A 21-year longitudinal analysis of impact, coping, and appraisals following spinal cord injury.

Objectives: To examine mortality, psychological impact, coping strategies, and cognitive appraisals in a cohort of individuals with spinal cord injury from 12 weeks postinjury to >21 years post-hospital discharge.

Method: This longitudinal, multiple-wave panel study accounted for 50.6% of Kennedy et al.'s (2000) original cohort. Twenty-two participants consented to take part in the current study, and data were collected from the COPE, Beck Depression Inventory, Functional Independence Measure, and a new measure of appraisal: Appraisals of DisAbility: Primary and Secondary Scale (ADAPSS). A further 22 individuals were deceased, giving a total sample of 44 for examining longitudinal factors in relation to mortality.

Results: The 22 deceased individuals were found to have significantly higher depression and anxiety at Week 12 than the 22 individuals who participated in the current study. There were significant increases in use of "positive" coping strategies and significant decreases in "negative" strategies. A significant regression model found coping strategies at Week 12 predicted 37% of variance in depression at 21-plus years. Depression and coping strategies at Week 12 were found to predict variance in cognitive appraisals at 21 years.

Conclusions: The findings suggest that psychological factors, such as depression, and aspects of coping strategies may contribute to premature mortality. Further research is needed to develop interventions that focus on protective psychological factors to reduce mortality risk following SCI. Coping strategies in the early stages of rehabilitation are an important predictor of both long-term psychological outcomes and appraisals, and this has clinical implications for psychological aspects of rehabilitation.