Academic journal article The Journal of Rehabilitation

Depressed Mood during Rehabilitation of Persons with Spinal Injury

Academic journal article The Journal of Rehabilitation

Depressed Mood during Rehabilitation of Persons with Spinal Injury

Article excerpt

Spinal cord injuyr (SCI) represents a catastrophic interruption and alteration not only in physical functioning but psychological functioning as well. Persons who incur a spinal cord injury are faced with changes in voluntary movement, sensation and proprioception, body image, bowel and bladder functioning, and sexual functioning, to which they must adapt. Since World War II, numerous clinicians have attempted to characterize the psychological adjustment of persons who incur a spinal cord injury, and to explain how and why the typical patient reacts the way he or she does (e.g., Wittkower, Gingras, Mergler et al., 1954; Siller, 1969).

In the 1950s and '60s, one of the areas explored was the premorbid (pre-injury) psychological status of patients. For example, Mueller (1962) described hostility and uncontrolled emotionality as prominent features. A similar clinical presentation in most patients lent credence to the idea that there were premorbid features common to SCI patients. However, Trieschmann (1988) has critically reviewed the literature and concluded that there is no specific personality type associated with SCI. Rather, a suggested by Crewe and Krause (1987), adjustment to disability is congruent to that required by most major life changes. Successful adjustment to disability requires the positive characteristics seen in successful, well-adjusted persons in general, namely, high self-esteem, productivity, and the ability to maintain satisfactory relationships.

Both lay persons' and clinicians' impression of psychological adjustment after SCI appears to be founded on one of many stage theories (e.g., Gunther, 1969; Kerr and Thompson, 1972; Hohmann, 1975). These stage theories are invariably based solely on the clinical assumption that depression is a necessary, positive step in adjustment. However, the vast majority of these studies provide no empirical evidence to support this assumption (Trieschmann, 1988). As Crewe and Krause (1987) have pointed out, stage theories may be a heuristic tool in the education of family, staff and patients. However, when forcibly applied to a given patient, they become counterproductive, at the least. Stage theories usually view depression as inevitable, so much so that when it doesn't appear, it must be concluded that denial is operative (Siller, 1969).

A review of studies done to determine the incidence of depression in newly spinal cord injured persons shows vastly different rates, from 10 to 100 percent. Crewe and Krause (1987) explain this variability as resulting from the wide variety of instruments used, from staff ratings to the MMPI, and whether or not a correction for somatic symptoms resulting from the SCI itself was used. Using a unique approach, Lawson (1978) performed a daily study of 100 quadriplegic patients throughout their rehabilitation stay, and reported no clear periods of depression. Furthermore, he found evidence that staff should more actively seek to combat (rather than encourage or tolerate) the patients' depression.

Factors that have been cited as essential to the methodological adequacy of studies of SCI patients' mood include the use of multiple instruments and multiple observations; in some cases, staff may mistakenly identify despondency or grief for clinical depression. The latter was thought to be true in Fullerton et al.'s (1981) study in which the incidence of depression (at 30%) was greater than the national average (for a nondisabled population) of 5.7, but certainly not universal among the SCI patients studied. Also, patients with a diagnosis of clinical depression often have a premorbid history of depression (Gans, 1981).

The present study was developed as part of a larger project examining changes in staff perception of SCI patient mood over time. Its aim was to describe patients' subjective experience of depressed mood (not clinical depression) at regular intervals over the course of their hospitalization. …

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