Coping flexibility as predictor of distress in persons with spinal cord injury

OBJECTIVES: Examine whether coping flexibility at admission to first spinal cord injury (SCI) rehabilitation was predictive of distress one year after discharge.

DESIGN: Longitudinal inception cohort study.

SETTING: Rehabilitation center.

PARTICIPANTS: Of the 210 people admitted to their first inpatient SCI rehabilitation program, 188 met the inclusion criteria. N= 150 (80%) agreed to participate, the data of 113 participants with a complete dataset were used in the statistical analysis.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Coping flexibility was operationalized by (a) flexible adjusting goals to given situational forces and constraints (FGA) and (b) tenacious pursuit goals as a way of actively adjusting circumstances to personal preference (TGP). The Assimilative-Accommodative Coping Scale was used to measure FGA and TGP. The Hospital Anxiety and Depression Scale (HADS) was used to assess distress.

RESULTS: Scores on FGA and TGP measured at admission were negatively associated with the scales Depression (r= -.33 and -.41, respectively) and Anxiety (r= -.23 and -.30, respectively) one year after discharge. All demographic and injury-related variables at admission together explained a small percentage of the variance of Depression and Anxiety. FGA, TGP and the interaction term together explained a significant additional 16% of the variance of Depression and 10% of Anxiety.

CONCLUSION: The tendency to pursue goals early after onset of the injury seems to have a protecting effect against distress one year after discharge. People with low TGP may experience protection against distress from high FGA.