Trajectories of Self-Efficacy, Depressed Mood, and Anxiety From Admission to Spinal Cord Injury Rehabilitation to 1 Year After Discharge



      Self-efficacy (SE) is an important determinant for the psychological adjustment of people with spinal cord injury (SCI). However, little is known about the course of SE during inpatient rehabilitation up to 1 year after discharge. The aim of this study was to determine latent trajectory classes of SE, depressive mood, and anxiety in people with SCI, as well as the interrelationships between these trajectories.


      Longitudinal inception cohort study.


      Eight specialized SCI rehabilitation centers.


      The participants (N=268) were mainly men 183 of 268 (68.3%) with a mean age of 55.6 years. Almost half had a traumatic SCI 135 of 268 (50.4%) and tetraplegia (53.7%), and the minority had a motor complete SCI (32.2%).


      Not applicable.

      Main Outcome Measures

      SE was measured using the University of Washington Self-Efficacy Scale. In addition, the Hospital Anxiety and Depression Scale was used to asses distress and perform dual trajectory modeling analyses.


      Three trajectories of SE, indicating low, middle, and high SE, could be distinguished. Furthermore, a 2-class trajectory solution for depressive mood and a 4-class solution for anxiety were found to be most suitable. All trajectories were stable over time. Developmental connections between SE and depressive mood and between SE and anxiety were revealed. In particular, participants who adjusted well, reporting low scores on depressive mood and anxiety, could be identified by their high SE scores. However, the group of participants with high depressive mood scores and anxiety scores could not always be identified based on their SE trajectory.


      In accordance with our hypotheses, distinct trajectories of SE, depressive mood, and anxiety were identified and high probabilities that SE trajectories were interrelated to the trajectories from depressive mood and anxiety were confirmed. Concurrent screening for SE and distress might best detect people at risk for adjustment problems.


      List of abbreviations:

