Adaptation During Spinal Cord Injury Rehabilitation: The Role of Appraisal and Coping

摘要

Impact and Implications This is the first longitudinal study testing the Spinal Cord Injury Adjustment model (SCIAM) in the inpatient rehabilitation setting.Different from what is hypothesized in the SCIAM, psychological resources, social support, and cognitive appraisals were not only associated with the adaptation outcomes by influencing the way individuals cope with their SCI, but also by directly contributing to lower levels of depressive or anxiety symptoms. Thus, interventions targeting appraisals and psychological resources (e.g., self-efficacy, optimism, or purpose in promote a better course of the psychological adaptation process during SCI rehabilitation. When testing adaptation models, considering other elements of the coping process beyond the use of specific coping strategies (e.g., coping flexibility) is needed to advance the understanding of the psychological adaptation process to SCI. Objective: To test the spinal cord injury adjustment model (SCIAM) by examining whether primary appraisals (threat or loss) and coping strategies (approach-oriented and denial) sequentially mediate the impact of functional independence, psychological resources, and social support on depressive and anxiety symptoms among individuals with spinal cord injury during inpatient rehabilitation. Method: Path analyses of longitudinal data from a Swiss inception cohort study (N = 207). Models were implemented separately for depressive and anxiety symptoms. Results: The initial models based on the SCIAM yielded poor fit and were respecified. Different from the SCIAM's assumptions, psychological resources and threat appraisal showed direct effects on depressive symptoms (beta = -.28, SE = .07, p < .001 and beta = .33, SE = .07, p < .001, respectively), while social support and threat appraisal showed direct effects on anxiety symptoms (beta = -.23, SE = .06, p < .001 and beta = .42, SE = .06, p < .001, respectively). Primary appraisals and coping strategies partially mediated the effects of psychological resources on depressive symptoms and fully mediated their effect on anxiety symptoms. However, this did not only happen via the SCIAM's sequential double mediation, since indirect effects were also observed via threat appraisal only. The final models explained 40 and 30% of the variance of depressive and anxiety symptoms, respectively. Conclusions: The findings only partially supported the SCIAM's sequential double mediation mechanism. Psychological resources, social support, and primary appraisals can have direct effects on psychological adaptation outcomes and may be suitable intervention targets during inpatient rehabilitation.