A comparison of posttraumatic stress disorder in veterans with and without spinal cord injury. Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury. Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial. Anxiety and depression after spinal cord injury: a longitudinal analysis. Spinal cord injury: a search for determinants of depression two years after the event. Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. Resilience following spinal cord injury: A prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation. Predicting posttraumatic stress symptoms from pretraumatic risk factors: a 2-year prospective follow-up study in firefighters. Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy. Myocardial Infarction - Stress PRevention INTervention (MI-SPRINT) to reduce the incidence of posttraumatic stress after acute myocardial infarction through trauma-focused psychological counseling: study protocol for a randomized controlled trial Preliminary investigation of the lateral postural stability of spinal cord-injured individuals subjected to dynamic perturbations Coping effectiveness training for people with spinal cord injury: preliminary results of a controlled trial. Mechanical ventilation, health, and quality of life following spinal cord injury. Depression and Posttraumatic Stress Disorder at Three Months After Mild to Moderate Traumatic Brain Injury Immunizing against depression and anxiety after spinal cord injury. Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury Psychological intervention during spinal rehabilitation: a preliminary study
The authors assessed effects of  paraplegic and quadriplegic spinal cord injuries ( SCIs )  on posttraumatic stress disorder ( PTSD ) by comparing severity and prevalence of PTSD in these groups to a sample of controls who experienced traumatic injuries other than SCI . The authors found that veterans with quadriplegia reported significantly less severe current PTSD symptoms than controls who were not significantly different from veterans with paraplegia . These results suggest that sustaining a quadriplegic SCI decreases risk of current PTSD , whereas sustaining a paraplegic SCI is associated with greater risk of PTSD , although the risk is no greater than that incurred from experiencing the trauma itself OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI PURPOSE To compare coping effectiveness training ( CET ) with supportive group therapy ( SGT ) for  anxiety , depression , and adjustment to injury in an acute spinal cord injury/dysfunction ( SCI/D ) rehabilitation population .  CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups ( Kennedy , Duff , Evans , & Beedie , 2003 ; King & Kennedy , 1999 ) . The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition , SGT . RESEARCH METHOD Participants ( N = 40 ) entering a hospital-based program were assigned to treatment condition using block r and omization . Question naire mood measures were completed at program admission , program discharge , and 3-month postdischarge follow-up . Adjustment to disability was assessed at follow-up only . Analyses of variance tested for group differences in anxiety , depression , and adjustment to injury . RESULTS Both groups reported reductions in mood symptoms with no differences between treatment conditions . However , similar reductions were obtained after fewer sessions of CET .  Symptoms of depression increased in both groups following hospital discharge . CONCLUSIONS Clinical and research implication s , including innovative interventions during the period after discharge , are discussed OBJECTIVE To examine the prevalence of anxiety and depression longitudinally in a sample of patients with a spinal cord injury ( SCI ) . DESIGN A prospect i ve , longitudinal , multiple wave panel design with measures taken on 14 observational periods ranging from initial contact in the acute stages of hospitalization to 2 years ' postdischarge to the community . SETTING The National Spinal Injuries Centre , Stoke M and eville Hospital , Aylesbury , UK , and the general community . PARTICIPANTS The cohort consisted of 104 patients with traumatic SCI ( 19 women , 85 men ) , although the numbers assessed at each interval ranged from 5 to 85 . MAIN OUTCOME MEASURES Measures included the Beck Depression Inventory , the Beck Hopelessness scale , the State Anxiety Inventory , the functional independence measure , and the Social Support Question naire . RESULTS When examined longitudinally , the data illustrate a consistent pattern of results across measures , with scores highest in the acute phase of the injury and during the months leading up to discharge . CONCLUSION The numbers of persons scoring above clinical cut-off scores for anxiety and depression highlight the need to continue to ensure that appropriate psychological care is available within SCI rehabilitation setting s. Moreover , the nature of the longitudinal results provides an indicator of subtle changes in anxiety and depression over time A prospect i ve longitudinal study employing repeated measures was used to isolate factors which might predispose a person to depression two years after sustaining spinal cord injury ( SCI ) . Thirty-one subjects who suffered acute spinal injuries result ing in permanent loss of movement , and who had no head injuries or any pre-existing psychopathology , were at least 17 years of age , and who were able to speak English , participated in the study . Using the Beck Depression Inventory ( BDI ) as a measure of depression , a regression analysis demonstrated that the experience of pain two years post-injury and feeling out of control of one 's life prior to hospital discharge were predictive of depression two years post-injury . No demographic variables or injury characteristics such as level of lesion or completeness of lesion were related to long-term depression .  