis in contrast to the other groups. Our results suggest that disclosure of diagnosis in an early recognition center leads to a reduction of psychological distress and increased feelings of control over one's health. Persons with ARMS seem to particularly benefit from disclosure of diagnosis as part of early intervention.

Posttraumatic stress following spinal cord injury: a systematic review of risk and vulnerability factors

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 (r_w=0.64, (95% CI, 0.54-0.72)), negative appraisals (r_w=0.63 (95% CI, 0.52-0.72)), distress (r_w=0.57 (95% CI, 0.50-0.62)), anxiety (r_w=0.56 (95% CI, 0.49-0.61)) and pain severity (r_w=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 (Q_B (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.

The Relationship Between Background Characteristics and Death Anxiety in Times of War: A Comparison Between Three Generations Arab and Jewish Families in Israel

(a) To compare the levels of death anxiety between the Jewish and Arab population in Israel after the Second Lebanon War and the Casting Lead Operation. (b) To compare the levels of death anxiety between three families' generations: elderly parents, their adult children and their adult grandchildren and (c) to learn about the relationship between background characteristics and death anxiety in times of war. The sample included 172 trios of elderly parents (ages 65 and up), their middle aged children (ages 41-64) and, their young adult children (ages 20-40) living at the northern and southern of Israel. Three quarters of the participants were Jews and the others were Arabs (including Muslims, Christians and Druze). Participants answered a self-report questioner. Death anxiety levels were measured by the Carmel and Mutran's instrument (1999). In general, the highest levels of death anxiety were found among the elderly parents (p < 0.01). Regarding the nationality and the gender variables, the highest levels of death anxiety were found among the adult Jewish daughters' group (p < 0.001). Nationality was found to be the most contributive variable for predicting death anxiety levels among the three generations; the sense of mastery was the second contributor, to predict death anxiety levels among the three generations' participants. Elderly population, Arab population and women, are at high risk to suffer from high levels of death anxiety in times of war in Israel. Special attention should be given to this population groups.

Posttraumatic stress symptoms, co-morbid psychiatric symptoms and distorted cognitions among flood victims of different ages

BACKGROUND

In literature, the effect of age on posttraumatic stress disorder (PTSD) is inconclusive; the effect on flood-related PTSD is particularly unclear. Little is known on distorted cognitions among flood victims, although cognition distortions and PTSD have been linked among victims of other traumas.

AIMS

To investigate: (1) whether flood-related PTSD, psychiatric co-morbidity and cognitive distortions would differ according to age and (2) distinctive patterns of association between the preceding variables for different age groups.

METHODS

One hundred and fifty-four flood victims of different ages completed standardized questionnaires measuring PTSD, psychiatric co-morbidity and cognitive distortions.

RESULTS

Adolescents and young adults reported significantly fewer PTSD, psychiatric co-morbidity and distorted cognition symptoms than people who were older. Preoccupation with danger and hopelessness were associated with both outcomes for adolescents, people in their thirties and middle-aged/older people. For young adults, helplessness was associated with PTSD; hopelessness and preoccupation with danger with psychiatric co-morbidity.

CONCLUSIONS

Adolescents and young adults buffered against flood-related psychological distress better than older people. Distorted cognitions related to distress outcomes differently depending on age.

Relationships Between Health Behaviors, Self-Efficacy, and Health Locus of Control of Students at the Universities of the Third Age

BACKGROUND This study aimed to determine the relationship of health behaviors with the health locus of control and the sense of self-efficacy against the background of socio-economic factors and self-rated health among students of the Universities of the Third Age (U3As). MATERIAL AND METHODS The study included 320 U3A students, with mean age of 67.5 years. The following research tools were used: Health Behavior Inventory (HBI), Multidimensional Health Locus of Control Scale (MHLC), Generalized Self-Efficacy Scale (GSES), and an original survey of the author's own design. RESULTS Mean total HBI and GSES scores were 90.63 and 30.12, respectively. These results are satisfactory. A slight predominance of internal health locus of control was documented. A number of significant correlations were found between the HBI, GSES, and MHLC scores, except for the MHLC subscale expressing the influence of chance. Educational attainment was shown to have a significant impact on the scores for the positive attitude and proper dietary habits subscales of HBI, as well as on the GSES scores. Economic status of the participants influenced the levels of positive attitude, internal health locus of control, and self-efficacy. Furthermore, internal health locus of control was found to be modulated by subjective health of the respondents. The scores for external health locus of control and the influence of chance increased significantly with age. CONCLUSIONS The currently noticeable emphasis placed on lifelong education should serve as a good prognostic factor for health behaviors and personal health resources for years to come.

