Positive Psychological Mechanisms Through Which Resilience Facilitates Adjustment Among Individuals With Spinal Cord Injury and Disease

Abstract

Objective: The study’s purpose is to examine potential mediating effects of pain interference and psychological inflexibility, as well as positive psychological mechanisms gratitude, meaning in life, strengths use, and authenticity on the relationship between the resilient personality prototype and adjustment among individuals with SCID. Design/Setting: The study is a cross-sectional, correlational design using survey data collected online from the membership of Paralyzed Veterans of America, a veteran service organization for veterans of the armed services who have experienced spinal cord injury or dysfunction (SCID). Two structural equation models tested the relationships between the resilient personality prototype and severity of SCID to the outcome variables, Health-Related Quality of Life (HRQoL) and Positive Mental Health (PMH) respectively. Pain interference and psychological inflexibility were tested along with positive psychological variables gratitude, meaning in life, use of strengths, and authenticity as mediating variables in each of the models. Participants: Participants included 298 of the organization’s members who completed the survey and met inclusion criteria. The sample were predominately White and male-identified, and their ages ranged from 29 to 88 years (M = 60.39, SD = 12.32). Main outcome Measures: The Mini-IPIP was used to measure each participant’s standing on each of the Big 5 personality types. A two-step clustering procedure was then employed to divide the participants into resilient-and non-resilient prototypes based on their constellation of scores on each of the subtypes. HRQoL was measured using the Healthy Days items from the CDC’s Core Healthy Days measure. PMH was assessed using the Mental Health Continuum- Short Form (MHC-SF). Results: In model 1, the resilient prototype predicted HRQoL partially through its beneficial inverse associations with pain interference and psychological inflexibility. Lower severity of SCID also predicted lower HRQoL, and this relationship was best understood partly through its association with pain interference. Further examination of the relationship between SCID and HRQoL revealed that cauda equina syndrome had the highest association with pain interference and lower HRQoL. In model 2, resilience predicted PMH, and this relationship is best understood through its beneficial associations with gratitude, meaning in life, strengths use, and psychological inflexibility. Conclusions: Results from this study indicate that pain interference and psychological inflexibility are important mechanisms through which the resilient prototype predicts HRQoL, and resilience facilitates positive mental through its beneficial associations with gratitude, meaning in life, use of strengths and psychological inflexibility. Therefore, these mediators reveal important behavioral mechanisms that characterize individuals with SCID who report a positive adjustment. Further, these are behaviors that can be addressed psychological interventions to promote the adjustment of those who are resilient. Additional findings indicate that those with cauda equina syndrome may be particularly vulnerable for lower HRQoL through higher pain interference, indicating that clinical efforts to reduce pain interference are particularly important to HRQoL in this population.