Depression after spinal cord injury : a multimeasure longitudinal study

dc.contributor.committeeMemberWillems, Edwin P.
dc.contributor.committeeMemberMillham, James F.
dc.contributor.committeeMemberRozelle, Richard M.
dc.contributor.committeeMemberTannenbaum, Sol
dc.contributor.committeeMemberVineberg, Shalom E.
dc.creatorLawson, Norman C.
dc.description.abstractSevere spinal cord injury provides an important opportunity to study the ways in which people react emotionally to a loss of bodily functions. Whether there is a period of depressive affect or grief and whether there are events in the rehabilitation process associated with depressive or elative reactions are two questions whose answers require a longitudinal approach. In this study, 10 quadriplegic patients were studied five days per week for the entire length of their hospital stay (Average = 119 days) at the Texas Institute for Rehabilitation and Research. Each patient dictated a nightly record (what, when, with whom, emotional reactions) of each day's events into a portable tape recorder. These recordings were analyzed for events which stood out or were significant in comparison to the usual events occurring in the patient's day. Once such a significant event was identified, further corroboration was sought in hospital records such as nursing notes. These events were grouped into categories. Each category was then t-tested against the group of days on which no significant events occurred (control days) on the following four measures of depressive affect: (a) a self-report measure obtained from daily responses by each patient to a semantic differential checklist; (b) a behavioral measure (words per minute) obtained from the first three minutes of uninterrupted speech in the daily taping session; (c) an interpersonal measure obtained by averaging semantic differential checklists filled out daily by four hospital staff members working closely with the patient; (d) an endocrine measure obtained by measuring the daily output of urinary tryptamine. Results indicate that there were no clear periods of depressive affect but that there was a slight slope from more depression to less depression over the course of the hospital stay. Average level of depressive affect was also not found to be significantly related to level of injury or age. Preliminary indications of a posthospital study suggest that level of depressive affect while in the hospital is inversely related to two posthospital outcome measures, employment and independence of living arrangements. A total of 43 categories of significant events were identified and compared to control days. Eleven other events, found only in taping sessions were grouped into two categories. Positive Personal Events and Negative Personal Events, and t-tested against the group of control days. All categories with a N of five days or more were tested for direction away from control days on all four dependent measures of depressive affect. Seventy-four per cent were found to be in the predicted direction. Then, all categories with an N of 10 days or more were t-tested for significance against the control group of days. Of the 60 t-tests run (four per category for 15 categories) 23 were significant at the .05 level or better and 12 more were significant at the .20 level or better (Total = 65%). When the categories of significant events were rank ordered according to their distance from the control group of days Negative Personal Events, Told About Prognosis, and Negative Doctors' Verdicts were associated with the greatest average depressive affect while Last Five Days in Hospital, Day and Weekend Passes, and Discharge Conference were associated with the greatest average elative affect. Of nine hypotheses tested, three were confirmed, three were partially confirmed, two were not confirmed, and one was not able to be tested due to insufficient data. The longitudinal, multilevel aspects of this study permitted further clarification of the results of two previous studies. The identification and evaluation of events seen as significant by patients may well have clinical and programmatic implications for hospital staff. Two examples are the following: (a) Special care would appear helpful prior to the patient's prognosis conference, and (b) Events whose timing is at the discretion of hospital staff might be spread out or rearranged.
dc.description.departmentPsychology, Department of
dc.format.digitalOriginreformatted digital
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dc.titleDepression after spinal cord injury : a multimeasure longitudinal study
dcterms.accessRightsThe full text of this item is not available at this time because it contains documents that are presumed to be under copyright and are accessible only to users who have an active CougarNet ID. This item will continue to be made available through interlibrary loan. of Social Sciences, Department of of Houston of Philosophy


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