Assessment of the relationship of spiritual well-being to depression and quality of life for persons with spinal cord injury

Abstract

Objective: This study sought to describe the association between spiritual well-being, demographic characteristics, quality of life (QOL) and depressive symptoms following spinal cord injury (SCI). We hypothesized QOL and depressed mood would both be explained by extent of spiritual well-being, and meaning-focused (M&P) spirituality would have a stronger impact than faith-focused spirituality.

Methods: 210 individuals with SCI were screened as part of a randomized control trial of venlafaxine XR for major depressive disorder (MDD). 204 completed all measures: Patient Health Questionniare-9 (PHQ-9) assessed depression, the FACIT-Sp assessed spiritual well-being, the Neuro-QOL PAWB scale assessed QOL, and the PANAS assessed affect.

Results: Approximately 26% had major depression. Bivariate correlations of scores on PAWB and PANAS and FACIT-Sp showed that all four scales had strong associations with those on PAWB (p < 0.0005). As hypothesized, both the M&P and Faith scales of the FACIT-Sp were significant predictors of QOL (β = 0.544; p < 0.0005 and β = 0.151; p = 0.004), though only the M&P scale was an independently significant predictor of likely MDD.

Conclusion: The findings support that spirituality, as measured by the FACIT-Sp, is strongly associated with QOL and likelihood of MDD. Assessment of spirituality should be included along with more traditional psychological measurements to better inform treatment.

Implications for Rehabilitation

• Spiritual beliefs can contribute to quality of life and may help moderate depressive symptoms that accompany chronic illness and disability, suggesting that rehabilitation professionals should address spirituality in working with their patients with spinal cord injury (SCI).

• While spiritual issues are often deferred to pastoral counselors during hospitalization, it is clear that addressing these is not the domain of one discipline and does not end upon inpatient discharge.

• In addressing spirituality, clinicians should tap the spiritual strengths present in their clients, whether meaning/peace-focused or religious, understanding that spirituality involves more than religiosity and also that having a sense of meaning and peace appears to be of great importance.

Keywords:

• Depression
• faith
• quality of life
• spinal cord injury
• spiritual well-being
• spirituality

Acknowledgements

We thank Sheila Smith Crego for invaluable comments on this paper. Joanna Jennie assisted in the preparation of the revised manuscript. We acknowledge Pfizer for supplying the study drug and the PRISMS investigators for their support. The opinions contained in this publication are those of the grantees and do not necessarily reflect those of the US Department of Education.

Disclosure statement

The authors declare no conflicts of interests. The authors are responsible for the content and writing of this article. They did receive advice from other investigators participating in the PRISMS study.

Funding information

This study was developed and funded by grants from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, US Department of Education to the University of Washington (H133A060107, H133N060033), University of Alabama, Birmingham (H133A060107), Rehabilitation Institute of Chicago (H133N110014), and the University of Michigan, Ann Arbor (H133N110002).