Relationships between activities, participation, personal factors, mental health, and life satisfaction in persons with spinal cord injury

Abstract

Objective: To clarify relationships between activities, participation, mental health, and life satisfaction in persons with spinal cord injury (SCI) and specify how personal factors (self-efficacy, neuroticism, appraisals) interact with these components. We hypothesized that (1) activities are related directly to participation, participation is related directly to mental health and life satisfaction, and mental health and life satisfaction are 2 interrelated outcome variables; and (2) appraisals are mediators between participation and mental health and life satisfaction, and self-efficacy and neuroticism are related directly to mental health and life satisfaction and indirectly through appraisals.

Design: Follow-up measurement of a multicenter prospective cohort study 5 years after discharge from inpatient rehabilitation.

Setting: Eight Dutch rehabilitation centers with specialized SCI units.

Participants: Persons (N=143) aged 18 to 65 years at the onset of SCI.

Interventions: Not applicable.

Main outcome measures: Mental health was measured by using the Mental Health subscale of the 36-Item Short Form Health Survey and life satisfaction with the sum score of "current life satisfaction" and "current life satisfaction compared with life satisfaction before SCI."

Results: Structural equation modeling showed that activities and neuroticism were related to participation and explained 49% of the variance in participation. Self-efficacy, neuroticism, and 2 appraisals were related to mental health and explained 35% of the variance in mental health. Participation, 3 appraisals, and mental health were related to life satisfaction and together explained 50% of the total variance in life satisfaction.

Conclusions: Mental health and life satisfaction can be seen as 2 separate but interrelated outcome variables. Self-efficacy and neuroticism are related directly to mental health and indirectly to life satisfaction through the mediating role of appraisals.