Alex W K Wong1, Allen W Heinemann2, Catherine S Wilson3, Holly Neumann4, Jesse R Fann5, Denise G Tate6, Martin Forchheimer6, J Scott Richards7, Charles H Bombardier8. 1. Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL. Electronic address: wwong@ric.org. 2. Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL. 3. Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; James A. Haley Veterans' Hospital, Tampa, FL. 4. Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL. 5. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA. 6. Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI. 7. Department of Psychiatry, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Spain Rehabilitation Center, Birmingham, AL. 8. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
Abstract
OBJECTIVES: (1) To examine the mediating effects of depressive symptoms on the relations between employment, grief, depression treatment, and participation enfranchisement after spinal cord injury (SCI); and (2) to examine the moderating role of demographic and injury characteristics, including sex, race, marital status, education, and injury level, and completeness on these relations. DESIGN: Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS). SETTING: Rehabilitation facilities. PARTICIPANTS: Persons with SCI (N=522; average age, 42 y; 76% men; 64% white; 64% completed at least a high school education) enrolled from 2007 to 2011. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participation enfranchisement. RESULTS: The final model fit the data relatively well (comparative fix index=.939; Tucker-Lewis Index=.894; root mean square error of approximation=.066; 90% confidence interval, .043-.089), explaining 32% of the variance in participation enfranchisement. Enfranchisement was positively related to employment and negatively related to depression. Grieving the loss of a loved one and the use of an antidepressant or psychotherapy were related to participation enfranchisement; these relations were mediated by depressive symptoms. Multigroup analyses supported the model's invariance across sex, marital status, severity of injury, and level of injury. CONCLUSIONS: Depression appears to mediate the influence of employment, grief, and depression treatments on participation enfranchisement after SCI. These relations are applicable regardless of sex, marital status, and injury completeness and level. These findings highlight efforts to improve the detection and treatment of depression in SCI rehabilitation programs that may enhance participation.
OBJECTIVES: (1) To examine the mediating effects of depressive symptoms on the relations between employment, grief, depression treatment, and participation enfranchisement after spinal cord injury (SCI); and (2) to examine the moderating role of demographic and injury characteristics, including sex, race, marital status, education, and injury level, and completeness on these relations. DESIGN: Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS). SETTING: Rehabilitation facilities. PARTICIPANTS: Persons with SCI (N=522; average age, 42 y; 76% men; 64% white; 64% completed at least a high school education) enrolled from 2007 to 2011. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participation enfranchisement. RESULTS: The final model fit the data relatively well (comparative fix index=.939; Tucker-Lewis Index=.894; root mean square error of approximation=.066; 90% confidence interval, .043-.089), explaining 32% of the variance in participation enfranchisement. Enfranchisement was positively related to employment and negatively related to depression. Grieving the loss of a loved one and the use of an antidepressant or psychotherapy were related to participation enfranchisement; these relations were mediated by depressive symptoms. Multigroup analyses supported the model's invariance across sex, marital status, severity of injury, and level of injury. CONCLUSIONS:Depression appears to mediate the influence of employment, grief, and depression treatments on participation enfranchisement after SCI. These relations are applicable regardless of sex, marital status, and injury completeness and level. These findings highlight efforts to improve the detection and treatment of depression in SCI rehabilitation programs that may enhance participation.