Psychological Adjustment After Spinal Cord Injury
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Psychological Adjustment after Spinal Cord Injury Useful strategies for health professionals Authors: Annalisa Dezarnaulds Clinical Psychologist, NSW SSCIS Psychosocial Strategy Coordinator, Department of Spinal Medicine, Prince of Wales Hospital, Level 2, High Street Building, Randwick NSW 2031 Dr Ralf Ilchef Clinical Senior Lecturer, Sydney Medical School–Northern; The University of Sydney; Liaison Psychiatrist, Spinal Injuries Unit, Royal North Shore Hospital Reviewed and updated in 2013 by Professor Ashley Craig, Sydney Medical School–Northern; The University of Sydney AGENCY FOR CLINICAL INNOVATION Level 4, Sage Building 67 Albert Avenue Chatswood NSW 2067 PO Box 699 Chatswood NSW 2057 T +61 2 9464 4666 | F +61 2 9464 4728 E [email protected] | www.aci.health.nsw.gov.au Produced by the ACI State Spinal Cord Injury Service SHPN (ACI) 140012 ISBN 978-1-74187-958-2 Further copies of this publication can be obtained from the Agency for Clinical Innovation website at: www.aci.health.nsw.gov.au Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written permission from the Agency for Clinical Innovation. © Agency for Clinical Innovation 2014 Published: February 2014 HS13-083 ACKNOWLEDGEMENTS First edition, 2002: This document was originally published as a fact sheet for the Rural Spinal Cord Injury Project (RSCIP), a pilot healthcare program for people with a spinal cord injury (SCI) conducted within New South Wales involving the collaboration of Prince Henry & Prince of Wales Hospitals, Royal North Shore Hospital, Royal Rehabilitation Centre Sydney, Spinal Cord Injuries Australia and the Paraplegic & Quadriplegic Association of NSW. The contributions of the following are acknowledged: Dr Peter Harradine, Dr Carmen Ast, Wendy Harris, Dr James Middleton, and Brian Mayhew. It was first published in October 2002, as part of a series of fact sheets for the RSCIP. The project was funded by the Motor Accidents Authority of NSW. Second edition, 2014: Reviewed and updated in 2013 by Professor Ashley Craig, Sydney Medical School–Northern, The University of Sydney. The revision was funded by the NSW Agency for Clinical Innovation. The work by Selina Rowe, Manager, NSW Spinal Outreach Service, Royal Rehab, Ryde, and Frances Monypenny, ACI Network Manager, State Spinal Cord Injury Service, Chatswood, NSW, Australia, in coordinating and managing the project to review and update this fact sheet, one of a suite of 10 fact sheets, is acknowledged. All recommendations are for patients with SCI as a group. Individual therapeutic decisions must be based on clinical judgment with a detailed knowledge of the individual patient’s unique risks and medical history, in conjunction with this resource. 1 ACI Psychological Adjustment after Spinal Cord Injury TABLE OF CONTENTS 1. Introduction ............................................................................................................ 3 2. MeetinG the person with A SCI FOR the first time ............................................... 4 3. The psYcholoGY of people with SCI ....................................................................... 5 4. PSYcholoGical sequelae of SCI/adjustment and copinG .................................. 6 5. PSYcholoGical complications and manaGement ............................................. 7 6. Depression Versus GrieVinG reactions followinG A SCI .................................... 8 7. Predictors of psYcholoGical VulnerabilitY and resilience followinG A SCI .............................................................................. 9 8. Suicide ...................................................................................................................... 10 9. Conclusion ...............................................................................................................11 10. Short QuiZ ............................................................................................................... 12 11. Appendices ............................................................................................................... 13 12. References ............................................................................................................... 16 2 ACI Psychological Adjustment after Spinal Cord Injury 1. INTRodUction Spinal Cord Injury (SCI) is a catastrophic injury with potential Summary devastating impacts including far-reaching physical, social and psychological consequences. Research on the • Severe emotional negative reactions following SCI are psychological impact following the sudden onset of SCI has common which can threaten both psychosocial integration shown that many will develop severe negative emotions and security, requiring attention to the long-term in response to the injury which could threaten both psychological adjustment of individuals following SCI. psychological and social integration. In the past 10 years • Successful rehabilitation involves reintegration into the substantial attention has been focussed on the dynamics community and adjustment to a very different lifestyle involved in psychological adjustment processes following with the re-establishment of satisfying relationships, SCI. Perhaps with some justification, early SCI rehabilitation roles and opportunities to express one’s own identity. research concentrated on physical and functional outcomes, • Experiencing a SCI poses a huge challenge and requires and the literature tended to concentrate on medical issues adaptation and resilience to cope in order to develop arising in the acute and rehabilitation phases in hospital. strengths and discover new ways of doing things, However, it is now accepted that a thorough appreciation not only physically, socially and vocationally, but also of the psychological and social factors associated with emotionally. adjustment is crucial for optimal rehabilitation outcomes • Each person is unique with his or her own individual following SCI. Factors that will influence psychological personality characteristics and coping style, and this adjustment will be multiple, including the effect of needs to be appreciated during rehabilitation. institutionalisation, grieving the loss of life before the injury, secondary complications like chronic pain and infections, and restrictions on social and physical mobility. Over the past 15 years or so, research has investigated the psychological and social dynamics associated with SCI adjustment, so that there is now a rich source of information arising from research detailing the short- and long-term psychological and social sequelae and adjustment to SCI. 3 ACI Psychological Adjustment after Spinal Cord Injury 2. Meeting THE peRson witH A SCI foR THE fiRst time First contact may be made with the individual soon after a Summary SCI or in the early days of hospitalisation. This phase marks the beginning of the healing process. Experiences will be • Emotional recovery following SCI is dependent on frightening and confusing for the person, highlighting the experiencing structure and normality in one’s daily importance of the first meeting. routine, and therefore it is crucial that this occur as soon as possible in the rehabilitation phase in hospital. Psychological adjustment is influenced by how people • Daily routines in the rehabilitation unit in the hospital are treated during the rehabilitation phase. Working with will help to establish some structure. people in this early phase should initially be gradual and measured, limited to relationship building and gathering • A sense of normality is created by interaction with the information. It is important to provide reassurance, various health professionals. delivered at the level people are able to accept. • It is essential that support is provided from the beginning and the individual is treated with respect as they begin to rebuild their lives, remembering that the rehabilitation process is both physically and emotionally intrusive. 4 ACI Psychological Adjustment after Spinal Cord Injury 3. THE psYCHologY of people witH SCI An injury like SCI can happen to anyone in society, although Summary active younger males are over-represented. Research suggests that there is a relationship between psychological • Anyone in society is at risk of sustaining a SCI dimensions such as personality, behaviour, perceptions with • There is a relationship between psychological aspects of adjustment after SCI, with factors like optimism, dimensions such as personality and perceptions and humour, self-efficacy and solution-focussed coping skills adjustment to SCI predicting better outcomes. Pre-injury education level could • Younger people tend to be more accepting of SCI also play a role in long-term adjustment. • There is a greater risk of depression for older people Younger people have been found to be more accepting with SCI of their injury regardless of duration. They tend to be • 40%-50% of people with SCI present with varying more flexible and open to new directions and experiences, degrees and patterns of cognitive impairment due to having a greater ability to adapt to new situations. Other TBI, which may manifest in personality, behavioural and research has found a positive relationship between cognitive changes.