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A Cross-Sectional Study to Investigate the Effects of Perceived Discrimination in the Health Care Setting on Pain and Depressive Symptoms in Wheelchair Users With Spinal Cord Injury

  • Nathan Hogaboom
    Correspondence
    Corresponding author Nathan Hogaboom, PhD, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052.
    Affiliations
    Department of Spinal Cord Injury Research, Kessler Foundation, West Orange, NJ

    Department of Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ

    Department of Physical Medicine and Rehabilitation, Rutgers New Jersey School of Medicine, Newark, NJ
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  • Denise C. Fyffe
    Affiliations
    Department of Spinal Cord Injury Research, Kessler Foundation, West Orange, NJ

    Department of Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ

    Department of Physical Medicine and Rehabilitation, Rutgers New Jersey School of Medicine, Newark, NJ
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  • Amanda L. Botticello
    Affiliations
    Department of Spinal Cord Injury Research, Kessler Foundation, West Orange, NJ

    Department of Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ

    Department of Physical Medicine and Rehabilitation, Rutgers New Jersey School of Medicine, Newark, NJ
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  • Lynn A. Worobey
    Affiliations
    Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
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  • Michael L. Boninger
    Affiliations
    Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
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Published:August 15, 2019DOI:https://doi.org/10.1016/j.apmr.2019.06.016

      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)
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