Pain management and rehabilitation techniques that enhance the individual 's belief of control over their lives are therefore recommended as interventions that could act to reduce depression in the long term in persons with spinal cord injury OBJECTIVE To extend the findings of a pilot study that evaluated a brief group-based psychological intervention aim ed at improving psychological adjustment , self-perception and enhancing adaptive coping following spinal cord injury . The theoretical underpinnings of the Coping Effectiveness Training ( CET ) Programme are Lazarus and Folkman 's ( 1984 ) cognitive theory of stress and coping , and cognitive behavioural therapy techniques . DESIGN A controlled trial comparing patients that received the CET intervention with matched controls on measures of psychological adjustment and coping . METHOD A total of 45 intervention group participants and 40 matched controls were selected from in patients at a hospital-based spinal cord injury centre . Outcome measures of anxiety and depression , self-perception and coping were collected before , immediately after and 6 weeks following the intervention . RESULTS Intervention group participants showed a significant reduction in depression and anxiety , compared to the matched controls following the intervention . There was no evidence of a significant change in the pattern of coping strategies used by the intervention group compared to controls . The intervention group alone completed measures of self-perception . There was a significant decrease in the discrepancy between participants ' ' ideal ' self and ' as I am ' , and between ' as I would be without the injury ' and ' as I am ' following the intervention and at follow-up . Significant correlations were also found between self-perception , and anxiety and depression over time . CONCLUSIONS These results confirm the findings of the pilot study , that the CET intervention facilitated a significant improvement in psychological adjustment to spinal cord injury . It is proposed that this improvement may be understood in terms of changing participants ' negative appraisal s of the implication s of spinal cord injury with the result of increasing the perceived manageability of its consequences . Such decatastrophizing alters appraisal s which are associated with current mood . Participants found shared discussion and problem-solving to be particularly helpful . Avenues for further research are discussed PURPOSE To examine change in resilience in people with spinal cord injury ( SCI ) when  group cognitive behavior therapy ( GCBT ) was added to routine psychosocial rehabilitation ( RPR ) . RESEARCH METHOD / DESIGN A prospect i ve repeated- measures cohort design was used to determine the efficacy of the addition of  GCBT ( n = 50 ) . The control group consisted of individuals receiving RPR  , which included access to individual CBT ( ICBT ) when required  ( n = 38 ) . Groups were assessed on 3 occasions : soon after admission , within 2 weeks of discharge , and 6-months postdischarge . Measures included sociodemographic , injury , and psychosocial factors . The outcome variable was resilience , considered an important outcome measure for recovery . To adjust for baseline differences in self-efficacy , depressive mood and anxiety between the 2 groups , these factors were entered into a repeated measures multivariate analysis of covariance ( MANCOVA ) as covariates . Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups . RESULTS The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group . Trajectory data indicated over 60 % were demonstrating acceptable resilience irrespective of group . CONCLUSION / IMPLICATION S Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes . Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration . Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to underst and complex trajectories . Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience OBJECTIVE Most studies focusing on risk factors for posttraumatic stress disorder ( PTSD ) have used retrospective study design s. Only a small number of studies have prospect ively examined risk factors in the immediate aftermath of trauma exposure in predicting PTSD symptoms . The purpose of this study was to identify predictive risk factors for posttraumatic stress symptoms and comorbid psychopathological symptoms present during the time before exposure to traumatic stress in a high-risk population . METHOD Forty-three professional firefighters were assessed immediately after basic training  ( baseline ) and at 6 , 9 , 12 , and 24 months after entry into firefighter service .  