Psychological Stress in Veterans with Spinal Cord Injury

by Diana H. Rintala, PhD; Susan Robinson-Whelen, PhD; and Rebeca Matamoros, BS

A study suggests being a veteran with SCI is more stressful than being a nonveteran with SCI.

Psychological stress has long been known to affect psychological and physical well-being. While some research studies have examined major life events (divorce, death of a loved one, loss of a job) as sources of stress, other studies have focused on everyday events, sometimes referred to as daily hassles. These daily hassles can range from relatively minor, time-limited events (an argument with a family member, getting stuck in traffic) to chronic life strains (living with low income or chronic illness). Most researchers now agree that chronic daily hassles have a greater negative effect on psychological well-being because they are often so persistent and inescapable.

Degrees of Stress

The effect of hassles on a person’s psychological well-being depends, in part, on how that person views the situation. A situation is viewed as stressful if a person believes that (a) there is something that must be dealt with, (b) he or she cannot cope with the situation very well, and (c) that the situation may have a negative effect on him or her. Having a chronic physical disability is a situation that often meets these criteria for being viewed as stressful. In the past two decades, research on stress has been extended to persons with spinal cord injury (SCI). Stress may have important clinical consequences for persons with SCI because, in addition to affecting psychological well-being, stress has been linked to a range of health problems, including heart disease, immune function, and wound healing, problems with which persons with SCI often have to deal. We recently completed a study that examined the effect of daily hassles and stress on psychological health outcomes. We also examined whether social support from family and friends helps to minimize the effects of stress on psychological well-being. Our study included 165 male veterans with SCI who had received care at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas during the previous two years. The average age of the participants was 55 years and they had lived with their SCI for an average of 18 years. Forty-three percent had tetraplegia (also known as quadriplegia) and 57% had paraplegia.

Study Results

We compared the level of stress reported by our veteran sample with two other samples from earlier studies-71 nonveterans with SCI and 926 people without SCI from the general population. Our veteran sample reported significantly higher stress than both the nonveteran SCI sample and the general population.

The veterans in our study were given a list of 53 possible hassles and were asked to indicate which items on the list have been a hassle for them in the past month. The hassles most frequently reported by our sample of veterans with SCI were those related to their “physical abilities” (reported by 70%), their “health” (62%), their “medical care” (56%), and their finances, including “money for extras” (59%), “money for emergencies” (57%), and “money for necessities” (56%).

Veterans who reported less stress also reported fewer symptoms of depression and anxiety and greater satisfaction with their lives. Self-reported levels of stress were not related to age, race/ethnicity, education, income, marital status, time since injury, and level and completeness of injury. However, the eight veterans who used a respirator had significantly higher stress scores than did those who did not use a respirator. Veterans with a lot of social support reported less stress, were less likely to have symptoms of depression and anxiety, and were more satisfied with their lives. Even among those reporting high levels of stress, if they had good social support, the stress had less of an impact on their psychological well-being.

To our knowledge, this is the first study to show that veterans with SCI who receive health care at a Veterans Affairs health care facility are at increased risk for psychological stress compared with non-veterans with SCI and the general population. Also of tremendous importance, we found that nearly half of the veterans participating in our study were reporting significant symptoms of depression.

Stress Management Needed

Given these findings, we believe it is important to design and make widely available stress management programs, as well as depression self-management programs, for veterans with SCI. Because some stress management strategies may be difficult or impossible for persons with SCI to practice, stress management programs need to be developed that meet their special needs.

There are many strategies that one can use for effective stress management, including relaxation strategies, cognitive restructuring, time management, assertiveness in social relationships, and healthy nutrition to name a few. In addition, regular physical activity or exercise, to the extent possible, can be an important stress management strategy. A recent study evaluating an exercise program for people with SCI was found to reduce stress, which then led to improved quality of life and reduced depression. Our results also suggest that social support may be an important component to include in stress management programs.

The hassles most frequently cited by veterans with SCI related to money, physical abilities, health, and health care. The Veterans Health Administration is positioned to help alleviate hassles related to health and health care. Issues related to financial concerns may be more difficult to address. Even if solutions to these hassles are challenging, it is important that individuals with SCI and their health care personnel be aware of the hassles and chronic strains affecting their everyday lives. With this knowledge, they can work to resolve those strains when possible and work to minimize their impact on the veteran’s physical and psychological health when resolution is not possible. If you are experiencing high levels of stress, you may want to talk with your health care provider about ways that you can better manage your stress.

If you would like more information about our study, a longer article has been published in the Journal of Rehabilitation Research and Development (JRRD), volume 42, issue 3, pages 291 to 304. It is available in libraries and on line, for free, at www.vard.org/jour/05/42/3/pdf/rintala.pdf.

The authors are researchers at Veterans Affairs Medical Center and Baylor College of Medicine in Houston, Texas. The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, and Rehabilitation Research and Development Service.