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Background:Spinal cord injury (SCI) can cause psychological consequences that negatively affect quality of life. It is increasingly recognized that factors such as resilience and social support may produce a buffering effect and are associated with improved health outcomes. However, the influence of adult attachment style on an individual's ability to utilize social support after SCI has not been examined. Objective: The purpose of this study was to examine relationships between adult romantic attachment, perceived social support, depression, and resilience in individuals with SCI. In addition, we evaluated potential mediating effects of social support and adult attachment on resilience and depression. Methods: Participants included 106 adults with SCI undergoing inpatient rehabilitation. Individuals completed measures of adult attachment (avoidance and anxiety), social support, resilience, and depression. Path analysis was performed to assess for presence of mediation effects. Results: When accounting for the smaller sample size, support was found for the model (comparative fit index = .927; chi square = 7.86, P = .01; β = -0.25, standard error [SE ] = -2.93, P < .05). The mediating effect of social support on the association between attachment avoidance and resilience was the only hypothesized mediating effect found to be significant (β = -0.25, SE = -2.93, P < .05). Conclusion: Results suggest that individuals with SCI with higher levels of attachment avoidance have lower perceived social support, which relates to lower perceived resilience. Assessing attachment patterns during inpatient rehabilitation may allow therapists to intervene to provide greater support.

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Dodd, Zane. Effects of adult romantic attachment and social support on resilience and depression in patients with acquired disabilities. Doctor of Philosophy (Counseling Psychology)August 2010, 84 pp., 7 tables, 6 figures, references, 109 titles.The acquirement of a disability (e.g., spinal cord injury, traumatic brain injury, amputation, multi trauma) is a risk factor for psychological disturbance (e.g., depression).Research has established that social support and secure attachment are protective factors against psychological disturbance. Attachment patterns have also been associated with differences in perceived social support. Secure attachment and higher perceived social support have been implicated in greater levels of resilience but need to be validated with a population of individuals who have acquired a disability.The Experiences in Close Relationships, Social Provisions Scale, Connor-Davidson Resilience Scale, Personal Health Questionnaire -9 Depression Scale, and a Demographic were administered to 102 adult inpatients at a rehabilitation hospital undergoing an individualized rehabilitation program. Two MANOVAs were conducted to examine the direct associations of attachment classifications with the major dependent variables, as well as the various social support subscales. Path analysis tested two mediational models suggested by literature. Model 1 assessed the mediating role of attachment anxiety and attachment avoidance on the effect of social support on depression and resilience. Model 2 assessed the mediating role of social support on the effect of attachment anxiety or attachment avoidance on depression and resilience.Partial support was obtained for both models based on fit indices. A small but significant difference in the fit of the models was found, favoring Model 1. Clinical and research implications for this population and the limitations of the study are discussed.ii Ruocco, Swirsky-Sacchetti, & Choca, 2007). In a review of SCI, Richards, Kewman, and Pierce (2000) report that depression is a common problem for individuals with SCI and is related to longer hospital stays, pressure sores, urinary tract infections, spending more time in bed, and increased overall medical expenses. Richards et al. (2000) also review findings that demonstrate the suicide rates are 5-10 times higher in individuals with SCI than the general population.While anxiety disorders have not received as much attention among the SCI population, evidence suggests anxiety rates, social anxiety, and post traumatic stress disorder are elevated (Richards et al., 2000). Individuals with an amputation are also at increased risk for problematic outcomes, including: insomnia, sadness, clinical depression, body image concerns, perceptions of social stigma, feelings of vulnerability, as well as death within two years of surgery (Rybarczyk, Szymanski, & Nicholas, 2000).The importance of social support to resilience has been established in the general and acquired disability populations (Chwalisz & Vaux, 2000;Luthar, 2006;Masten, 2001)...

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