Psychological variables associated with employment following spinal cord injury: a meta-analysis

Abstract

Objectives: Spinal cord injury (SCI) research has highlighted links between psychological variables and employment outcome; however, there remains a need to consolidate the available heterogenous data. Methods: Meta-analytic techniques were used to examine and quantify differences in psychological functioning and employment status among adults with an acquired SCI. Fourteen observational studies (N ¼ 9, 868 participants) were identified from an electronic database search. Standardised mean difference scores between employed and unemployed groups were calculated using Cohen's d effect sizes. Additionally, 95% confidence intervals, fail-safe Ns, percentage overlap scores and heterogeneity statistics were used to determine the significance of d. Results: Moderate to large and positive weighted effects were noted across three broad psychological constructs: affective experience or feelings (d w ¼ 3.16), quality of life (d w ¼ 1.06) and life satisfaction (d w ¼ 0.70). However, the most compelling non-heterogeneous finding was associated with life satisfaction, a finding that was also not subject to publication bias. Inconsistent and weak associations between employment and individual measures of vocational attitude, self-efficacy, locus of control, adjustment and personality were also noted. Conclusion: Psychological factors and attributes are linked to employment post-SCI; however, the available data are limited in quantity. Longitudinal research is also needed to determine whether these variables can help to preserve employment over time.

Return to Work Practices and Research with Spinal Cord Injury: An Australian Perspective

“…More recently, psychological factors and attributes have been implicated in this process, considered to explain a significant amount of variance in post-injury employment status (Ottomanelli & Lind, 2009;Kent & Dorstyn, 2014;Murphy, Young, Brown & King, 2003). This includes heightened risk of post-traumatic stress disorder from the trauma of experiencing a SCI (McFarlane & Bryant, 2007), which, in turn, can impede RTW success and other post-injury participation outcomes.…”

“…Indeed, employment status remains one of the strongest predictors of well-being post-injury, with those employed reporting higher levels of psychological and physical health as well as reduced use of health facilities, post-injury (Kent & Dorstyn, 2014;Murphy & Young, 2008). RTW support services include assistance with employer contacting, work scheduling and accommodations and supervisor/co-worker work re-entry induction (with same employer) or job seeking (with different employer).…”

“…Depression and anxiety, both of which are compounded by the neurological effects of SCI such as fatigue and neuropathic pain, are also prevalent in persons with SCI. The co-occurrence of depression and anxiety with SCI may represent further complications to RTW Craig, Tran, Lovas & Middleton, 2008;Kent & Dorstyn, 2014;Elliot & Kennedy, 2004). It follows that improvements in psychological well-being may lead to improved chances of employment post rehabilitation.…”

“…One pertinent personal attribute important to RTW is resilience, or the ability to adjust successfully and persist in goal attainment efforts (Craig, 2012). Assessment of resilience within a VR context might include the following aspects: (a) actual or perceived risks and barriers to successful outcomes (e.g., investigating risks of chronic fatigue and neuropathic pain following SCI and its relation to vocational status); (b) investigating cycles of failure (e.g., cycles of unsuccessful job interviews or of employment cessation in the injured and reasons why); (c) the establishment and maintenance of protective factors such as self-esteem and self-efficacy beliefs even after frequent job-application failures; and (d) opening up of opportunities, such as vocational opportunities (see also Kilic, Dorstyn & Guiver, 2013;Kent & Dorstyn, 2014;Rutter, 1987). This assessment framework goes beyond the traditional deficit model typically used in SCI rehabilitation or one in which clinical assessment predominately focuses on the risk factors that contribute to poor psychological adjustment post-injury (Craig, 2012; and gives priority to addressing potentialities for work participation including job retention (see also Murphy & O'Hare, 2011).…”

Editorial Note on: High-quality systematic reviews within spinal cord research

“…1 This is an important contribution to the evidence base on vocational rehabilitation in the SCI field.…”