Objectives. Spinal cord injury (SCI) is a catastrophic event that may result in diminished physic... more Objectives. Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. Design. Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (N = 88), at discharge from the inpatient phase (N = 81) and 6 months following discharge (N = 71). Methods. Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social reintegration or participation post-discharge after 6 months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge. Results. Six months after discharge, around 55% of the sample had difficulties with social participation. The odds against being employed for an adult with poor social participation was found to be 8.4 to 1. Factors that predicted social participation included a younger age, having less severe secondary medical complications like bladder and bowel dysfunction, having a higher cognitive capacity, perceiving one has control (self-efficacy) over one's life and environment, and having greater perceived social support. Conclusions. These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation, affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation.
Cross-section design. The development of reliable screen technology for predicting those at risk ... more Cross-section design. The development of reliable screen technology for predicting those at risk of depression in the long-term remains a challenge. The objective of this research was to determine factors that classify correctly adults with spinal cord injury (SCI) with depressed mood and to develop a diagnostic algorithm that could be applied for prediction of depressed mood in the long-term. SCI rehabilitation unit, rehabilitation outpatient clinic and Australian community. Participants included 107 adults with SCI. The assessment regimen included demographic and injury variables, negative mood states, pain intensity, health-related quality of life and self-efficacy. Participants were divided into those with 'normal' mood versus those with elevated depressed mood. Discriminant function analysis (DFA) was then used to isolate factors that in combination, best classify the presence or absence of depressed mood. At the time of assessment, 24 participants (22.4%) had elevated depressed mood. DFA identified six factors that discriminated between those with depressed mood (P<0.01) and those with normal mood, explaining 61% of the variance. Factors consisted of pain intensity, mental health, emotional and social functioning, self-efficacy and fatigue. DFA correctly classified 91.7% (n=22 of 24) of those with depressed mood and 95.2% (n=79 of 83) of those without. Demographic, injury and physical health function variables were not found to discriminate depressed mood. Clinical implications of applying a diagnostic algorithm for detecting depression in adults with SCI are discussed. Prospective research is needed to test the predictive efficacy of the algorithm.
To examine change in resilience in people with spinal cord injury (SCI) when group cognitive beha... more To examine change in resilience in people with spinal cord injury (SCI) when group cognitive behavior therapy (GCBT) was added to routine psychosocial rehabilitation (RPR). Research Method/Design: A prospective repeated-measures cohort design was used to determine the efficacy of the addition of GCBT (n = 50). The control group consisted of individuals receiving RPR, which included access to individual CBT (ICBT) when required (n = 38). Groups were assessed on 3 occasions: soon after admission, within 2 weeks of discharge, and 6-months postdischarge. Measures included sociodemographic, injury, and psychosocial factors. The outcome variable was resilience, considered an important outcome measure for recovery. To adjust for baseline differences in self-efficacy, depressive mood and anxiety between the 2 groups, these factors were entered into a repeated measures multivariate analysis of covariance (MANCOVA) as covariates. Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups. The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group. Trajectory data indicated over 60% were demonstrating acceptable resilience irrespective of group. Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes. Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration. Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to understand complex trajectories. Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience. (PsycINFO Database Record
To examine change in resilience in people with spinal cord injury (SCI) when group cognitive beha... more To examine change in resilience in people with spinal cord injury (SCI) when group cognitive behavior therapy (GCBT) was added to routine psychosocial rehabilitation (RPR). Research Method/Design: A prospective repeated-measures cohort design was used to determine the efficacy of the addition of GCBT (n = 50). The control group consisted of individuals receiving RPR, which included access to individual CBT (ICBT) when required (n = 38). Groups were assessed on 3 occasions: soon after admission, within 2 weeks of discharge, and 6-months postdischarge. Measures included sociodemographic, injury, and psychosocial factors. The outcome variable was resilience, considered an important outcome measure for recovery. To adjust for baseline differences in self-efficacy, depressive mood and anxiety between the 2 groups, these factors were entered into a repeated measures multivariate analysis of covariance (MANCOVA) as covariates. Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups. The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group. Trajectory data indicated over 60% were demonstrating acceptable resilience irrespective of group. Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes. Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration. Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to understand complex trajectories. Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience. (PsycINFO Database Record
Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, ... more Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (NÂ =Â 88), at discharge from the inpatient phase (NÂ =Â 81) and 6Â months following discharge (NÂ =Â 71). Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social re-integration or participation post-discharge after 6Â months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6Â months post-...
