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Prediction of Psychological Distress Among Persons With Spinal Cord Injury or Acquired Brain Injury and Their Significant Others

  • Eline W.M. Scholten
    Affiliations
    Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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  • Marjolijn Ketelaar
    Affiliations
    Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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  • Johanna M.A. Visser-Meily
    Affiliations
    Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
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  • Ellen H. Roels
    Affiliations
    University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
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  • Mirjam Kouwenhoven
    Affiliations
    Department of Neurological Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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  • POWER Group
  • Marcel W.M. Post
    Correspondence
    Corresponding author Marcel W.M. Post, PhD, De Hoogstraat Rehabilitation, Rembrandtkade 10, 3583 TM, Utrecht, The Netherlands.
    Affiliations
    Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
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      Abstract

      Objectives

      To identify intra- and interpersonal sociodemographic, injury-related, and psychological variables measured at admission of inpatient rehabilitation that predict psychological distress among dyads of individuals with spinal cord injury (SCI) or acquired brain injury (ABI) and their significant others (ie, individuals close to the individual with a disability, mostly family members) 6 months after discharge. Differences in predictors were investigated for persons with SCI or ABI and their significant others and were compared between diagnoses.

      Design

      Prospective longitudinal study.

      Setting

      Twelve Dutch rehabilitation centers.

      Participants

      Dyads (N=157) consisting of adults with SCI or ABI who were admitted to inpatient rehabilitation and their adult significant others.

      Interventions

      Not applicable.

      Main Outcome Measures

      Psychological distress (Hospital Anxiety and Depression Scale).

      Results

      Sociodemographic and injury-related variables were not or were only weakly associated with psychological distress among individuals with SCI or ABI and their significant others 6 months after discharge. Bivariately, higher baseline psychological distress, lower scores on adaptive psychological characteristics (combination of self-efficacy, proactive coping, purpose in life, resilience), and higher scores on maladaptive psychological characteristics (combination of passive coping, neuroticism, appraisals of threat and loss) were related to higher psychological distress, as well as crosswise between individuals with SCI or ABI and their significant others, although less strongly. Combined prediction models showed that psychological distress among persons with SCI or ABI was predicted by education level of their significant other, their own baseline psychological distress, and their own maladaptive psychological characteristics (explained variance, 41.9%). Among significant others, only their own baseline psychological distress predicted psychological distress (explained variance, 40.4%). Results were comparable across diagnoses.

      Conclusions

      Although a dyadic connection was shown, primarily one's own baseline psychological distress and psychological characteristics were important in the prediction of later psychological distress among both individuals with SCI or ABI and their significant others. Screening based on these variables could help to identify persons at risk for psychological distress.

      Keywords

      List of abbreviations:

      ABI (acquired brain injury), A-PC (adaptive psychological characteristics scale), HADS (Hospital Anxiety and Depression Scale), MANCOVA (multivariate analysis of covariance), M-PC (maladaptive psychological characteristics scale), pwABI (persons with ABI), pwSCI (persons with SCI), SCI (spinal cord injury), USER (Utrecht Scale for Evaluation of Rehabilitation)
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