Subjects were screened for psychopathological symptoms , including symptoms of PTSD , depression , and anxiety . Subjects were also characterized with regard to personality traits such as self-efficacy , hostility , and alexithymia . Neuroendocrine activity was assessed by examination of awakening and diurnal salivary cortisol profiles and 24-hour urinary catecholamine excretion . Multiple linear regression analysis was used to analyze posttraumatic stress symptoms at 24-month follow-up as a function of pretraumatic characteristics . RESULTS A high level of hostility and a low level of self-efficacy at baseline accounted for 42 % of the variance in posttraumatic stress symptoms after 2 years . Subjects who had both risk factors at baseline showed a significant increase in measures of PTSD symptoms , depression , anxiety , general psychological morbidity , global symptom severity , and alexithymia during the 2-year period . Biological characteristics were not predictive of the development of psychopathological symptoms . CONCLUSIONS These results suggest that specific personality traits may constitute markers of vulnerability to the development of psychopathological symptoms after trauma exposure . Early identification of preexisting risk factors is needed to provide effective prevention and intervention for individuals who are at risk of developing trauma-related disorders OBJECTIVE Although there are many anecdotal reports that psychological intervention is effective in enhancing adjustment to spinal cord injury ( SCI ) , there are little data to support this assertion . To date , reports of few longitudinal-based controlled trials that assessed psychological outcomes for SCI persons have been published . This study was conducted to determine long-term efficacy of cognitive behavior therapy during rehabilitation . DESIGN The study employed a nonr and omized controlled trial , and measures were taken on three occasions : before , immediately after , and 12 months after treatment . SETTING , OUTCOME MEASURES , AND INTERVENTION : Anxiety , depressive mood , and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hospital , who participated in  specialized group cognitive behavior therapy ( CBT ) during rehabilitation . CONTROLS The intervention group 's responses on the measures were compared with a  control group of 41 SCI persons who only received traditional rehabilitation services during their hospitalization . RESULTS There were no overall group differences on anxiety , depressive mood , and self-esteem , although there was a trend for the treatment group to have greater levels of improvement in depression scores across time in comparison to the control group . However , those in the treatment group who reported high levels of depressive mood before the CBT treatment were significantly less depressed 1 year after injury , compared to similar persons in the control group . CONCLUSIONS While it appears not everyone who experiences SCI needs CBT , at least in the hospital phase of their rehabilitation , those who report high levels of depressive mood benefited greatly from CBT Background Posttraumatic Stress Disorder ( PTSD ) may occur in patients after exposure to a life-threatening illness . About one out of six patients develop clinical ly relevant levels of PTSD symptoms after acute myocardial infa rct ion ( MI ) . Symptoms of PTSD are associated with impaired quality of life and increase the risk of recurrent cardiovascular events . The main hypothesis of the MI-SPRINT study is that trauma-focused psychological counseling is more effective than non-trauma focused counseling in preventing posttraumatic stress after acute MI . Methods / Design The study is a single-center , r and omized controlled psychological trial with two active intervention arms . The sample consists of 426 patients aged 18 years or older who are at ' high risk ’ to develop clinical ly relevant posttraumatic stress symptoms . ' High risk ’ patients are identified with three single-item questions with a numeric rating scale ( 0 to 10 ) asking about ' pain during MI ’ , ' fear of dying until admission ’ and /or ' worrying and feeling helpless when being told about having MI ’ . Exclusion criteria are emergency heart surgery , severe comorbidities , current severe depression , disorientation , cognitive impairment and suicidal ideation . Patients will be r and omly allocated to a single 45-minute counseling session targeting either specific MI-triggered traumatic reactions ( that is , the verum intervention ) or the general role of psychosocial stress in coronary heart disease ( that is , the control intervention ) . The session will take place in the coronary care unit within 48 hours , by the bedside , after patients have reached stable circulatory conditions . Each patient will additionally receive an illustrated