Study Design:This is a longitudinal design study.Objectives:The objective of this study was to de... more Study Design:This is a longitudinal design study.Objectives:The objective of this study was to determine factors that predict resilience in people with spinal cord injury (SCI) at discharge from inpatient rehabilitation and after reintegration into the community 6 months post discharge.Setting:This study was conducted in SCI rehabilitation units and the community in New South Wales, Australia.Methods:Participants included 88 adults with SCI admitted over almost 3 years into three SCI Units in Sydney. Standardized self-report and clinician-based measures were used. Longitudinal assessment occurred up to 6 months post discharge. Sociodemographic, injury and psychological variables were assessed at admission, before discharge and 6 months post discharge. Standard multiple regression was used to determine factors that predict resilience at discharge from hospital and 6 months post discharge.Results:Almost 70% of the participants were classified as resilient at discharge and 66% after 6 ...
Archives of Physical Medicine and Rehabilitation, 2015
To conduct a prospective study of the occurrence of psychological disorders and co-morbidities fo... more To conduct a prospective study of the occurrence of psychological disorders and co-morbidities following spinal cord injury (SCI), determine psychotropic medication usage, and establish predictors of psychological disorders after transition to the community. Longitudinal design with multiple measures SETTING: Assessment occurred in SCI Units and the community. Participants included 88 adults with SCI, admitted over a period of 32 months into three SCI Units in Sydney, Australia. Participants completed inpatient rehabilitation for an acute SCI. Longitudinal assessment occurred up to six-months post-discharge. Measures were chosen that had a theoretical and clinical foundation for contributing to recovery following SCI. The Mini International Neuropsychiatric Interview, a structured diagnostic psychiatric interview, was conducted to determine presence of psychological disorders. Medical measures included severity of secondary conditions or complications. Psychological measures included measures of anxiety and depressive mood, resilience, pain catastrophization, self-efficacy and cognitive capacity. Rates of psychological disorder of 17 to 25% were substantially higher than rates found in the Australian community. The occurrence of psychological disorder co-morbidities was also very high. Anxiety was significantly elevated in those with a psychological disorder. Psychotropic medications were prescribed to over 36% of the sample, with the majority being anti-depressants. Factors predictive of psychological disorders included years of education, pre-morbid psychiatric/ psychological treatment, cognitive impairment, secondary complications, resilience and anxiety. SCI can have a substantial negative impact on mental health that does not change up to six months post-discharge. Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community. Additional resources should be invested into improving the mental health of adults with SCI.
Cross-section design. The development of reliable screen technology for predicting those at risk ... more Cross-section design. The development of reliable screen technology for predicting those at risk of depression in the long-term remains a challenge. The objective of this research was to determine factors that classify correctly adults with spinal cord injury (SCI) with depressed mood and to develop a diagnostic algorithm that could be applied for prediction of depressed mood in the long-term. SCI rehabilitation unit, rehabilitation outpatient clinic and Australian community. Participants included 107 adults with SCI. The assessment regimen included demographic and injury variables, negative mood states, pain intensity, health-related quality of life and self-efficacy. Participants were divided into those with 'normal' mood versus those with elevated depressed mood. Discriminant function analysis (DFA) was then used to isolate factors that in combination, best classify the presence or absence of depressed mood. At the time of assessment, 24 participants (22.4%) had elevated depressed mood. DFA identified six factors that discriminated between those with depressed mood (P<0.01) and those with normal mood, explaining 61% of the variance. Factors consisted of pain intensity, mental health, emotional and social functioning, self-efficacy and fatigue. DFA correctly classified 91.7% (n=22 of 24) of those with depressed mood and 95.2% (n=79 of 83) of those without. Demographic, injury and physical health function variables were not found to discriminate depressed mood. Clinical implications of applying a diagnostic algorithm for detecting depression in adults with SCI are discussed. Prospective research is needed to test the predictive efficacy of the algorithm.