The Application of Tensegrity Massage in a Professionally Active Musician - Case Report

PURPOSE

The purpose of our study was to present options for the application of tensegrity massage to manage pain caused by the overload of soft tissues in musicians.

DESIGN

Tensegrity massage was applied to a 34-year-old male violinist.

METHODS

The methodology included a correct positioning and tensegrity massage with individually designed procedure.

FINDINGS

After therapy, the patient achieved complete pain relief, and relaxation of muscles in the shoulder girdle and free part of the upper arm. The analgesic effect lasted for 6 months after the end of therapy.

CONCLUSIONS

Massage is an effective method in eliminating pain caused by the overload of soft tissues. If used regularly before physical effort, it can prevent muscle overload.

CLINICAL RELEVANCE

The presented massage procedure is an effective therapy in pain caused by the overload of soft tissues in musicians and it can be one of the elements of complex physiotherapy in active musicians.

Risk factors for posttraumatic stress disorder in persons with spinal cord injury

PURPOSE

Many of the events that cause spinal cord injury (SCI) are traumatic events that can result in posttraumatic stress disorder (PTSD). It therefore appears that most persons with SCI are at risk for developing PTSD. This study retrospectively examined risk factors for PTSD symptoms in a sample of 71 persons with SCI.

METHOD

The Structured Clinical Interview for DSM-IV was used to assess full and partial PTSD diagnoses. Self-administered questionnaires were used to measure potential risk factors.

RESULTS

Results indicated that 11% of the participants met the criteria for full PTSD, and an additional 20% met the criteria for partial PTSD at some point after their SCI. Hierarchical linear regression analyses revealed that trauma history, peritraumatic reactions, and intolerance of uncertainty predicted the number of PTSD symptoms.

CONCLUSION

This study highlights the importance of trauma history, peritraumatic reactions, and intolerance of uncertainty in the development of PTSD symptoms. Patients at risk for PTSD should be identified early in the rehabilitation process and could benefit from psychological interventions with the aim of preventing PTSD development.

Post-traumatic stress disorder in patients with spinal-cord injuries

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.

Psychological coping with intermittent self-catheterisation (ISC) in people with spinal injury: a qualitative study

BACKGROUND

Management of bladder function is important in rehabilitation of spinal injury. Failure to comply with bladder management techniques, such as intermittent catheterisation, can have long-term consequences leading to renal failure. It is important, therefore, that spinal injured people adapt to the therapy at an early stage, but there is little research aimed at exploring patient experiences of ISC.

OBJECTIVES

This study explores the experiences of patients who have a spinal cord injury and who carry out ISC in order to identify psychological coping factors that might affect therapy adherence.

DESIGN

A qualitative study using a Grounded Theory framework involving individual interviews.

SETTING AND PARTICIPANTS

There were 15 participants (11 men and 4 women), median age 52 years (range 24-68) who were discharged from spinal rehabilitation, living in the community and using ISC. The sample was recruited from the patient lists of a tertiary spinal injury unit and a Specialist Continence Service.

METHODS

In-depth interviews were carried out in participants' own homes by a trained interviewer. Interviews were audio-recorded, transcribed and analysis carried out using NUD*IST6 software.

RESULTS

A core category of 'normalisation' was identified and the causes and consequences related to this category are reported. Categories of 'independence' and 'control' were closely related to, and were interdependent with, 'normalisation'. Participants were relieved of worry when they could exert control over their bladder function, and a feeling of normalisation helped them to maintain the integrity of their self-image. The ultimate outcome was either adaptation or maladaptation. Adaptation was dependent on positive acceptance of intermittent catheterisation and the need for good bladder management at the outset, whereas maladaptation was a result of avoidance and denial.

CONCLUSIONS

Adherence to ISC is related to early psychological coping strategies of active acceptance rather than denial and avoidance in relation to bladder management. It is important to support positive appraisals of ISC, particularly from the patient perspective, which suggest that it is the first step to independence and that it also provides normalisation and control of bladder function. ISC can contribute to a good quality of life, dignity, privacy and self-esteem.

