Abstract
Objectives
(1) To examine the mediating effects of depressive symptoms on the relations between
employment, grief, depression treatment, and participation enfranchisement after spinal
cord injury (SCI); and (2) to examine the moderating role of demographic and injury
characteristics, including sex, race, marital status, education, and injury level,
and completeness on these relations.
Design
Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI
(PRISMS).
Setting
Rehabilitation facilities.
Participants
Persons with SCI (N=522; average age, 42y; 76% men; 64% white; 64% completed at least
a high school education) enrolled from 2007 to 2011.
Interventions
Not applicable.
Main Outcome Measure
Participation enfranchisement.
Results
The final model fit the data relatively well (comparative fix index=.939; Tucker-Lewis
Index=.894; root mean square error of approximation=.066; 90% confidence interval,
.043–.089), explaining 32% of the variance in participation enfranchisement. Enfranchisement
was positively related to employment and negatively related to depression. Grieving
the loss of a loved one and the use of an antidepressant or psychotherapy were related
to participation enfranchisement; these relations were mediated by depressive symptoms.
Multigroup analyses supported the model's invariance across sex, marital status, severity
of injury, and level of injury.
Conclusions
Depression appears to mediate the influence of employment, grief, and depression treatments
on participation enfranchisement after SCI. These relations are applicable regardless
of sex, marital status, and injury completeness and level. These findings highlight
efforts to improve the detection and treatment of depression in SCI rehabilitation
programs that may enhance participation.
Keywords
List of abbreviations:
CFI (comparative fix index), CI (confidence interval), ICF (International Classification of Functioning, Disability and Health), MDD (major depressive disorder), ML (maximum likelihood), PHQ-9 (Patient Health Questionnaire-9), RMSEA (root mean square error of approximation), SCI (spinal cord injury), SEM (structural equation model), TLI (Tucker-Lewis Index)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate.Spinal Cord. 2014; 52: 110-116
- Symptoms of major depression in people with spinal cord injury: implications for screening.Arch Phys Med Rehabil. 2004; 85: 1749-1756
- Functioning and disability in spinal cord injury from the consumer perspective: an international qualitative study using focus groups and the ICF.Spinal Cord. 2010; 48: 603-613
- International Classification of Functioning, Disability and Health-ICF.World Health Organization, Geneva2001
- Measurement of participation in rehabilitation research.Arch Phys Med Rehabil. 2010; 91: S1-S4
- Difficult to measure constructs: conceptual and methodological issues concerning participation and environmental factors.Arch Phys Med Rehabil. 2009; 90: S22-S35
- Participation after spinal cord injury: the evolution of conceptualization and measurement.J Neurol Phys Ther. 2005; 29: 147-156
- Measures of social outcomes in disability research.Arch Phys Med Rehabil. 2000; 81: S63-S80
- What does participation mean? An insider perspective from people with disabilities.Disabil Rehabil. 2008; 30: 1445-1460
- Measuring enfranchisement: importance and control of participation by people with disabilities.Arch Phys Med Rehabil. 2013; 94: 2157-2165
- Predicting quality of life 5 years after medical discharge for traumatic spinal cord injury.Br J Health Psychol. 2013 Aug 9; ([Epub ahead of print])
- Adjustment to spinal cord injury: stage theory revisited.Paraplegia. 1991; 29: 125-130
- Psychological morbidity and spinal cord injury: a systematic review.Spinal Cord. 2008; 47: 108-114
- Life stress and psychologic adjustment following spinal cord injury.Arch Phys Med Rehabil. 1987; 68: 344-347
- Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators.Arch Phys Med Rehabil. 2000; 81: 1099-1109
- Social support and leisure activities following severe physical disability: testing the mediating effects of depression.Basic Appl Soc Psych. 1995; 16: 471-487
- Depressive symptomatology in persons with spinal cord injury who reside in the community.Arch Phys Med Rehabil. 1993; 74: 255-260
- Psychological investigation of spinal cord injury patients.Spinal Cord. 1997; 35: 516-520
- Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap.Arch Phys Med Rehabil. 1994; 73: 175-183
