Depression in Spinal Cord Injury: Assessing the Role of Psychological Resources

Purpose: To test the spinal cord injury adjustment model (SCIAM) and to examine how psychological resources may influence depressive symptoms in persons with spinal cord injury (SCI). We expect that (a) higher general self-efficacy (GSE) and higher purpose in life (PIL) are associated with lower levels of depressive symptoms, and that (b) the effect of GSE and PIL on depressive symptoms is mediated by appraisals and coping strategies, as proposed by the SCIAM. Method: A nationwide cross-sectional survey (the Swiss Spinal Cord Injury Cohort Study) was conducted with individuals with SCI living in the Swiss community (N = 516). Structural equation modeling was used to test relationships between variables as specified in the SCIAM. Results: Higher GSE (r = -.54) and PIL (r = -.62) were significantly associated with lower depressive symptoms. The initial model yielded poor model fit. However, the final modified model fitted well, with chi(2)(21) = 54.00, p < .01, RMSEA = .055 (90% CI [.038, .073]), CFI = .98, explaining 62.9% of the variance of depressive symptoms. PIL had a direct large effect and an indirect effect on depressive symptoms via appraisals and coping strategies. The influence of GSE on depressive symptoms was fully mediated by appraisals and coping strategies. Conclusions: Psychological resources of individuals with SCI can have a direct effect on depressive symptoms. The mediated pathways are present, but not exclusive in our data, yielding only partial support for the mechanism proposed by the SCIAM.