Trajectories of Resilience, Depression, and Anxiety Following Spinal Cord Injury
Trajectories of Resilience, Depression, and Anxiety Following Spinal Cord Injury
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DOI：
10.1037/a0029256
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发表时间：
2012-08-01
影响因子：
2.7
通讯作者：
Elfstrom, Mangus L.
中科院分区：
文献类型：
--
作者：
Bonanno, George A.;Kennedy, Paul;Elfstrom, Mangus L.
目的：研究脊髓损伤(SCI)后抑郁和焦虑症状的纵向轨迹及其预测因素。研究方法/设计：一项对233名参与者的纵向研究，在4个时间点进行评估：受伤后6周内、3个月内、1年内和2年内。使用潜在生长混合模型对数据进行分析，以确定抑郁和焦虑轨迹的最佳拟合模型。在住院期间评估的协变量被探索为轨迹的预测因子。结果：对抑郁和焦虑症状的分析显示出3个相似的潜在类型：稳定的低症状的弹性模式，高症状后改善(恢复)的模式，以及症状上升延迟的模式。慢性高抑郁模式也出现了，但不是慢性高焦虑模式。对预测因素的分析表明，与其他组相比，恢复力患者的SCI相关生活质量问题较少，挑战评估较多，威胁评估较少，接受和战斗精神较强，通过社会依赖和行为脱离应对的较少。结论/暗示：总体而言，大多数脊髓损伤患者表现出相当大的心理韧性。抑郁和焦虑的模型证明了一种症状先升高后改善的模式，以及一种延迟症状的模式。也观察到慢性高度抑郁，但没有观察到慢性高度焦虑。对预测因素的分析与以下假设一致，即有弹性的个人将主要应激源视为需要接受的挑战，并采取积极的应对努力。这些结果与最近对主要健康应激源的其他研究相媲美。
Purpose/Objective: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. Research Method/Design: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, I year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. Results: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. Conclusion/Implications: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors.