Citation

Wong AW, Heinemann AW, Wilson CS, Neumann H, Fann JR, Tate DG, Forchheimer M, Richards JS, Bombardier CH. Arch. Phys. Med. Rehabil. 2014; 95(6): 1106-1113.

Affiliation

Department of Rehabilitation Medicine, University of Washington School of Medicine.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.apmr.2014.01.027

PMID

24561060

Abstract

OBJECTIVES: (1) To examine the mediating effects of depressive symptoms on the relationships between employment, grief, depression treatment, and participation enfranchisement following spinal cord injury (SCI), and (2) to examine the moderating role of demographic and injury characteristics including gender, race, marital status, education, and injury level and completeness on these relationships. DESIGN: Cross-sectional survey design as part of the Project to Improve Symptoms and Mood after SCI (PRISMS). SETTING: Five rehabilitation facilities participating in the PRISMS study. PARTICIPANTS: Persons with SCI (N=522) enrolled from 2007 to 2011. Participants were an average of 42 years old, 76% male, 64% white, and 64% completed at least a high school education. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation enfranchisement. RESULTS: The final model fit the data relatively well (CFI= 0.939, TLI= 0.894, RMSEA = 0.066, 90% CI: 0.043-0.089), 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 use of an antidepressant or psychotherapy were related to participation enfranchisement; these relationships were mediated by depressive symptoms. Multi-group analyses supported the model's invariance across gender, 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 following SCI. These relationships are applicable regardless of gender, 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.

Language: en