Objectives: This article reviews literature examining the psychological adjustment to Spinal
Cord Injury (SCI) and illustrates the applicability of a Stress Appraisal and Coping model
(SAC) for rehabilitation of this population.
Method: Articles concerning psychological adjustment to SCI from the previous three
decades have been reviewed and critiqued. When possible the articles have been discussed in a
SAC framework.
Results: The literature indicates that psychological adjustment to SCI is largely predictable
from psychological variables including coping, appraisal and psychosocial resources. Recent
literature has suggested psychological intervention can promote positive psychological
adjustment following SCI for those individuals at risk of developing clinical levels of
depression.
Conclusion: The SAC model provides a comprehensive formulation to incorporate the
heterogeneity of populations with SCI. Suggestions for future research include developing
assessment and treatment regimes speci®cally tailored to the strengths and weaknesses of an
individual as highlighted in the model.
Spinal Cord (2001) 39, 615 ± 627
Keywords: stress; appraisal; coping; spinal cord injury
Introduction
Recovery from a spinal cord injury (SCI) requires
signi®cant ongoing psychological adjustment. For
example, 30% to 40% of individuals with a SCI
develop a depressive disorder1 ± 4 and between 20% and
25% experience an anxiety disorder.3,4 Longitudinal
studies of adjustment have found that psychological
distress does not decrease signi®cantly over time. An
estimated 30% of individuals still experience depression
or anxiety at 2 years after injury.5 Suicide rates are two
to six times higher in populations with SCI than in
community populations.6 In addition to clinical
depression and anxiety, SCI has been shown to have
a signi®cant impact on a variety of other areas of
psychological functioning. For example, the prevalence
of substance abuse in populations with SCI's is twice
as high as that of community populations (46% vs
25%).7 However, diculty exists in stating high rates
of abuse in this population are related to the injury
when rates of misuse in this population have been
found to be high before injury.7 Furthermore, divorce
rates in marriages are higher for those with a SCI than
the general population.8 Finally, ®nancial and occupa-
tional opportunities are restricted for this population.9
An important task in rehabilitation is the promo-
tion of successful adjustment of both the individual
with SCI and his or her signi®cant others. Adaptation
to SCI is a complex process and variability in
emotional adjustment to injury has characterised the
literature in this area. For those working with injured
individuals and their families, an increased under-
standing of the psychosocial and emotional conse-
quences of SCI could be facilitated by a clearly
articulated model of the in¯uences on psychological
adjustment following injury. This article describes a
stress appraisal coping formulation of emotional
adjustment to SCI. This model proposes general rules
underlying adaptation to stressful life events and also
recognises conditions that re¯ect dierences in in-
dividuals and their environments. By including envir-
*Correspondence: L Galvin, Psychology Department, University of
Otago, PO Box 56, Dunedin, New Zealand
Spinal Cord (2001) 39, 615 ± 627
ã 2001 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/01 $15.00
www.nature.com/sc
Objectives: This article reviews literature examining the psychological adjustment to SpinalCord Injury (SCI) and illustrates the applicability of a Stress Appraisal and Coping model(SAC) for rehabilitation of this population.Method: Articles concerning psychological adjustment to SCI from the previous threedecades have been reviewed and critiqued. When possible the articles have been discussed in aSAC framework.Results: The literature indicates that psychological adjustment to SCI is largely predictablefrom psychological variables including coping, appraisal and psychosocial resources. Recentliterature has suggested psychological intervention can promote positive psychologicaladjustment following SCI for those individuals at risk of developing clinical levels ofdepression.Conclusion: The SAC model provides a comprehensive formulation to incorporate theheterogeneity of populations with SCI. Suggestions for future research include developingassessment and treatment regimes speci®cally tailored to the strengths and weaknesses of anindividual as highlighted in the model.Spinal Cord (2001) 39, 615 ± 627Keywords: stress; appraisal; coping; spinal cord injuryIntroductionRecovery from a spinal cord injury (SCI) requiressigni®cant ongoing psychological adjustment. Forexample, 30% to 40% of individuals with a SCIdevelop a depressive disorder1 ± 4 and between 20% and25% experience an anxiety disorder.3,4 Longitudinalstudies of adjustment have found that psychologicaldistress does not decrease signi®cantly over time. Anestimated 30% of individuals still experience depressionor anxiety at 2 years after injury.5 Suicide rates are twoto six times higher in populations with SCI than incommunity populations.6 In addition to clinicaldepression and anxiety, SCI has been shown to havea signi®cant impact on a variety of other areas ofpsychological functioning. For example, the prevalenceof substance abuse in populations