Longitudinal changes in psychological adaptation outcomes during spinal cord injury inpatient rehabilitation

Rehabil Psychol. 2021 Nov;66(4):491-506. doi: 10.1037/rep0000396. Epub 2021 Nov 4.


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. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

MeSH terms

  • Adaptation, Psychological
  • Cohort Studies
  • Humans
  • Inpatients
  • Male
  • Neurological Rehabilitation*
  • Spinal Cord Injuries*