Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 4 , Pages 628-633, April 2009

Psychologic Factors and Risk of Mortality After Spinal Cord Injury

  • James S. Krause, PhD

      Affiliations

    • College of Health Professions, Medical University of South Carolina, Charleston, SC
    • Corresponding Author InformationCorrespondence to James S. Krause, PhD, Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St, Suite 117, MSC 700, Charleston, SC 29425
    • ,
  • Rickey Carter, PhD

      Affiliations

    • Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC
    • ,
  • Yusheng Zhai, MSPH

      Affiliations

    • Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, SC
    • ,
  • Karla Reed, MA

      Affiliations

    • College of Health Professions, Medical University of South Carolina, Charleston, SC

Abstract 

Krause JS, Carter R, Zhai Y, Reed K. Psychologic factors and risk of mortality after spinal cord injury.

Objective

To identify the association of 2 distinct psychologic constructs, personality and purpose in life (PIL), with risk of early mortality among persons with spinal cord injury (SCI).

Design

Prospective cohort study with health data collected in late 1997 and early 1998 and mortality status ascertained in December 2005.

Setting

A large rehabilitation hospital in the southeastern United States.

Participants

Adults (N=1386) with traumatic SCI, at least 1 year postinjury.

Interventions

Not applicable.

Main Outcome Measures

We first evaluated the significance of a single psychologic predictor (a total of 6 scales) while controlling for biographic and injury predictors using Cox proportional hazards modeling and subsequently built a comprehensive model based on an optimal group of psychologic variables.

Results

There were a total of 224 (16.2%) observed deaths in the full sample. The total number of deaths was reduced to 164 in the final statistical model (of 1128 participants) because of missing data. All 6 psychologic factors were statistically significant in the model that was adjusted for biographic and injury factors, whereas only 3 psychologic factors were retained in the final comprehensive model, including 2 personality scales (Impulsive Sensation Seeking, Neuroticism-Anxiety) and the PIL scale. The final comprehensive model only modestly improved the overall prediction of survival compared with the model with only biographic and injury variables, because the pseudo-R2 increased from 0.121 to 0.129, and the concordance increased from 0.730 to 0.747.

Conclusions

The results affirm the importance of psychologic factors in relation to survival after SCI.

Key Words: Mortality, Personality, Rehabilitation, Risk, Spinal cord injuries

List of Abbreviations: CI, confidence interval, HR, hazard ratio, IQR, interquartile range, NDI, National Death Index, PIL, purpose in life, SCI, spinal cord injury, SMR, standardized mortality ratio, SSDI, Social Security Death Index, ZKPQ, Zuckerman-Kuhlman Personality Questionnaire

 

 Supported by a field initiated grant from the National Institute for Disability and Rehabilitation Research (grant no. H133G030117) and the Model Spinal Cord Injury Systems (grant no. H133N000005) and the National Institutes of Health (1R01 NS 48117-01 A1). The opinions here are those of the grantee and do not necessarily reflect those of the funding agencies.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Reprints are not available from the author.

PII: S0003-9993(09)00026-4

doi:10.1016/j.apmr.2008.10.014

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 4 , Pages 628-633, April 2009

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