A Narrative Review of Research on Adjustment to Spinal Cord Injury and Mental Health: Gaps, Future Directions, and Practice Recommendations

Abstract

Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into “positive” or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with “outcomes” to better inform management of mental health after SCI.

Needs Assessment of Self-Management for Individuals With Chronic Spinal Cord Injury/Disease

“…Results from the Needs Assessment indicate which of these shared experiences are most important to address within a tailored SM program. Psychological health and coping was ranked most highly which is consistent with literature as persons with SCI/D are at higher risk of anxiety, depression, alcohol dependency, dementia, and psychological multimorbidity (Sandalic et al, 2022).…”

International Classification of Function, Disability and Health (ICF) Word Mapping to Determine the Human Functioning Associated with Upper Extremity Surgery for Tetraplegia

“…This is particularly important given recent work from our broader research group on SCI in relation to cognition and psychosocial adjustment. 34,35 While there are several valid measures to assess cognition and psychosocial adjustment, one straightforward approach for development of future outcome measures might be the creation of an item bank of UE surgery priorities. The clinician-lead interview used with the COPM for priority identification might be an opportunity to address higher executive cognitive demands at play.…”

Suicidal Ideation in People with Traumatic Spinal Cord Injury

“…On the other hand, it is necessary to carry out early detection (i.e., screening assessments) and plan intervention strategies to reduce suicide risk among people living with TSCI [24]. Improving TSCI patients' access to healthcare and community resources may decrease the risk of suicide, as there will be increased contact with healthcare providers, mental health services, and peer support, which may alleviate the effect of physical comorbidities and psychological suffering.…”