Psychological adjustment to spinal cord injury
The purpose of the present study was to investigate the relationship between depression and adjustment to spinal cord injury. Traditionally, depression has been viewed as a necessary part of adjustment to traumatic injury. The absence of depression has been equated with denial of illness, which is maladaptive and which allegedly impairs adequate psychological adjustment to the disability. The major thesis of the present study was that the absence of depression does not necessarily imply denial of illness and subsequent maladjustment. Rather, it was argued that the absence of depression favors good adjustment rather than disfavors it. That is, individuals whose emotional response styles predispose them to depression as a reaction to spinal cord injury will experience greater difficulty in adjusting to the disability than those who do not manifest such a response style. Two psychological scales were assumed to predict depression and adjustment to spinal cord injury. They were the Repressor-Sensitizer Scale and the Internal- External Locus of Control Scale. The two scales were combined to create the categories internal repressor (IR), internal sensitizer (IS), external repressor (ER), and external sensitizer (ES). The following hypotheses were generated based on a sample of 53 hospitalized male spinal cord patients: 1) Repressors will demonstrate better self-concepts as disabled persons; 2) Sensitizers will manifest more depression than repressors; 3) Of the four groups IR, IS, ER, and ES, ESs will be most depressed and IRs least depressed; and 4) Of the four groups IR, IS, ER, and ES, IRs will show best adjustment to disability and ESs will show poorest adjustment to disability. Self-concept was measured by the Litman Disability Self-Concept Scale. Depression was measured in the style of the semantic differential by having Ss rate the concept of 'meâ€� on seven evaluative scales. Adjustment ratings were obtained from physical therapists, occupational therapists and nurses. The following conclusions emerged from the study: 1) The repressor-sensitizer scale is a meaningful predictor both of self-concept and of depression for a sample of spinal cord patients. a) Repressors hold higher self-concepts than sensitizers. b) Sensitizers are more depressed than repressors. 2) The internal-external locus of control scale is a meaningful predictor of both self-concept and of depression for a sample of spinal cord patients. a) Internals hold higher self-concepts than externals. b) Externals are more depressed than internals. 3) Combining the repressor-sensitizer scale with the internal-external locus of control scale to produce the categories internal repressor (IR) and external sensitizer (ES) is a meaningful way to predict adjustment to spinal cord injury. a) Internal repressors (IRs) show best adjustment to spinal cord injury. b) External sensitizers (ESs) show poorest adjustment to spinal cord injury. 4) In the present study, the absence of depression was shown to favor good adjustment. 5) The study supports the idea that those individuals who react to spinal cord injury with depression are less well-adjusted at any given point in their rehabilitation than the individuals who do not react with depression.