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Trajectories of Self-Efficacy and Depressed Mood and Their Relationship in the First 12 Months Following Spinal Cord Injury

  • Ashley Craig
    Correspondence
    Corresponding author Ashley Craig, PhD, John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, Kolling Institute of Medical Research, The University of Sydney, Corner Reserve Road & First Avenue Royal North Shore Hospital, St Leonards NSW 2065, NSW Australia, 1680.
    Affiliations
    John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia
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  • Yvonne Tran
    Affiliations
    John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia

    Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
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  • Rebecca Guest
    Affiliations
    John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia
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  • James Middleton
    Affiliations
    John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia
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Published:September 12, 2018DOI:https://doi.org/10.1016/j.apmr.2018.07.442

      Abstract

      Objectives

      To establish self-efficacy and depressive mood trajectories in adults with spinal cord injury (SCI), determine their interrelationship over time, and determine the influence that appraisals and comorbid physical conditions have on the development of self-efficacy.

      Design

      A prospective cohort design.

      Setting

      Inpatient rehabilitation and community settings.

      Participants

      Adults (N=88) admitted consecutively into 3 SCI units (mean age, 42.6 years, 70.4% male, 61% paraplegia).

      Interventions

      Multidisciplinary inpatient SCI rehabilitation.

      Main Outcome Measures

      The Moorong Self-Efficacy Scale and Hospital Anxiety and Depression Scale were used to model self-efficacy and depressive mood trajectories. Appraisals were assessed using the Appraisals of Disability Scale and frequency/type of secondary conditions using the Secondary Conditions Scale. Growth mixture modeling was used to determine trajectories. Dual trajectory probability analysis was used to determine concurrent changes in self-efficacy and depressive mood. Linear mixed modeling incorporating repeated measures determined the contribution of appraisals and physical complications to self-efficacy trajectories.

      Results

      Modeling identified 4 trajectories of self-efficacy and depressive mood. The majority (around 60%) of the sample was estimated to have moderate to high self-efficacy and low levels of depressive mood. Dual trajectory analysis revealed that robust self-efficacy was strongly connected to low depressive mood over time, while low self-efficacy was strongly linked to clinically elevated depressive mood. Low self-efficacy was related to higher severity of secondary conditions and negative appraisals.

      Conclusions

      Findings highlight the importance of self-efficacy not only as a strategic clinical measure for assessing adjustment following SCI but also in relation to the implications it raises for improving SCI rehabilitation.

      Keywords

      List of abbreviations:

      ADAPSS (Appraisals of Disability Primary and Secondary Scale), BIC (Bayesian information criterion), DM (depressive mood), GBTM (group-based trajectory modeling), HADS (Hospital Anxiety and Depression Scale), MSES (Moorong Self-Efficacy Scale), SCI (spinal cord injury), SCI-SCS (SCI Secondary Conditions Scale)
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