The impact of perceptions of health control and coping modes on negative affect among individuals with spinal cord injuries

A wide range of demographic, medical, and personality and coping variables have been implicated as predictors of psychosocial outcomes following the onset of spinal cord injuries (SCI). The primary purpose of this study was to examine the role that perceptions of health control (internality, chance-determined, and other persons-determined) and coping strategies play in predicting respondents' negative affect, namely, reactions of depression and anxiety [i.e., posttraumatic stress disorder (PTSD)], as outcomes of psychosocial adaptation to disability. A second purpose was to investigate the potential role that time since injury (TSI) plays in moderating the influence of coping on psychosocial outcomes related to SCI. Ninety five survivors of SCI participated in the study by completing a battery of self-report measures. Two sets of multiple regression analyses were employed to address the study's goals. Findings indicated that after controlling the influence of gender, age, time since injury, and number of prior life traumas: (a) the use of disengagement coping successfully predicted both respondents' levels of depression and PTSD; (b) none of the perceptions of control of one's health significantly influenced psychosocial reactions to SCI, as indicated by depression and PTSD, although perceptions of chance control showed a moderate positive trend; and (c) time since injury did not moderate the relationships between coping and negative affect related to the onset of SCI. The implications of these findings to rehabilitation professionals are discussed.

Promoting optimal functioning in spinal cord injury: the role of rehabilitation psychology

Comprehensive treatment and rehabilitation includes attention to the psychological needs of individuals with SCI and their families. This chapter is designed to familiarize neurologists and other practitioners with psychological issues and care in SCI. While psychologists play a key role, attention to psychosocial health is a responsibility shared by all members of the rehabilitation team, beginning with the patient and family, and including clinicians who are not formally identified as mental health providers. Treatment planning for a person with SCI begins with a thorough assessment of the cognitive, emotional, personality, and social factors that influence functioning and rehabilitation. Rehabilitation psychologists use a mixture of assessment tools, including clinical interviews, behavioral observations, and a wide range of standardized test instruments. Psychological interventions can involve direct intervention with the patient, in individual, family or group-based therapies. Other psychological strategies involve assistance through less direct methods - consultation and training to other rehabilitation team members or facilitating peer role-modeling and support groups. The chapter provides an overview of core clinical issues (emotional responses, substance use, pain, cognitive deficits, sexuality and vocational rehabilitation), delineates the process of psychological assessment and intervention, and provides guidance on incorporation of rehabilitation psychology into SCI rehabilitation.

Intergenerational Transmission, Attitudes, and Post-Traumatic Stress Disorder in Times of War: A Comparison between Elderly People and Their Adult Offspring after the Second Lebanon War (2006) and Casting Lead Operation (2008)

Background:

While the effects of war on individuals, age groups, and communities have been thoroughly studied, there has been relatively little mention in the literature regarding its differential effects on adult children and their elderly parents and grandparents.

Methods:

Three hundred thirty-eight participants (167 elderly parents and 171 adult offspring) living in the northern and southern regions of Israel, were interviewed after the Second Lebanon War (2006) and the Casting Lead Operation (2008). (A military operation took place at the Israeli southern border as a reaction to the 7 years of missiles bombing from the Gaza strip to the Israeli civilians.) The participants were sampled by a cluster sampling.

Findings:

Elderly population experiences higher levels of PTSD symptoms than their adult children do. Women experience higher levels of PTSD symptoms than men and Israeli Arabs and Druze more than Israeli Jews.

Conclusions:

A policy should be enacted among the local authorities and the governmental offices that would ensure accessibility to and the ability to provide proper care for the elderly population during times of war or terror events. In addition, it is important to setup local teams in every local community to deal with the level of mental and emotional preparedness of the home front and its inhabitants, in case the latter should again become part of the human casualties of the wars and terrorist events that occur in Israel.

Capturing the psychologic-personal perspective in spinal cord injury

OBJECTIVE

The overall objective of this study was to illustrate a systematic approach for capturing the psychologic-personal perspective in International Classification of Functioning, Disability and Health-based comprehensive research on spinal cord injury (SCI) in terms of what and how to measure. The specific aims were to identify (1) relevant areas of research for capturing the psychologic-personal factors in a study that is planned and conceptualized according to the comprehensive context of the International Classification of Functioning, Disability and Health, using SCI as a case in point; (2) a set of domains relevant for SCI research from a psychologic-personal perspective; and (3) suitable measurement instruments that can be considered for the assessment of those identified domains based on a set of predefined guiding principles.

DESIGN

The psychologic-personal factor structure was developed based on an item pool of 1246 entries from secondary analyses of available data from SCI studies. The domain set for psychologic-personal factors was identified through reviewing the scientific literature in PubMed and PsycInfo. The set of measurement instruments was collected using available measurement reviews, searches in the literature, instrument databases, and further sources and was selected using guiding principles.

