Cases of spinal cord injury: correlation among resilience, social support and psychological well-being

Abstract

Background: Spinal injuries are highly prevalent and are a major cause of disability. Studying resilience, perceived social support, and psychological well-being in persons with spinal cord injury is important for better-managing patients with spinal cord injuries. 

Objectives: To analyze the correlation among resilience, perceived social support, and psychological well-being in persons with spinal cord injury. 

Methods: This cross-sectional correlational study was conducted at Riphah International University, Lahore Pakistan from September 2019 to February 2020. The study utilized a sample of 100 patients with spinal cord injury using purposive sampling. The sample included paraplegic patients 6 months following SCI, of both genders above 18 years of age who were active wheelchair users. A demographic sheet, scale of psychological well-being, resilience scale, and multi-dimensional scale of perceived social support (MSPSS) were used for data collection. SPSS Version 22 was utilized for data analysis & correlation was analyzed using bivariate statistics with p< 0.05 was considered statistically significant.

Results: The study revealed a positive correlation (γ=0.57, p<0.001) between Resilience with Perceived Social Support; Resilience and Psychological well-being (γ=0.55, p<0.001); and Perceived Social Support and Psychological Well-being (γ =0.57, p<0.001). 

Conclusion: There is a positive relationship between resilience perceived social support and psychological well-being. 

INTRODUCTION

Spinal injuries are highly prevalent with 60% occurring among young men 15-35 years of age [1]. Injuries of spinal column and spinal cord injuries (SCI) are major causes of disability. Literature reveals that 95.8% of cases of SCI have one or more health-related issues [2], which involve financial consequences for care and rehabilitation over the lifetime of the individuals [1]. The most common issues of SCI individuals are pain (77%); issues of musculature (73%), bowel (70%), sexual (71%), & sensorium (29%); and respiratory problems which are the least common (28%) [2]. 

Patients with SCI need comprehensive health coverage since they must endeavor to bear different problems related to their healthcare as well as social needs. These include psychological and emotional requirements to ensure mental health. Individuals with SCI face serious emotional issues including depression, pity, lack of dignity lack of care of oneself, sexual problems, job and educational issues, loss of proper support from financial institutions and sponsorships, etc [3]. 

Resilience has an important role in dealing with adversities which results in the formation of skills that are necessary to deal with hardships. On the other hand, social support is a multidimensional concept that includes emotional support, close relationships, help with information, and personal help in the form of physical activity perceived social support points to a person’s sense that people will be at hand if help is needed [4]. 

A relationship may exist between resilience, social support, and psychological well-being, and revealed that social support intervention enhances resilience and mental wellbeing [5]. The subjective well-being (SWB) of these patients with spinal cord injury is related to several factors and steps to improve resilience, self-efficacy, and social support can enhance SWB, however further research is needed for validation of these findings [6]. Also, resilience in crisis situations is essential because its reduction and need for medical care, finances, and social segregation can result in an increase in depression and affect the quality of life [6]. Similarly, improved knowledge of social support in patients with SCI could be helpful in establishing targets as well as interventions to improve functions in SCI by enhancing resources [7]. 

Hence a current study was conducted to determine the correlation between resilience, perceived social support, and psychological well-being in persons with spinal cord injury (SCI) the study hypothesis states that there exists a relationship between resilience, perceived social support, and psychological wellbeing.  The present research is very important and beneficial since results can help better manage patients with SCI enhancing the wellbeing of SCI individuals. It could also be used by clinicians, counselors, etc., to assess the mental condition of these individuals. It could also prove helpful for policy-making for the SCI individuals.

METHODOLOGY

This cross-sectional correlational study was conducted at Paraplegic Centre, Peshawar Khyber Khyber Pakhtunkhwa, Pakistan after obtaining ethical approval (REC/RCR & AHS/19/1111) from Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University Lahore, Pakistan over six months from 1^st September 2019 to 29^th February 2020. The nonprobability purposive sampling technique was used for sample collection. 

The sample included paraplegic patients due to spinal cord injury within 6 months following SCI, of both genders above 18 years of age who were active wheelchair users. Cases with tetraplegia, bedridden patients, and patients with pressure ulcers and bed sores were excluded from the study.   

A sample of n=114 was calculated using Open Epi online sample size calculator with a confidence level of 95%, Design Effect (DEFF) = 1, prevalence 8%±5 [8], and population of 1000000. The n=14 cases dropped out of the study and refused consent hence a sample of n=100 was utilized. 

Tools used for data collection included a demographic sheet with details regarding age, gender, duration, and type of injury & neurological level.  

The psychological well-being scale (PWS) is used for the assessment of six aspects of well-being and happiness. It is a 42-item reliable scale (α>0.70) composed of six including environmental mastery, positive relations with others, autonomy, personal growth, self-acceptance, and purpose in life. It uses a 6-point Likert scale with 1 for strongly disagree 6 for strongly agree and a score range from 42 to 252[9]. 

The resilience scale (RS) developed by Wagnildand Young is 25 items scale valid and reliable scale with α=0.863 indicating excellent internal consistency. It is scored on a 7-point Likert scale with score ranges between 25 and 175 with higher scores indicating higher resilience. It is composed of a unifactorial structure that includes items referring to aspects related to self-esteem, independence, mastery, resourcefulness, perseverance, adaptability, balance, flexibility, and a balanced perspective on life [10].  

