Longitudinal Changes in Psychological Adaptation Outcomes During Spinal Cord Injury Inpatient Rehabilitation

Impact and Implications Although the psychological adaptation process to a spinal cord injury (SCI) may extend over years, improvements in mental health and life satisfaction can be observed at the group level during SCI inpatient rehabilitation. Still, at the individual level, different adaptation patterns such as improvement, resilience, or vulnerability can be identified. Clinicians should be aware that resilient responses in some adaptation outcomes may coexist with vulnerability in other outcomes. These findings highlight the importance screening processes during inpatient rehabilitation to detect early signs of psychological adaptation issues, and the need for psychosocial support extending beyondinpatient rehabilitation. Specific psychosocial factors can be targeted during inpatient rehabilitation to promote a more favorable psychological adaptation process across different outcomes with more general self-efficacy and social support contributing to improvement in depressive symptoms and optimism to improvements in distress and life satisfaction.

Objectives: To determine average changes and individuals' patterns of change in depressive symptoms, anxiety symptoms, general distress, and life satisfaction between admission to spinal cord injury inpatient rehabilitation and discharge; and to identify factors associated with change. Method: Longitudinal data collection as part of a national cohort study (N = 281). Changes in the psychological adaptation outcomes were analyzed using latent change score models. Reliable change indexes were calculated for each outcome to identify individuals' patterns of change. Biopsychosocial factors were examined as covariates of change. Results: On average, depressive symptoms, anxiety symptoms, and general distress decreased between admission and discharge, while life satisfaction increased. According to the reliable change indexes, several adaptation patterns were identified. The proportion of individuals following each pattern varied depending on the analyzed outcome: resilience (absence of clinically relevant symptoms at admission and discharge) was the most common for symptoms of depression (61.57%) and anxiety (66.55%), whereas vulnerability (clinically relevant symptoms at both measurement times) was the most common for distress (57.32%). Improvement patterns (statistically significant decreases) were identified for 6.41%, 4.27%, and 7.83% of participants in depressive symptoms, anxiety symptoms and distress, respectively. For life satisfaction, improvement (statistically significant increases) was found for 8.54%. Male sex, tetraplegia, self-efficacy, optimism, and social support were associated with average changes in the psychological adaptation outcomes. Conclusions: On average, participants showed improvement in all analyzed outcomes. Still, there is substantial variability in change. Self-efficacy, social support, and optimism are potential intervention targets during inpatient rehabilitation to promote a favorable psychological adaptation process.