information booklet as study material . Sociodemographic factors , psychosocial and medical data , and cardiometabolic risk factors will be assessed during hospitalization . The primary outcome is the interviewer-rated posttraumatic stress level at three-month follow-up , which is hypothesized to be at least 20 % lower in the verum group than in the control group using the t-test . Secondary outcomes are posttraumatic stress levels at 12-month follow-up , and psychosocial functioning and cardiometabolic risk factors at both follow-up assessment s. Discussion If the verum intervention proves to be effective , the study will be the first to show that a brief trauma-focused psychological intervention delivered within a somatic health care setting can reduce the incidence of posttraumatic stress in acute MI patients .Trial registration Clinical Trials.gov : Study Design : A study of the impact of spinal cord injury ( SCI ) on seated balance was conducted by comparing the results obtained from experiments with able-bodied and SCI subjects . Objectives : The purpose of this preliminary study was to examine the lateral postural stability of seated individuals with SCI in a dynamic environment . Setting : Experiments were conducted at the Clevel and Clinic Foundation in Clevel and , Ohio . Methods : Controlled perturbations were applied to each subject , seated in a wheelchair , through the use of a servo-controlled tilt platform . The platform was rotated so as to create disturbances similar in nature to those experienced in the frontal plane during left turns in a vehicle . Four quadriplegic , four paraplegic , and five able-bodied subjects participated in this study . Kinematic information and center of pressure ( COP ) movement were recorded . Results : None of the spinal cord-injured subjects was able to maintain his stability when exposed to the stronger perturbations , while all of the able-bodied subjects stayed upright for all of the trials . On an individual basis , injury level was not always indicative of balance . However , regression results suggest a correlation between ability to perform static leaning and dynamic balance ( P<0.001 ) . Conclusions : SCI subjects lost stability under dynamic conditions even though they were stable in the static situation . Initial results also raise some questions about where and when external support may be needed . Information of this nature could help to guide the design of new lateral supports with improved client acceptance 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 implication s of spinal cord injury and of the coping skills needed to continue living meaningful and satisfying lives OBJECTIVE To examine differences in perceived quality of life ( QOL ) at 1 year postinjury between people with tetraplegia who required mechanical ventilation assistance at discharge from rehabilitation and those who did not . DESIGN Prospect i ve cross-sectional examination of people with spinal cord injury ( SCI ) drawn from the SCI Model Systems National Data base . SETTING Community . PARTICIPANTS People with tetraplegia ( N=1635 ) who sustained traumatic SCI between January 1 , 1994 , and September 30 , 2008 , who completed a 1-year follow-up interview , including 79 people who required at least some use of a ventilator at discharge from rehabilitation . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Satisfaction With Life Scale ( SWLS ) ; Craig H and icap Assessment and Reporting Technique (CHART)-Short Form Physical Independence , Mobility , Social Integration , and Occupation subscales ; Patient Health Question naire-9 ( PHQ-9 ) , Medical Outcomes Study 36-Item Short-Form Health Survey self-perceived health status . RESULTS Significant differences were found between the ventilator-user ( VU ) group and non-ventilator-user ( NVU ) group for cause of trauma , proportion with complete injury , neurologic impairment level , and number of rehospitalizations . The NVU group had significantly higher SWLS and CHART Social Integration scores than the VU group after controlling for selected covariates . The NVU group also had more positive perceived health status compared with a year previously and a lower incidence of depression assessed by using the PHQ-9 than the VU group . There were no significant differences between groups for perceived current health status . CONCLUSIONS People in this study who did not require mechanical ventilation at discharge from rehabilitation post-SCI reported generally better health and improved QOL compared with those who required ventilator assistance at 1 year postinjury . Nonetheless , the literature suggests that perceptions of QOL improve as people live in the community for longer periods To investigate the frequency and risk factors of major depressive disorder ( MDD )  after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To further report on the effectiveness of early psychological intervention in reducing anxiety and depressive mood in persons with spinal cord injury 2 years after injury . DESIGN A nonr and omized , longitudinal , controlled trial . SETTING , OUTCOME