Objectives. Spinal cord injury (SCI) is a catastrophic event that may result in diminished physic... more Objectives. Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. Design. Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (N = 88), at discharge from the inpatient phase (N = 81) and 6 months following discharge (N = 71). Methods. Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social reintegration or participation post-discharge after 6 months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge. Results. Six months after discharge, around 55% of the sample had difficulties with social participation. The odds against being employed for an adult with poor social participation was found to be 8.4 to 1. Factors that predicted social participation included a younger age, having less severe secondary medical complications like bladder and bowel dysfunction, having a higher cognitive capacity, perceiving one has control (self-efficacy) over one's life and environment, and having greater perceived social support. Conclusions. These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation, affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation.
Cross-section design. The development of reliable screen technology for predicting those at risk ... more Cross-section design. The development of reliable screen technology for predicting those at risk of depression in the long-term remains a challenge. The objective of this research was to determine factors that classify correctly adults with spinal cord injury (SCI) with depressed mood and to develop a diagnostic algorithm that could be applied for prediction of depressed mood in the long-term. SCI rehabilitation unit, rehabilitation outpatient clinic and Australian community. Participants included 107 adults with SCI. The assessment regimen included demographic and injury variables, negative mood states, pain intensity, health-related quality of life and self-efficacy. Participants were divided into those with 'normal' mood versus those with elevated depressed mood. Discriminant function analysis (DFA) was then used to isolate factors that in combination, best classify the presence or absence of depressed mood. At the time of assessment, 24 participants (22.4%) had elevated depressed mood. DFA identified six factors that discriminated between those with depressed mood (P<0.01) and those with normal mood, explaining 61% of the variance. Factors consisted of pain intensity, mental health, emotional and social functioning, self-efficacy and fatigue. DFA correctly classified 91.7% (n=22 of 24) of those with depressed mood and 95.2% (n=79 of 83) of those without. Demographic, injury and physical health function variables were not found to discriminate depressed mood. Clinical implications of applying a diagnostic algorithm for detecting depression in adults with SCI are discussed. Prospective research is needed to test the predictive efficacy of the algorithm.
To examine change in resilience in people with spinal cord injury (SCI) when group cognitive beha... more To examine change in resilience in people with spinal cord injury (SCI) when group cognitive behavior therapy (GCBT) was added to routine psychosocial rehabilitation (RPR). Research Method/Design: A prospective repeated-measures cohort design was used to determine the efficacy of the addition of GCBT (n = 50). The control group consisted of individuals receiving RPR, which included access to individual CBT (ICBT) when required (n = 38). Groups were assessed on 3 occasions: soon after admission, within 2 weeks of discharge, and 6-months postdischarge. Measures included sociodemographic, injury, and psychosocial factors. The outcome variable was resilience, considered an important outcome measure for recovery. To adjust for baseline differences in self-efficacy, depressive mood and anxiety between the 2 groups, these factors were entered into a repeated measures multivariate analysis of covariance (MANCOVA) as covariates. Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups. The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group. Trajectory data indicated over 60% were demonstrating acceptable resilience irrespective of group. Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes. Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration. Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to understand complex trajectories. Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience. (PsycINFO Database Record
To examine change in resilience in people with spinal cord injury (SCI) when group cognitive beha... more To examine change in resilience in people with spinal cord injury (SCI) when group cognitive behavior therapy (GCBT) was added to routine psychosocial rehabilitation (RPR). Research Method/Design: A prospective repeated-measures cohort design was used to determine the efficacy of the addition of GCBT (n = 50). The control group consisted of individuals receiving RPR, which included access to individual CBT (ICBT) when required (n = 38). Groups were assessed on 3 occasions: soon after admission, within 2 weeks of discharge, and 6-months postdischarge. Measures included sociodemographic, injury, and psychosocial factors. The outcome variable was resilience, considered an important outcome measure for recovery. To adjust for baseline differences in self-efficacy, depressive mood and anxiety between the 2 groups, these factors were entered into a repeated measures multivariate analysis of covariance (MANCOVA) as covariates. Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups. The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group. Trajectory data indicated over 60% were demonstrating acceptable resilience irrespective of group. Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes. Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration. Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to understand complex trajectories. Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience. (PsycINFO Database Record
Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, ... more Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (NÂ =Â 88), at discharge from the inpatient phase (NÂ =Â 81) and 6Â months following discharge (NÂ =Â 71). Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social re-integration or participation post-discharge after 6Â months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6Â months post-...
