The literature concerning the psychological consequences following spinal cord injury (SCI) indicates a discordance between clinical impressions and empirical research. Although many studies report that psychological morbidity is not an inevitable consequence of SCI, much of this research is characterised by methodological inadequacies and the conclusions are therefore tenuous. The present study assessed 41 persons with SCI for depression and anxiety using objective psychological measures on three occasions over the first year of SCI and compared them with 41 able bodied controls matched for age, sex, education and, as far as possible, occupation. Results demonstrated significant differences between the two groups, with the SCI group being more anxious and depressed. However, psychological morbidity was not an inevitable consequence of SCI, with group means reflecting mild levels of depression and anxiety. No significant differences were found across time and no interactions between groups and time were detected. Implications for the treatment of SCI are discussed.

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Anxiety and depression over the first year of spinal cord injury: a longitudinal study

Objectives. To develop and evaluate a brief group-based psychological intervention for improving psychological adjustment and enhancing adaptive coping following spinal cord injury. The Coping Effectiveness Training (CET) programme is grounded on the cognitive theory of stress and coping of Lazarus & Folkman (1984), and represents an original adaptation of the theory to the needs of this client group.



Design. A controlled trial comparing patients receiving the CET intervention to matched controls in measures of psychological adjustment and coping was used.



Methods. Nineteen intervention group participants and 19 matched controls were selected from in-patients at a hospital-based spinal injury rehabilitation centre. Outcome measures of depression, anxiety and coping were collected before, immediately after and six weeks after the intervention.



Results. Intervention group participants showed significantly greater reductions in levels of depression (p<.01) and anxiety (p<.05) compared to matched controls immediately after the intervention and at six weeks follow-up. There was no evidence of a significantly greater change in the coping strategies used by the intervention group. Participants highlighted their interactions with other group members as the most helpful aspect of the intervention.



Conclusions. This evidence suggests that the CET intervention facilitated a significant improvement in psychological adjustment to spinal cord injury. It is proposed this may be understood in terms of changes in participants appraisal of the implications of spinal cord injury and of the coping skills needed to continue living meaningful and satisfying lives.

Coping effectiveness training for people with spinal cord injury : Preliminary results of a controlled trial

Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy.

Although increased attention has been directed toward the special risks for substance misuse of persons with disabilities, there continues to be a paucity of epidemiologic data detailing prevalence and potential etiologies for use. This review describes the research problems contributing to the limited findings in the field. The risk factors of special relevance to persons with disabilities are discussed, and the data related to specific disabilities are presented. A hierarchy of research needs is suggested, along with several working hypotheses concerning substance use/misuse and persons with disabilities. Finally, current issues impacting intervention and treatment services in this field are discussed.

Rogers Es

Papers

The mental health needs of individuals with severe physical disability: a consumer advocate perspective.