Appraisals of disability and psychological adjustment in veterans with spinal cord injuries

Abstract

Context/Objective: Following a spinal cord injury or disability (SCI/D), cognitive appraisals are a marker of psychological adjustment. The present study evaluated the clinical utility and discriminant validity of the Appraisals of DisAbility Primary and Secondary Scale – Short Form (ADAPSS-sf). The ADAPSS-sf was evaluated on 1. identification of individuals experiencing poor psychological adjustment and 2. prediction of life satisfaction beyond measures of emotional distress.

Design: A retrospective study was completed using ROC analyses and odds ratios to identify the clinical utility of the ADAPSS-sf. In addition, blocked hierarchical regression explored the ADAPSS-sf predictive characteristics for satisfaction with life beyond measures of emotional distress.

Setting: Veteran’s Health Administration SCI Center.

Participants: Ninety outpatient veterans with SCI/Ds.

Outcome Measures: Measures of psychological adjustment post-SCI/D included the PHQ-9, GAD-7, PC-PTSD, and the Diener Satisfaction with Life Scale (SWLS). The ADAPSS-sf was used as a measure of cognitive appraisals.

Results: Results indicated the ADAPSS-sf is effective in identification of poor psychological adjustment, P < .001. Diagnostic odds ratios and ADAPSS-sf cut scores were selected to prioritize sensitivity (7.17, ≤ 11), specificity (68.25, ≥ 22), or a balance of the two (16.32, ≤ 19). Hierarchical regression indicated the ADAPSS-sf accounted for unique variance in life satisfaction beyond measures of emotional distress, (ΔR² = .20, β = −.66, t(89) = 6.54, P < .001).

Conclusion: Results indicated SCI/D specific appraisals are predictive of concurrent poor psychological adjustment and provide insight into satisfaction with life beyond measures of emotional distress.

Keywords:

• Spinal Cord Injury
• Appraisals of Disability
• Veterans
• Psychological Adjustment