OBJECTIVE: To establish self-efficacy and depressive mood trajectories in adults with spinal cord injury (SCI), determine their interrelationship over time, and determine the influence that appraisals and co-morbid physical conditions have on the development of self-efficacy.
DESIGN: A prospective cohort design. SETTING: Inpatient rehabilitation and community settings. PARTICIPANTS: Eighty-eight adults admitted consecutively into three SCI units (mean age 42.6 years, 70.4% male, 61% paraplegia). INTERVENTIONS: Multidisciplinary inpatient SCI rehabilitation. MAIN OUTCOME MEASURES: The Moorong Self-Efficacy Scale and Hospital Anxiety and Depression Scale were used to model self-efficacy and depressive mood trajectories. Appraisals were assessed by The Appraisals of Disability Scale and frequency/type of secondary conditions using the Secondary Conditions Scale. ANALYSIS: Growth mixture modelling was used to determine trajectories. Dual trajectory probability analysis was used to determine concurrent changes in self-efficacy and depressive mood. Linear mixed modelling incorporating repeated measures determined the contribution of appraisals and physical complications to self-efficacy trajectories.
RESULTS: Modelling identified four trajectories of self-efficacy and depressive mood. The majority (around 60%) of the sample was estimated to have moderate to high self-efficacy and low levels of depressive mood. Dual trajectory analysis revealed that robust self-efficacy was strongly connected to low depressive mood over time while low self-efficacy was strongly linked to clinically elevated depressive mood. Low self-efficacy was related to higher severity of secondary conditions and negative appraisals.
CONCLUSIONS: Findings highlight the importance of self-efficacy, not only as a strategic clinical measure for assessing adjustment following SCI, but they also raise implications for improving SCI rehabilitation.