LONG-TERM PSYCHOSOCIAL ADJUSTMENT FOLLOWING HEAD OR SPINAL-CORD INJURY

The long-term psychosocial sequelae of traumatic injury to the brain or spinal cord were comparatively examined in patients who had sustained either moderate-to-severe closed head injury (CHI) or spinal cord injury (SCI). Both groups experienced significant pre- to postinjury reductions in socioeconomic and employment status. In addition to cognitive dysfunction, the patients with CHI reported significantly greater depressive symptomotology, and a pattern of psychological adjustment characterized by greater chronic tension, social alienation, and moodiness. No differences were found between patients' reports of psychosocial functioning as assessed across a broad range of relevant dimensions that included the vocational, domestic, and social environments. In the group with CHI, memory dysfunction was consistently correlated with a broad range of psychological variables, including degree of depressive symptomotology and anxiety. Memory dysfunction was also the most significant correlate of long-term psychosocial adjustment for the patients with CHI; degree of depressive symptomotology, age at injury, and level of injury to the spinal cord were the most significant correlates for the patients with SCI. The relatives of the patients with CHI reported significantly greater patient dysfunction in the areas of vocational and social-role performance outside the home than did the patients themselves. The results are discussed in terms of the specific and the general long-term sequelae resulting from traumatic injury to the brain or spinal cord and associated implications for rehabilitation.