Psychosocial Considerations in Spinal Cord Injury

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Introduction[edit | edit source]

Spinal cord injury (SCI) has the potential of resulting in devastating consequences after occurrence.[1] Often, the management of SCI is centered on the motor, sensory, and autonomic dysfunctions, yet SCI can have tremendous psychosocial consequences on affected individuals.[2][3][4] Research has shown that many with sudden onset of SCI will exhibit extreme negative emotions after a SCI which can impair psychological as well as social integration after an injury.[1] Also, mental health problems such as anxiety, depression, post traumatic stress disorder among others may be at an elevated level for people with SCI,[3][4] with psychological and social factors having a role to play in both the incidence and progression of these mental health problems.[5] Thus, it is necessary to pay attention to these psychosocial factors which may have extreme consequences on achieving remarkable rehabilitation goals and improving the quality of life of people with SCIs,[1]

Incidence of Psychosocial Issues in Patients with Spinal Cord Injury[edit | edit source]

The advances in the medical management following spinal cord injury has increased the life expectancy of patients in recent years.[6] Yet SCI leads to considerable physical disability and also secondary medical complications[2]. Furthermore, there has been reports of abnormal incidence of substance abuse,[7] psychological morbidity,[8] and risk of suicide in patients with spinal cord injury.[7]

A research showed that psychological and social support factors are related to subjective well being in patients with SCI.[3] A systematic review on psychological morbidity in revealed that up to 30% of people with SCI are at the risk of having a depressive disorder, with higher relative risk of anxiety disorder, increased level of anxiety, poor quality of life (QoL) and feelings of helplessness.[8]

In a study[9] in Iran on psychosocial outcomes following SCI, there were findings of psychosocial problems that were associated with financial hardship, basically due to unemployment, high cost of living, with other factors such as difficulty in transportation, inadequate home modifications, marriage, social communication, education, sports and entertainment. These issues were also found to vary with the gender of persons with SCI.[9]

Psychosocial Factors in Spinal Cord Injury[edit | edit source]

The occurrence of SCI is statistically determined to be around the second to the third decade of life. [10] This period corresponds to an important period of emotional and psychological development for many people.[1] Therefore, the psychology of the patient with SCI is affected, and this is influenced by culture, conditions, and settings in a community. [9] These psychosocial factors may feature early after a SCI, and continue into individual's life, requiring adjustments and adaptions in order to improve the quality of life of the patient, and overall outcome of care.[1] There is a link described between psychological dimensions such as personalities, perceptions and adjustments to SCI, with younger individuals more accepting of SCI than older individuals.[1]

Psychosocial Reactions to SCI[edit | edit source]

The psychological and social reaction following spinal cord injury in an individual may include the following:[1][3][4][5]

  • Depression
  • Post-traumatic stress disorder
  • Suicidal thinking or lack of desire to live
  • Apathy and not caring about life
  • Inability to provide self-care and follow medical advice
  • Marital and relationship conflict
  • Lack of motivation for vocational or educational pursuits
  • Feeling trapped in the family surroundings
  • Unnecessary dependency on others
  • Social Isolation
  • Negative body image or shame
  • Feelings of worthlessness
  • Low self esteem
  • Anger and aggression
  • Shame and embarrassment
  • Feelings of helplessness and hopelessness
  • High levels of stress
  • Self-Blame

Psychosocial Considerations in Spinal Cord Injury[edit | edit source]

With increasing evidence depicting elevated levels of depression in people with SCI,[8] as well as negative psychosocial states such as anxiety and a reduction in the quality of life of people with spinal cord injuries[1], it is important that appropriate considerations should be applied to psychosocial issues in SCI. According to Dezarnaulds and Ilchef,[1] about 40% of patients recently diagnosed with SCI can have an accompanying psychiatric diagosis, with common ones including substance abuse disorders, delirium, depressive disorders and adjustment disorders.

Thus, individuals with SCI must receive psychosocial treatment in a bid to decrease psychosocial morbidity and improve general quality of life.[8][6] The aim of these treatments would primarily be to improve perceptions of control, improve mood, elevate the level of social engagement, increase level of self-management, improve employability, increase understanding and influence of injury on important aspects of life such as physical and mental health, and sexuality.[11][12][13]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Dezarnaulds A, Ilchef R. Psychological adjustment after spinal cord injury. Useful Strategies for Health Professionals. Agency for Clinical Innovation. 2014.
  2. ↑ 2.0 2.1 Dijkers MP. Quality of life of individuals with spinal cord injury: a review of conceptualization, measurement, and research findings. Journal of rehabilitation research and development. 2005 May 1;42(3):87.
  3. ↑ 3.0 3.1 3.2 3.3 Post MW, Van Leeuwen CM. Psychosocial issues in spinal cord injury: a review. Spinal cord. 2012 May;50(5):382-9.
  4. ↑ 4.0 4.1 4.2 North NT. The psychological effects of spinal cord injury: a review. Spinal cord. 1999 Oct;37(10):671-9.
  5. ↑ 5.0 5.1 Chevalier Z, Kennedy P, Sherlock O. Spinal cord injury, coping and psychological adjustment: a literature review. Spinal Cord 2009; 47: 778–782.
  6. ↑ 6.0 6.1 Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM . Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006; 87: 1079–1085.
  7. ↑ 7.0 7.1 North NT . The psychological effects of spinal cord injury: a review. Spinal Cord 1999; 37: 671–679.
  8. ↑ 8.0 8.1 8.2 8.3 Craig A, Tran Y, Middleton J . Psychological morbidity and spinal cord injury. Spinal Cord 2009; 47: 108–114.
  9. ↑ 9.0 9.1 9.2 Khazaeipour Z, Norouzi-Javidan A, Kaveh M, Khanzadeh Mehrabani F, Kazazi E, Emami-Razavi SH. Psychosocial outcomes following spinal cord injury in Iran. The journal of spinal cord medicine. 2014 May 1;37(3):338-45.
  10. ↑ Chamberlain, J.D., Deriaz, O., Hund-Georgiadis, M. et al. Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland. Inj. Epidemiol. 2, 28 (2015). https://doi.org/10.1186/s40621-015-0061-4
  11. ↑ Mehta, S., Aubut, J-A. L., Legassic, M., Orenczuk, S., Hansen, K. T., Hitzig, S. L., & Teasell, R. W. An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabilitation Psychology 2011; 56 :15 -25.
  12. ↑ Middleton J., Craig A. Psychological challenges in treating persons with spinal cord injury. In A. Craig and y. Tran (Eds.). Psychological dynamics associated with spinal cord injury rehabilitation: New directions and best evidence. New york: Nova Science Publishers, 2008.
  13. ↑ Middleton J., Tran y., Craig A. Relationship between quality of life and self-efficacy in persons with spinal cord injuries. Archives of Physical Medicine and Rehabilitation 2007; 88:1643-1648.
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