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Mental health is important: Whether people with spinal cord injury participate in everyday life or not strongly depends on their confidence and self-esteem

Author of summary: Szilvia Geyh (Swiss Paraplegic Research)
Original article: Geyh S, Nick E, Stirnimann D, Ehrat S, Michel F, Peter C, Lude P. Self-efficacy and self-esteem as predictors of participation in spinal cord injury-an ICF-based study. Spinal Cord. 2012;50(9):699-706. - Geyh S, Nick E, Stirnimann D, Ehrat S, Müller R, Michel F. Biopsychosocial outcomes in individuals with and without spinal cord injury: a Swiss comparative study. Spinal Cord. 2012;50(8):614-22.
Promoting mental health (e.g. self-confidence and self-esteem) as well as preventing mental illnesses (e.g. fear and depression), is a very important aim of rehabilitation. This way, people with spinal cord injury participate more actively in everyday life.

What was the aim of this study?

Participation is a very important aim in the rehabilitation of people with spinal cord injury (SCI): the term refers to the ability of people to complete tasks in various areas of life. Such areas of life are for example mobility (at home and over long distances), self-sufficiency (e.g. washing, getting dressed, cooking, eating), professional life and education, leisure time activities and maintaining relationships within the family or within their circle of friends and acquaintances. The objective of this study was to find out whether, apart from the physical disabilities related to SCI, there are also certain psychological aspects that play an important role with regard to participation in everyday life.

How did the researchers proceed?

Amongst all psychological factors, the researchers mainly focused on two of them. The first one was “self-efficacy” of a person – broadly speaking this refers to the conviction: “I can do it”, i.e. I can handle future challenges. This could also be described as self-confidence. The second aspect was self-esteem, meaning a self-judgment or, more precisely, considering yourself as a valuable person just the way you are (“I am okay”).
The study tried to find out whether there is a link between self-confidence and self-esteem on the one hand and participation on the other hand. Another objective was to find out if there is a difference between people with SCI and people without SCI in this respect. 102 people with SCI from German-speaking Switzerland participated in the study. The comparison group of people without SCI consisted of 73 employees of a rehabilitation centre for paraplegics. The researchers chose people that were comparable with the people with SCI with regard to age, gender and educational background.
All participants had to complete the same questionnaire. The questions referred to personal details, the spinal cord injury, self-confidence, self-esteem and participation, but also to the frequency and severity of health conditions in the last six months, as well as to pain, anxiety and depression, and support provided by the social environment etc.

What did the researchers discover?

The researchers found out that there is a strong link between self-confidence and self-esteem of people with SCI and their participation in everyday life. They also found out that self-confidence and self-esteem are more important with regard to participation than physical or mental stress, such as pain, depression, anxiety or the frequency of health problems. They are also more important than certain external factors, e.g. the number of people who support them. However, there is no correlation between confidence and self-esteem on the one hand and factors, such as age, gender, educational background, paraplegia, tetraplegia and complete or incomplete SCI on the other hand. There is also no link between the degree of participation and the degree of paralysis (paraplegia or tetraplegia, complete or incomplete).
Among people without SCI, anxiety and depression are the factors that have the biggest influence on participation in everyday life. Confidence and self-esteem were only of minor significance for that group.
It also turned out that people with SCI do generally have lower values in terms of self-confidence and self-esteem. However, these results do not allow any conclusions regarding the development of these factors after the spinal cord injury. People with SCI fall ill more frequently, they show higher values in anxiety and depression, suffer from more severe pain, participate less in everyday life and have less support compared with people without SCI.

What do these findings mean?

The results of the study show that rehabilitation should also always strengthen self-confidence and self-esteem in people with SCI, as this might help them to better cope with their life later on. It is also important to promote their mental health, e.g. by reducing anxiety and depression. Further research should focus on the question of how to promote mental health even better.

Who conducted and financed the study?

The study was coordinated and financed by Swiss Paraplegic Research (SPF) in Nottwil. It was carried out in cooperation with the Zurich University of Applied Sciences (ZHAW) and leading rehabilitation centres for people with SCI in German-speaking Switzerland that are: the Balgrist University Hospital, the Centre for Paraplegia in Zurich, REHAB Basel, the Centre for People with SCI and Brain Injuries, the Swiss Paraplegic Centre in Basel and the Swiss Paraplegic Centre (SPZ) in Nottwil. 

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