RESULTS

Forty specific psychologic-personal factors, subdivided into seven areas of research, were identified: (1) sociodemographic personal characteristics, (2) the position in the immediate social and physical context, (3) personal history and biography, (4) feelings, (5) thoughts and beliefs, (6) motives, and (7) patterns of experience and behavior. The psychologic-personal factors domain set contains both cross-cutting outcome domains, namely quality-of-life, life satisfaction, subjective well-being, and sociodemographic personal characteristics, life events, positive and negative affect, perceived stress, locus of control, self-efficacy, purpose in life, coping, lifestyle, and personality. For each of the identified domains, a pool of measurement instruments was listed, and the application of predefined guiding principles for measurement instrument selection was exemplified for self-efficacy. It resulted in the selection of the General Self-Efficacy Scale by Schwarzer and Jerusalem (Measures in Health Psychology: A User's Portfolio. Causal and Control Beliefs. pp. 35-37; 1995).

CONCLUSIONS

The results of the current article contributed to creating a transparent protocol for the Swiss Spinal Cord Injury Cohort study, coordinated by the Swiss Paraplegic Research in Nottwil, Switzerland. This article also stresses the relevance of the comprehensive approach to SCI and the consideration of the psychologic-personal perspective in this approach. The study, therefore, hopes to encourage scientists to use the International Classification of Functioning, Disability and Health and the psychologic-personal perspective as a frame of reference for their research. Furthermore, the research reported in this article can inform the World Health Organization's future development of the personal factors classification in the International Classification of Functioning, Disability and Health.

Coping strategies recalled by young adults who sustained a spinal cord injury during adolescence

STUDY DESIGN

Qualitative study.

OBJECTIVE

To determine categories of coping the first year after injury used by 24 young adults who sustained a spinal cord injury (SCI) during adolescence (11-15 years).

SETTING

Sweden.

METHODS

Content analysis using the existing theories of coping as a framework, including the instrument BriefCOPE-a deductive category application. The analysis looked critically at comments in the interviews that reflected attempts to cope with the injury during the first post-injury year.

RESULTS

All 14 of the categories of coping described by the BriefCOPE were included in the interviews at least once, except 'self-blame', which was not used by any interviewee. In addition to the predefined categories of the BriefCOPE, three new coping categories emerged from the interviews: fighting spirit, downward comparison and helping others.

CONCLUSIONS

Adolescents who sustain SCIs use a variety of strategies to help them to cope with the consequences of the injury. Many of these coping strategies are similar to those used by others facing stresses, but it is instructive to hear, in their own words, how young adults recall the coping strategies they used as adolescents when they were injured and also how they conceptualized the process of coping. This information can be useful in helping future patients.

Pain symptom profiles in persons with spinal cord injury

OBJECTIVE

Persistent pain is a common consequence of spinal cord injury. A patient-specific assessment that combines both the identification of pain symptoms and psychosocial factors is needed for a tailored treatment approach. The aim of the study was to define pain symptom profiles and to determine their relationship with psychosocial factors in persons with spinal cord injury.

DESIGN

Face-to-face interview and examination.

SETTING

VA Medical Center and Miami Project to Cure Paralysis, Miami, Florida.

PATIENTS

Persons with spinal cord injury (135 men and 21 women) provided detailed descriptions of 330 neuropathic pains.

OUTCOME MEASURES

The American Spinal Injury Impairment Scale, pain history and measures of pain interference, life satisfaction, locus of control, social support and depression.

RESULTS

The exploratory factor analyses and regression analyses revealed three distinct symptom profiles: 1) aching, throbbing pain, aggravated by cold weather and constipation predicted by a combination of chance locus of control and lower levels of life satisfaction; 2) stabbing, penetrating, and constant pain of high intensity predicted by a combination of pain interference, localized pain, powerful others locus of control and depressed mood; and 3) burning, electric, and stinging pain aggravated by touch and muscle spasms predicted by pain interference.

CONCLUSIONS

Although these results need to be replicated in other spinal cord injury samples, our findings suggest that pain symptom profiles may be a useful way to further characterize pain in a comprehensive assessment strategy.

Posttraumatic stress disorder in older people after a fall

BACKGROUND

Posttraumatic Stress Disorder (PTSD) is a debilitating psychological condition, never studied in relation to falls in older people. This study determines the prevalence and correlates of PTSD in older people post-fall.

METHOD

A prospective survey study, with baseline data collected by interview in hospital post-fall and by postal self-completion at 12 and 24 weeks post-baseline. A convenience sample of 196 people (> or = 65 years) were serially recruited, 87.9% of those eligible. Information collected at baseline included falls-related data, activity problems, fear of falling, PTSD symptoms, anxiety and depression, and at follow-up PTSD symptoms, anxiety and depression, the receipt of rehabilitation and further falls.