with SCI's is twiceas high as that of community populations (46% vs25%).7 However, diculty exists in stating high ratesof abuse in this population are related to the injurywhen rates of misuse in this population have beenfound to be high before injury.7 Furthermore, divorcerates in marriages are higher for those with a SCI thanthe general population.8 Finally, ®nancial and occupa-tional opportunities are restricted for this population.9An important task in rehabilitation is the promo-tion of successful adjustment of both the individualwith SCI and his or her signi®cant others. Adaptationto SCI is a complex process and variability inemotional adjustment to injury has characterised theliterature in this area. For those working with injuredindividuals and their families, an increased under-standing of the psychosocial and emotional conse-quences of SCI could be facilitated by a clearlyarticulated model of the in¯uences on psychologicaladjustment following injury. This article describes astress appraisal coping formulation of emotionaladjustment to SCI. This model proposes general rulesunderlying adaptation to stressful life events and alsorecognises conditions that re¯ect dierences in in-dividuals and their environments. By including envir-*Correspondence: L Galvin, Psychology Department, University ofOtago, PO Box 56, Dunedin, New ZealandSpinal Cord (2001) 39, 615 ± 627ã 2001 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/01 $15.00www.nature.com/sc
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วัตถุประสงค์: Objectives: This article reviews literature examining the psychological adjustment to Spinal
ความคิดเห็นบทความนี้วรรณกรรมการตรวจสอบการปรับตัวทางจิตวิทยาเพื่อกระดูกสันหลังบาดเจ็บโค้ด(SCI) และแสดงให้เห็นถึงการบังคับใช้ในการประเมินความเครียดและการเผชิญปัญหาแบบจำลองCord Injury (SCI) and illustrates the applicability of a Stress Appraisal and Coping model
(SAC) สำหรับการฟื้นฟูสมรรถภาพของประชากรกลุ่มนี้. (SAC) for rehabilitation of this population.
วิธีการ: บทความเกี่ยวกับการปรับตัวทางจิตวิทยาเพื่อ SCI Method: Articles concerning psychological adjustment to SCI from the previous three
จากสามก่อนหน้าทศวรรษที่ผ่านมาได้รับการตรวจสอบและวิเคราะห์ decades have been reviewed and critiqued. When possible the articles have been discussed in a
SAC framework.
Results: The literature indicates that psychological adjustment to SCI is largely predictable
from psychological variables including coping, appraisal and psychosocial resources. Recent
literature has suggested psychological intervention can promote positive psychological
adjustment following SCI for those individuals at risk of developing clinical levels of
depression.
Conclusion: The SAC model provides a comprehensive formulation to incorporate the
heterogeneity of populations with SCI. Suggestions for future research include developing
assessment and treatment regimes speci®cally tailored to the strengths and weaknesses of an
individual as highlighted in the model.
Spinal Cord (2001) 39, 615 ± 627
Keywords: stress; appraisal; coping; spinal cord injury
Introduction
Recovery from a spinal cord injury (SCI) requires
signi®cant ongoing psychological adjustment. For
example, 30% to 40% of individuals with a SCI
develop a depressive disorder1 ± 4 and between 20% and
25% experience an anxiety disorder.3,4 Longitudinal
studies of adjustment have found that psychological
distress does not decrease signi®cantly over time. An
estimated 30% of individuals still experience depression
or anxiety at 2 years after injury.5 Suicide rates are two
to six times higher in populations with SCI than in
community populations.6 In addition to clinical
depression and anxiety, SCI has been shown to have
a signi®cant impact on a variety of other areas of
psychological functioning. For example, the prevalence
of substance abuse in populations with SCI's is twice
as high as that of community populations (46% vs
25%).7 However, diculty exists in stating high rates
of abuse in this population are related to the injury
when rates of misuse in this population have been
found to be high before injury.7 Furthermore, divorce
rates in marriages are higher for those with a SCI than
the general population.8 Finally, ®nancial and occupa-
tional opportunities are restricted for this population.9
An important task in rehabilitation is the promo-
tion of successful adjustment of both the individual
with SCI and his or her signi®cant others. Adaptation
to SCI is a complex process and variability in
emotional adjustment to injury has characterised the
literature in this area. For those working with injured
individuals and their families, an increased under-
standing of the psychosocial and emotional conse-
quences of SCI could be facilitated by a clearly
articulated model of the in¯uences on psychological
adjustment following injury. This article describes a
stress appraisal coping formulation of emotional
adjustment to SCI. This model proposes general rules
underlying adaptation to stressful life events and also
recognises conditions that re¯ect dierences in in-
dividuals and their environments. By including envir-
*Correspondence: L Galvin, Psychology Department, University of
Otago, PO Box 56, Dunedin, New Zealand
Spinal Cord (2001) 39, 615 ± 627
ã 2001 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/01 $15.00
www.nature.com/sc
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