      GBTM (group-based trajectory modeling), HADS (Hospital Anxiety and Depression Scale), SCI (spinal cord injury), SE (self-efficacy), UW-SES (University of Washington self-efficacy Scale)
      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 access
      One-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 to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Craig A
        • Nicholson Perry K
        • Guest R
        • Tran Y
        • Middleton J
        Adjustment following chronic spinal cord injury: determining factors that contribute to social participation.
        Br J Health Psychol. 2015; 20: 807-823
        • Craig A
        • Nicholson Perry K
        • Guest R
        • et al.
        Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury.
        Arch Phys Med Rehabil. 2015; 96: 1426-1434
        • van Leeuwen CMC
        • Kraaijeveld S
        • Lindeman E
        • Post MWM.
        Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review.
        Spinal Cord. 2012; 50: 174-187
        • van Leeuwen CMC
        • Post MWM
        • van Asbeck FWA
        • et al.
        Life satisfaction in people with spinal cord injury during the first five years after discharge from inpatient rehabilitation.
        Disabil Rehabil. 2012; 34: 76-83
        • Williams R
        • Murray A.
        Prevalence of depression after spinal cord injury: a meta-analysis.
        Arch Phys Med Rehabil. 2015; 96: 133-140
        • Moussavi S
        • Chatterji S
        • Verdes E
        • Tandon A
        • Patel V
        • Ustun B.
        Depression, chronic diseases, and decrements in health: results from the world health surveys.
        Lancet. 2007; 370: 851-858
        • Le J
        • Dorstyn D.
        Anxiety prevalence following spinal cord injury: a meta-analysis.
        Spinal Cord. 2016; 54: 570-578
        • Craske MG
        • Stein MB.
        Lancet. 2016; 388: 3048-3059
        • Peter C
        • Müller R
        • Post MWM
        • van Leeuwen CMC
        • Werner CS
        • Geyh S.
        Psychological resources, appraisals, and coping and their relationship to participation in spinal cord injury: a path analysis.
        Arch Phys Med Rehabil. 2014; 95: 1662-1671
        • van Diemen T
        • Crul T
        • van Nes I
        • Group SELF-SCI
        • Geertzen JH
        • Post MW.
        Associations between self-efficacy and secondary health conditions in people living with spinal cord injury: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2017; 98: 2566-2577
        • Bandura A
        • Adams NE
        • Beyer J.
        Cognitive processes mediating behavioral change.
        J Pers Soc Psychol. 1977; 35: 125-139
        • Bisson T
        • Newsam CJ.
        Short-duration, high-intensity bouts of physical therapy to increase self-efficacy, confidence, and function in an individual with incomplete spinal cord injury: a case report.
        Physiother Theory Pract. 2017; 33: 888-895
        • Craig A
        • Tran Y
        • Guest R
        • Middleton J.
        Trajectories of self-efficacy and depressed mood and their relationship in the first 12 months following spinal cord injury.
        Arch Phys Med Rehabil. 2019; 100: 441-447
        • Geyh S
        • Nick E
        • Stirnimann D
        • Ehrat S
        • Michel F
        • Peter C
        • Lude P.
        Self-efficacy and self-esteem as predictors of participation in spinal cord injury–an ICF-based study.
        Spinal Cord. 2012; 50: 699-706
        • Wijenberg MLM
        • Van Heugten CM
        • Van Mierlo ML
        • Visser-Meily JMA
        • Post MWM.
        Psychological factors after stroke: are they stable over time?.
        J Rehabil Med. 2019; 51: 18-25
        • Giesbrecht EM
        • Miller WC.
        Effect of an mHealth wheelchair skills training program for older adults: a feasibility randomized controlled trial.
        Arch Phys Med Rehabil. 2019; 100: 2159-2166
        • Silveira SL
        • Ledoux TA
        • Johnston CA
        • et al.
        Well on wheels intervention: satisfaction with life and health for adults with spinal cord injuries.
        J Spinal Cord Med. 2020; 43: 60-68
        • Driver S
        • Warren AM
        • Reynolds M
        • et al.
        Identifying predictors of resilience at inpatient and 3-month post-spinal cord injury.
        J Spinal Cord Med. 2016; 39: 77-84
        • Kunz S
        • Joseph S
        • Geyh S
        • Peter C.
        Perceived posttraumatic growth and depreciation after spinal cord injury: actual or illusory?.
        Heal Psychol. 2019; 38: 53-62
        • Guest RR
        • Craig A
        • Nicholson Perry K
        • et al.
        Resilience following spinal cord injury: a prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation.
        Rehabil Psychol. 2015; 60: 311-321
        • Dorsett P
        • Geraghty T
        • Sinnott A
        • Hope Acland R.
        coping and psychosocial adjustment after spinal cord injury.
        Spinal Cord Ser Cases. 2017; 3: 17046
        • Boat AA
        • Weiler LM
        • Bailey M
        • Haddock S
        • Henry K.
        Mentor's self-efficacy trajectories during a mentoring program for at-risk adolescents.
        J Prim Prev. 2019; 40: 575-589
        • Blanchard CM
        • Arthur HM
        • Gunn E.
        Self-efficacy and outcome expectations in cardiac rehabilitation: associations with women's physical activity.
        Rehabil Psychol. 2015; 60: 59-66
        • Sweet SN
        • Tulloch H
        • Fortier MS
        • Pipe AL
        • Reid RD.
        Patterns of motivation and ongoing exercise activity in cardiac rehabilitation settings: a 24-month exploration from the TEACH study.
        Ann Behav Med. 2011; 42: 55-63
        • McAuley E
        • Mailey EL
        • Mullen SP
        • et al.
        Growth trajectories of exercise SE in older adults influence of measures and initial status.
        Healh Psychol. 2011; 30: 75-83
        • van Diemen T
        • Scholten EW
        • van Nes IJ
        • Group S-S
        • Geertzen JH
        • Post MW.
        Self-management and self-efficacy in patients with acute spinal cord injuries: protocol for a longitudinal cohort study.
        JMIR Res Protoc. 2018; 7: e68
      1. American Spinal Injury Association. ASIA e-learning center. Available at: Accessed May 13,2017.