RESULTS

In hospital, of 40 participants whose fall had occurred over 1 month previously 35% had full acute PTSD and 17.5% had partial acute PTSD. At follow-up full or partial chronic PTSD was found in 26.1% of participants at first follow-up, and in 27.4% of participants at second follow-up. Older age, pre-fall activity problems, fear of falling, and anxiety assessed at baseline were associated (p < 0.05) with follow-up PTSD diagnosis, as were anxiety and depression assessed concurrently.

CONCLUSION

PTSD occurs in a substantial minority of older people post-fall. No pattern emerged of factors predictive of PTSD, although the association between fear of falling and PTSD suggests some patients thought to have fear of falling may be manifesting PTSD, and require identification to enable therapeutic intervention.

Spinal cord injury, coping and psychological adjustment: a literature review

OBJECTIVES

This paper reviews the literature concerning psychological adjustment to spinal cord injury, focusing on the recent methodological developments and new directions in research.

METHOD

Several literature reviews using the search terms Spinal Cord Injury, Paraplegia, Coping and Adjustment were undertaken using the databases in Pubmed, Medline and Embase. The papers that were published from 2001 onwards, written in English and used a sample of adults were included.

RESULTS

The literature reviewed lends further support to the importance of appraisals and coping strategies in the adjustment to spinal cord injury. Methodological issues highlighted in earlier reviews are addressed in conjunction with further theoretical explorations.

CONCLUSIONS

Although many of the methodological criticisms have been addressed, there remains a need for longitudinal research into the process of adjustment to spinal cord injury and the contributory role of appraisals and coping strategies. Measurement tools designed specifically for use within the spinal cord injured population should be utilized in the prevention of maladaptive adjustment issues, whereas able-bodied comparison groups would allow identification of coping strategies unique to the spinal cord injured population.

What predicts post-traumatic stress following spinal cord injury?

OBJECTIVES

Spinal cord injury (SCI) is a severe, traumatic event and recently research into the role of post-traumatic stress disorder (PTSD) subsequent to the injury has become of increasing interest. This study has been conducted in order to investigate potential risk factors for the development of post-traumatic stress disorder symptoms in those with SCI.

DESIGN

This cross-sectional study used multiple regression analysis to look for associations between post-traumatic stress symptom severity, SCI-related factors and previously identified risk factors for PTSD such as dysfunctional cognitions, demographic factors and personality predispositions (neuroticism, alexithymia).

METHOD

A total of 102 participants with SCI completed measures of post-traumatic stress severity, acceptance of injury, post-traumatic cognitions, social support, neuroticism and alexithymia. In addition, information about type, level and cause of the SCI was assessed.

RESULTS

High levels of post-traumatic stress symptoms were found. Potential risk factors for the development of PTSD were negative cognitions of self and neuroticism. Variables that added to the variance explained by the models included time since injury and difficulty identifying feelings. Acceptance of injury was mediated by negative cognitions of the self and neuroticism.

CONCLUSIONS

The study highlights the need for services to be aware of the psychological difficulties experienced by this client group. An important finding is that the acceptance of the injury is mediated by negative cognitions of the self which need to be identified as potential risk factors in order to prevent the development of post-traumatic symptoms in this population.

Posttraumatic stress and co-morbidity following myocardial infarction among older patients: the role of coping

This study aimed to investigate co-morbidity and coping strategies among older patients who suffer from different levels of posttraumatic stress disorder (PTSD) following myocardial infarction. Ninety-six older myocardial infarction (MI) patients were recruited from two general practices and completed the Posttraumatic Stress Diagnostic Scale (PDS), the General Health Questionnaire-28 (GHQ-28) and the COPE Scale. Ninety-two older patients with no previous MI experience constituted the control. Using the PDS, 30, 42 and 28% had full, partial and no-PTSD respectively. There were significant differences between the patient groups and the control on all GHQ-28 sub-scales. Significant differences were also identified between the patient groups in the following coping strategies: seeking emotional social support, suppression of competing activities, restraint coping, focusing on and venting of emotion, mental and behavioural disengagement. Controlling for bypass surgery, previous mental health difficulties, angioplasty, heart failure and angina, MANCOVA results did not change the overall results of the GHQ-28 but changed the results of coping in that seeking emotional social support and behavioural disengagement stopped being significant. Coping was a partial mediator between different levels of post-MI PTSD and co-morbidity. Depending on the severity of PTSD symptoms, co-morbidity and coping strategies can vary among older patients. Older patients with full-PTSD tend to use both maladaptive coping strategies as well as problem-focused coping.