The Multidimensional Scale of Perceived Social Support (MSPSS) is a valid and reliable (α=.93), brief research tool designed to measure perceptions of support from 3 sources: family, friends, and a significant Other.  The scale is comprised of a total of 12 items, with 4 items for each subscale with a greater score indicating greater perceived social support [11].

Data was collected from the admitted patients directly and through online forms from those discharged from the facility.  The SPSS Version 22 was utilized for data analysis. Pearson's moment correlation coefficient was utilized to determine the correlation between the variables. The p<0.05 is set as a level of significance.

RESULTS

The current study sample N=100 comprised males mostly with a male-to-female ratio of 9:1 and a mean age of 30.3±11.56 years. The majority 77% presented within 50 days post-injury only 6% presented between 151-200 days post-injury and the majority 77% received post-injury physical rehabilitation (Figure 1).

Figure 1: Descriptive statistics for duration at presentation & rehabilitation (n=100)

The study revealed a resilience scale mean score of 136.87±18.79 indicating a high resilience. The multidimensional scale of perceived social support scale mean score was 69.55±13.63) indicating adequate perceived social support. The psychological wellbeing scale result revealed a mean score of 171,79±24.98 indicating good psychological wellbeing.

Pearson’s correlation Matrix revealed a statistically significant moderate positive correlation (γ=0.57, p<0.001) of Resilience with Perceived Social Support indicating that resilience enhances the perceived social support. Similarly, Resilience and Psychological Well-being also show a statistically significant moderate positive correlation (γ=0.55, p<0.001) hence, resilience improves psychological well-being. Also Perceived Social Support and Psychological Well-being have a statistically significant moderate positive correlation (γ=0.57, p<0.009) thus perceived social support enhances psychological well-being. Hence the study hypothesis that states that there exists a relationship between resilience, perceived social support, and psychological well-being is proved.  (table 1)

Table 1: Correlation among Resilience, Perceived Social Support and Psychological Wellbeing.

DISCUSSION

The current study determined the correlation between resilience, perceived social support, and psychological well-being in persons with spinal cord injury (SCI). Utilizing a predominantly male population with SCI study revealed that Resilience and perceived Social Support; Resilience and psychological Well-being; and Perceived Social Support and psychological Well-being are positively correlated with each other. 

Literature reveals that methods to positively cope with the post-traumatic effects partly mediate the influence of resilience on post-traumatic growth [12]. Similarly, the current study revealed a positive correlation between Resilience with Perceived Social Support indicating that resilience greatly enhances perceived social support. A reported that the enhanced levels of optimism, with perceived social support resulted in advanced levels of resilience, however, the subscales of perceived social support did not significantly correlate to resilience [13]. This might be because the resilient person negates the need for social support. For social desirability, the participants scored lower on it. Similarly, literature revealed that the perceived social support moderates the effect of the frequency and severity of Post-Traumatic Stress Disorder (PTSD), thus promoting resilience [14]. In contrast, a study by Zhang M et al [15] revealed that resilience was not significantly related to perceived social support in females, rather it was significantly associated with psychological distress because gender moderates this relationship [15], hence the results contrast with current study with a predominantly male population.

In compliance with the literature [16, 17], the current study also revealed a significant moderate positive correlation between Resilience and psychological well-being. Similarly, Haddadi & Besharat reported that resilience was positively linked with mental well-being and negatively linked with psychological distress [18]. In contrast, Smith & Yang [19], reported that Resilience was negatively associated with psychological well-being in nursing students. This difference in this relationship might be due to coping strategies to deal with different sources of stress. 

Literature reveals that Perceived social support has a significant positive relation with psychological well-being [20], This complies with our study results in which Perceived Social Support and Psychological Well-being were found to be positively correlated. This is in compliance with a study by Liu H et al., [21] and Bergeman CS et al., who reported a positive association between the perceived capability of social care and psychological well-being and partly mediated by hereditary factors [22]. Social support can be a shielding utility for psychological well-being through different samples, and it compensates for the negative relationship between accumulative healthcare load and psychological well-being. Hence, perceived social support is significantly linked with better psychological well-being [23].

CONCLUSION

There is a clear positive connection between resilience, perceived social support, and psychological well-being among individuals with spinal cord injuries.

DECLARATIONS & STATEMENTS

Author’s Contribution

The following format should be used for the author’s contribution.

SA: substantial contributions to the conception and design of the study.

SN and MK: acquisition of data for the study.

SN: interpretation of data for the study.

SN: analysis of the data for the study.

SUR: drafted the work.

SA, SN, SN, SUR, GS and MK: revised it critically for important intellectual content.

SA, SN, SN, SUR, GS and MK: final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors contributed to the article and approved the submitted version.

Ethical Statement

This study received approval from Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University Lahore, Pakistan Research Ethical Committee (REC/RCR & AHS/19/1111). Subsequently, Paraplegic Centre, Peshawar Khyber Khyber Pakhtunkhwa granted permission for data collection based on the approved ethical protocol from Riphah International University.

Consent Statement

Informed consent was taken before inclusion in the study

Data Availability Statement 

Data related to the study is available on request form the principal author.

Acknowledgments 

None to declare

Conflicts of Interest 

Authors declare that there is no conflict of interest, no source of funding, as well as data collection, preparation for manuscript and publication funding.

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