Resumen de Long-term psychosocial outcomes in the population with spinal cord injury living in the community
The main aim of this thesis was to determine to what extent injury-related variables, sociodemographic characteristics or psychosocial aspects are predictive of the adjustment process among community-residing individuals with spinal cord injury (SCI). A secondary objective of this thesis was to adapt and validate into Spanish language two specific questionnaires for spinal cord injury individuals to assess pain and coping strategies respectively. This thesis is divided into three separate studies: I. Psychometric evaluation of the Spanish version of the MPI-SCI.
II. Adaptation and validation of the Spanish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL CSQ-S).
III. Depression in individuals with traumatic and non-traumatic spinal cord injury living in the community.
Participants of paper I, II and III were individuals with SCI living in the community and attended an annual comprehensive hospital check-up. Paper I encompassed 126 individuals with an SCI and chronic pain (CP) and proved that the Spanish version of the West Haven-Yale Multidimensional Pain Inventory for Spinal Cord Injury (MPI-SCI-S) is a reliable and valid measure. Its subscales have a prediction capacity over the person's perception of well-being. In paper II 511 subjects with SCI were included in the study and the results verified the robustness of the structure of the Spanish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL CSQ) and coping strategies contributed to the prediction of outcomes related to disability adaptation such as quality of life or social participation between others. In paper III a total of 831 individuals with traumatic or non-traumatic SCI were enrolled in the study and a higher prevalence of probable major depressive disorder (PMDD) was noted for individuals with a non-traumatic SCI. The results demonstrated that risk factors between the two etiologies did not differ greatly. Female sex, chronic pain, and lower levels of/difficulties in participation were associated with the presence of PMDD.
This thesis concludes that chronic pain is related to psychological distress and may be a risk factor to adaptation to disability in the population of SCI individuals. Also, provided further support for the positive effect of psychological factors such as coping strategies during adaptation to physical disabilities. Several demographic and injury-related aspects that may coexist at a greater frequency among individuals with NT-SCI seem to indicate a greater emotional vulnerability and a bigger difficulty in adapting to disability. Female sex, chronic pain, environmental barriers to participation, low mobility, low occupation score, and difficulty integrating socially should alert clinicians to an increased risk for a negative long-term outcome such as depression. Finally, the results if this thesis highlights the need for greater awareness and implementation of treatment aims to empower individuals with SCI and facilitate their smooth reintegration into the community.