- Treatment of major depression in individuals with spinal cord injury.J Spinal Cord Med. 2004; 27: 22-28
- Depression following spinal cord injury. A prospective in-patient study.Br J Psychiatry. 1989; 154: 668-671
- Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial.Rehabil Psychol. 2009; 54: 123-132
- Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being.Spinal Cord. 2003; 41: 34-43
- Productivity after injury in a sample of spinal cord injured persons: a pilot study.J Chron Dis. 1971; 24: 259-275
- Social support and depression following spinal cord injury.Rehabil Psychol. 1992; 37: 37-48
- Quantifying handicap: a new measure of long-term rehabilitation outcomes.Arch Phys Med Rehabil. 1992; 73: 519-526
- The Craig Handicap Assessment and Reporting Technique (CHART): metric properties and scoring.Top Spinal Cord Injury Med. 1998; 4: 16-30
- Predicting community reintegration after spinal cord injury from demographic and injury characteristics.Arch Phys Med Rehabil. 1999; 80: 1485-1491
- Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury.J Rehabil Med. 2005; 37: 3-8
- Principles and practice of structural equation modeling.2nd ed. Guildford Pr, New York2005
- The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2002; 16: 606-613
- Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation.Arch Phys Med Rehabil. 2012; 93: 1838-1845
- International standards for neurological classification of spinal cord injury.J Spinal Cord Med. 2003; 26: S50-S56
- Rating scales as outcome measures for clinical trials in neurology: problems, solutions, and recommendations.Lancet Neurol. 2007; 6: 1094-1105
- The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.J Pers Soc Psychol. 1986; 51: 1173-1182
- Structural equation modeling in practice: a review and recommended two-step approach.Psychol Bull. 1988; 103: 411-423
- An introduction to using structural equation models in rehabilitation psychology.Rehabil Psychol. 2008; 53: 340-356
- Testing for multigroup invariance using AMOS graphics: a road less traveled.Struct Equ Modeling. 2004; 11: 272-300
- Applications of some measures of multivariate skewness and kurtosis in testing normality and robustness studies.Sankhya Ser B. 1974; 36: 115-128
- Bootstrapping techniques in analysis of mean and covariance structures.in: Marcoulides G.A. Schemacker R.E. Advanced structural equation modeling: issues and techniques. Lawrence Erlbaum Associates, Mahwah1996: 195-226
- The prevention and treatment of complicated grief: a meta-analysis.Clin Psychol Rev. 2011; 31: 69-78
- The relationship between productivity and adjustment following spinal cord injury.Rehabil Couns Bull. 1990; 33: 188-199
- Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study.Arch Phys Med Rehabil. 2012; 93: 740-747
- Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment.Arch Phys Med Rehabil. 2011; 92: 352-360
- Exercise and well-being: a review of mental and physical health benefits associated with physical activity.Curr Opin Psychiatry. 2005; 18: 189-193
- Physical activity, social support, and family structure as determinants of mood among European-American and African-American women.Women Health. 2004; 39: 101-116
- Evidence review: efficacy and effectiveness of antidepressant treatment in primary care.Gen Hosp Psychiat. 2002; 24: 213-224
- Alternative ways of assessing model fit.in: Bollen K.A. Long J.A. Testing Structural Equation Models. Sage Publications, Thousand Oaks1993: 136-162
- Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.Struct Equ Modeling. 1999; 6: 1-55
Article info
Publication history
Published online: February 21, 2014
Footnotes
Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, U.S. Department of Education to the University of Washington, Seattle (grant nos. H133A060107 and H133N060033), University of Alabama, Birmingham (grant no. H133A060107), Rehabilitation Institute of Chicago (grant no. H133N110014), and the University of Michigan, Ann Arbor (grant no. H133N110002).
The contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated (Wong, Heinemann, Wilson, Neumann, Fann, Tate, Forchheimer, Richards).
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on the author or one or more of the authors. Bombardier reports nonfinancial support from Pfizer during the conduct of the study. Data were collected as part of a controlled trial of venlafaxine extended release for major depression after SCI, and Pfizer supplied some of the study drug.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