        • Amtmann D
        • Bamer AM
        • Cook KF
        • Askew RL
        • Noonan VK
        • Brockway JA.
        University of Washington Self-Efficacy Scale: a new self-efficacy scale for people with disabilities.
        Arch Phys Med Rehabil. 2012; 93: 1757-1765
        • Cijsouw A
        • Adriaansen JJE
        • Tepper M
        • et al.
        Associations between disability-management self-efficacy, participation and life satisfaction in people with long-standing spinal cord injury.
        Spinal Cord. 2017; 55: 47-55
        • Post MWM
        • Adriaansen JJE
        • Peter C.
        Rasch analysis of the University of Washington Self-Efficacy Scale short-form (UW-SES-6) in people with long-standing spinal cord injury.
        Spinal Cord. 2018; 56: 1095-1101
        • Sakakibara BM
        • Miller WC
        • Orenczuk SG
        • Wolfe DL.
        A systematic review of depression and anxiety measures used with individuals with spinal cord injury.
        Spinal Cord. 2009; 47: 841-851
        • Hallin P
        • Sullivan M
        • Kreuter M.
        Spinal cord injury and quality of life measures: a review of instrument psychometric quality.
        Spinal Cord. 2000; 38: 509-523
        • Spinhoven P
        • Ormel J
        • Sloekers PP
        • Kempen GI
        • Speckens AE
        • Van Hemert AM.
        A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects.
        Psychol Med. 1997; 27: 363-370
        • Zigmond AS
        • Snaith RP.
        The Hospital Anxiety and Depression Scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Goretzko D
        • Heumann C
        • Bühner M.
        Investigating parallel analysis in the context of missing data: a simulation study comparing six missing data methods.
        Educ Psychol Meas. 2020; 80: 756-774
        • Nagin DS.
        Group-based modeling of development.
        Harvard University Press, Cambridge, MA2005
        • Nagin DS
        • Odgers CL.
        Group-based trajectory modeling in clinical research.
        Annu Rev Clin Psychol. 2010; 6: 109-138
        • Muthén LK
        • Muthén BO.
        Statistical analysis with latent variables: Mplus user's guide.
        Eighth edition. Muthén & Muthén, Los Angeles2009
        • Reinecke J
        • Seddig D.
        Growth mixture models in longitudinal research.
        AStA Adv Stat Anal. 2011; 95: 415-434
        • Nylund KL
        • Asparouhov TI
        • Muthén BO.
        Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study.
        Struct Equ Model. 2007; 14: 535-569
        • Lo Y
        • Mendell NR
        • Rubin DB.
        Testing the number of components in a normal mixture.
        Biometrika. 2001; 88: 767-778
        • Bentler PM
        • Chou C-P.
        Practical issues in structural modeling.
        Sociol Methods Res. 1987; 16: 78-117
        • Xie H
        • Mchugo GJ
        • He X
        • Drake RE.
        Using the group-based dual trajectory model to analyze two related longitudinal outcomes.
        J Drug Issues. 2010; 40: 45-62
        • Bandura A.
        Self-efficacy: toward a unifying theory of behavioral change.
        Psychol Rev. 1977; 84: 191-215
        • van Diemen T
        • Craig A
        • van Nes IJW
        • et al.
        Enhancing our conceptual understanding of state and trait self-efficacy by correlational analysis of four self-efficacy scales in people with spinal cord injury.
        BMC Psychol. 2020; 8: 108
        • Miller SM.
        The measurement of self-efficacy in persons with spinal cord injury: psychometric validation of the moorong self-efficacy scale.
        Disabil Rehabil. 2009; 31: 988-993
        • Hampton NZ.
        Subjective well-being among people with spinal cord injuries: the role of self-efficacy, perceived social support, and perceived health.
        Rehabil Couns Bull. 2004; 48: 31-37
        • Pang MY
        • Eng JJ
        • Lin KH
        • Tang PF
        • Hung C
        • Wang YH.
        Association of depression and pain interference with disease-management self-efficacy in community-dwelling individuals with spinal cord injury.
        J Rehabil Med. 2009; 41: 1068-1073
        • Craig A
        • Tran Y
        • Siddall P
        • et al.
        Developing a model of associations between chronic pain, depressive mood, chronic fatigue, and self-efficacy in people with spinal cord injury.
        J Pain. 2013; 14: 911-920
        • Horn W
        • Yoels W
        • Wallace D
        • Macrina D
        • Wrigley M.
        Determinants of self-efficacy among persons with spinal cord injuries.
        Disabil Rehabil. 1998; 20: 138-141
        • Bonanno GA
        • Kennedy P
        • Galatzer-Levy IR
        • Lude P
        • Elfström ML.
        Trajectories of resilience, depression, and anxiety following spinal cord injury.
        Rehabil Psychol. 2012; 57: 236-247
        • Bombardier CH
        • Hoekstra T
        • Dikmen S
        • Fann JR.
        Depression trajectories during the first year after traumatic brain injury.
        J Neurotrauma. 2016; 33: 2115-2124
      2. van Diemen T. Self-management, self-efficacy, and secondary healthconditions in people with spinal cord injury [dissertation]. Groningen, The Netherlands: University of Groningen; 2020. Accessed July 9, 2021.

        • Williams RT
        • Heinemann AW
        • Neumann HD
        • et al.
        Evaluating the psychometric properties and responsiveness to change of 3 depression measures in a sample of persons with traumatic spinal cord injury and major depressive disorder.
        Arch Phys Med Rehabil. 2016; 97: 929-937