Abstract
Objectives
In a sample of wheelchair users with spinal cord injury (SCI), the objectives were
to investigate which participant characteristics are associated with greater perceived
discrimination in the health care setting, and how such discrimination relates to
health outcomes of pain and depressive symptoms.
Design
Survey, cross-sectional.
Setting
Spinal Cord Injury Model Systems (SCIMS) Center.
Participants
Full-time wheelchair users with SCI from 9 SCIMS centers (N=410), with data collected
between 2011 and 2016.
Interventions
N/A.
Main Outcomes
A 7-item questionnaire inquiring about perceived discrimination by hospital staff,
self-reported pain severity over the past month using a 0-10 Numeric Rating Scale,
and depressive symptoms using the 2-question Patient Health Questionnaire screener.
Results
Participants who were black or from the lowest income group were more likely to report
experiencing more discrimination than those who were white or from the highest income
group, respectively (incidence rate ratio=2.2-2.6, P<.01). Those who reported more perceived discrimination had greater risk of severe
pain compared to no pain (relative risk [RR]=1.11; 95% confidence interval [95% CI],
1.01-1.23; P<.05), mild depressive symptoms (RR=1.09; 95% CI, 1.02-1.17; P<.05), and severe depressive symptoms (RR=1.12; 95% CI, 1.04-1.21; P<.05) compared to no symptoms.
Conclusions
Wheelchair users with SCI who were from more disadvantaged groups (black, lower income
levels) reported experiencing more discrimination in their health care setting. Furthermore,
those who reported more discrimination were more likely to report worse mental and
physical health outcomes. Attempts to reduce discrimination in health care settings
may lead to better outcomes for people with SCI. These observations were correlational
and not causal; a prospective analysis is necessary to prove causation. Future investigations
should further explore the effect of discrimination on the many facets of living with
an SCI.
Keywords
List of abbreviations:
95% CI (95% confidence interval), PHQ (Patient Health Questionnaire), RR (relative risk), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model System)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 15, 2019
Footnotes
Supported by resources and the use of facilities at the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA. The contents of this paper do not represent the views of the Department of Veterans Affairs or the United States Government. Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant nos. 90SI5008 [Pittsburgh, 2011-2016], 90SI5014 [Pittsburgh, 2016-2021], 90SI5011 [Kessler, 2011-2016], 90SI5026 [Kessler, 2016-2021]). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government. Also supported by the National Science Foundation Graduate Research Fellowship (grant no. 1247842), National Science Foundation IGERT Fellowship (DGE grant no. 1144584), and a Derfner Foundation Regenerative Rehabilitation Postdoctoral Fellowship. The contents of this publication do not necessarily reflect the view of the National Science Foundation or the Derfner Foundation.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