Study Design:This is a longitudinal design study.Objectives:The objective of this study was to de... more Study Design:This is a longitudinal design study.Objectives:The objective of this study was to determine factors that predict resilience in people with spinal cord injury (SCI) at discharge from inpatient rehabilitation and after reintegration into the community 6 months post discharge.Setting:This study was conducted in SCI rehabilitation units and the community in New South Wales, Australia.Methods:Participants included 88 adults with SCI admitted over almost 3 years into three SCI Units in Sydney. Standardized self-report and clinician-based measures were used. Longitudinal assessment occurred up to 6 months post discharge. Sociodemographic, injury and psychological variables were assessed at admission, before discharge and 6 months post discharge. Standard multiple regression was used to determine factors that predict resilience at discharge from hospital and 6 months post discharge.Results:Almost 70% of the participants were classified as resilient at discharge and 66% after 6 ...
Archives of Physical Medicine and Rehabilitation, 2015
To conduct a prospective study of the occurrence of psychological disorders and co-morbidities fo... more To conduct a prospective study of the occurrence of psychological disorders and co-morbidities following spinal cord injury (SCI), determine psychotropic medication usage, and establish predictors of psychological disorders after transition to the community. Longitudinal design with multiple measures SETTING: Assessment occurred in SCI Units and the community. Participants included 88 adults with SCI, admitted over a period of 32 months into three SCI Units in Sydney, Australia. Participants completed inpatient rehabilitation for an acute SCI. Longitudinal assessment occurred up to six-months post-discharge. Measures were chosen that had a theoretical and clinical foundation for contributing to recovery following SCI. The Mini International Neuropsychiatric Interview, a structured diagnostic psychiatric interview, was conducted to determine presence of psychological disorders. Medical measures included severity of secondary conditions or complications. Psychological measures included measures of anxiety and depressive mood, resilience, pain catastrophization, self-efficacy and cognitive capacity. Rates of psychological disorder of 17 to 25% were substantially higher than rates found in the Australian community. The occurrence of psychological disorder co-morbidities was also very high. Anxiety was significantly elevated in those with a psychological disorder. Psychotropic medications were prescribed to over 36% of the sample, with the majority being anti-depressants. Factors predictive of psychological disorders included years of education, pre-morbid psychiatric/ psychological treatment, cognitive impairment, secondary complications, resilience and anxiety. SCI can have a substantial negative impact on mental health that does not change up to six months post-discharge. Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community. Additional resources should be invested into improving the mental health of adults with SCI.
Cross-section design. The development of reliable screen technology for predicting those at risk ... more Cross-section design. The development of reliable screen technology for predicting those at risk of depression in the long-term remains a challenge. The objective of this research was to determine factors that classify correctly adults with spinal cord injury (SCI) with depressed mood and to develop a diagnostic algorithm that could be applied for prediction of depressed mood in the long-term. SCI rehabilitation unit, rehabilitation outpatient clinic and Australian community. Participants included 107 adults with SCI. The assessment regimen included demographic and injury variables, negative mood states, pain intensity, health-related quality of life and self-efficacy. Participants were divided into those with 'normal' mood versus those with elevated depressed mood. Discriminant function analysis (DFA) was then used to isolate factors that in combination, best classify the presence or absence of depressed mood. At the time of assessment, 24 participants (22.4%) had elevated depressed mood. DFA identified six factors that discriminated between those with depressed mood (P<0.01) and those with normal mood, explaining 61% of the variance. Factors consisted of pain intensity, mental health, emotional and social functioning, self-efficacy and fatigue. DFA correctly classified 91.7% (n=22 of 24) of those with depressed mood and 95.2% (n=79 of 83) of those without. Demographic, injury and physical health function variables were not found to discriminate depressed mood. Clinical implications of applying a diagnostic algorithm for detecting depression in adults with SCI are discussed. Prospective research is needed to test the predictive efficacy of the algorithm.
Uploads
Papers by Rebecca Guest