MEASURES , AND INTERVENTION : Twenty-eight spinal cord injured persons participated in group cognitive behavior therapy  during  hospital rehabilitation . They were assessed for depressive mood and anxiety before , immediately after , and 12 and 24 months after treatment . The intervention group 's responses on the measures were compared with a control group of 31 spinal cord injured persons who only received traditional rehabilitation services during their hospitalization . RESULTS Subjects in the treatment group with high depression and anxiety scores before treatment were significantly less depressed and reduced their anxiety to a greater extent 2 years after the injury in comparison with similar persons in the control group . CONCLUSIONS Group cognitive behavior therapy for spinal cord injured persons who are abnormally depressed and anxious appears to reduce depressive mood and anxiety in the short and long term & NA ; Distinct developmental trajectories for neck disability and posttraumatic stress disorder ( PTSD ) symptoms after whiplash injury have recently been identified . This study aim ed to identify baseline predictors of membership to these trajectories and to explore their dual development . In a prospect i ve study , 155 individuals with whiplash were assessed at < 1 month , 3 , 6 , and 12 months postinjury . Outcomes at each time point were assessed according to the Neck Disability Index and the Posttraumatic Stress Diagnostic Scale . Baseline predictor variables were age , gender , initial pain ( based on a visual analogue scale [ VAS ] ) , pressure pain thresholds ( PPT ) , cold pain thresholds ( CPT ) , and sympathetic vasoconstrictor responses . Group‐based trajectory analytical techniques were used to parameterise the optimal trajectories and to identify baseline predictors . A dual trajectory analysis was used to explore probabilities of conditional and joint trajectory group membership . CPT ⩾ 13 ° C ( OR = 26.320 , 95 % CI = 4.981–139.09 ) , initial pain level ( VAS ) ( OR = 4.3 , 95 % CI = 4.98–139.1 ) , and age ( OR = 1.109 , 95 % CI = 1.043–1.180 ) predicted a chronic/severe disability trajectory . The same baseline factors also predicted chronic moderate/severe PTSD ( CPT ⩾ 13 ° C , OR = 9.7 , 95%CI = 2.22–42.44 ; initial pain level [ VAS ] : OR = 2.13 , 95 % CI = 1.43–3.17 ; age : OR = 1.07 , 95 % CI = 1.01–1.14 ) . There was good correspondence of trajectory group for both disability and PTSD . These findings support the proposal of links between the development of chronic neck related disability and PTSD after whiplash injury . Developmental trajectories of disability and posttraumatic stress disorder ( PTSD ) after whiplash injury are mostly in synchrony , and similar factors predict their membership . This suggests links between the development of chronic neck pain‐related disability and PTSD Study design : A repeated measures , non-r and omised controlled trial . Objective : To examine the effectiveness of individualised cognitive behaviour therapy ( CBT ) on the psychological adjustment of patients undergoing rehabilitation for newly acquired spinal cord injury . Setting : South Australian Spinal Cord Injury Service , Hampstead Rehabilitation Centre , South Australia , Australia . Methods : Eleven participants received individual CBT as part of their spinal rehabilitation .  Self-reported levels of depression , anxiety and stress were assessed before the intervention , at week 12 of rehabilitation and at 3 months post-discharge , using the depression , anxiety and stress scales ( DASS-21 ) . Functional independence was also assessed , using the Functional Independence Measure ( FIM ) . Responses were compared with 13 participants , closely matched on demographic and injury variables , who received  st and ard psychological care ( that is , assessment and monitoring only ) . Results : Depression scores for treatment participants showed a significant time effect , with worsening symptoms reported at three-month follow-up , after CBT was discontinued . In contrast , the DASS-21 scores of st and ard care participants remained at sub clinical levels throughout the study . Clinical improvements in symptoms of anxiety and stress were also reported by the treatment group as inpatient therapy progressed . Conclusion : Targeted , individualised psychological treatment contributed to short-term , meaningful improvements in emotional outcomes for individuals reporting psychological morbidity after recent spinal injury . The results also highlight the need for ongoing access to specialised , psychological services post-discharge . Replication of these results with a larger sample is required before definitive conclusions can be drawn
Conclusion : Combinations of peri- and post-injury factors appear to be influential in the development of PTSD among persons with SCI .
Objectives : To summarise quantitatively the available evidence relating to pretraumatic , peritraumatic and posttraumatic characteristics that may increase or decrease the risk of developing posttraumatic stress disorder ( PTSD ) following spinal cord injury ( SCI ) .