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Collateral damage: psychosocial issues arising in cases of spinal cord injury

Posted: 14/03/2022

In this series, we have covered the Motability Scheme and accommodation for catastrophic injuries. In this article, we focus on spinal cord injury and mental health.

Spinal cord injuries (SCI) can have an extreme effect on the lives of all involved. Following SCI, urgent acute care is necessarily about dealing with the immediate risk to life. After this, primary care is typically focused on physical rehabilitation, utilising an understanding of the precise makeup of the motor, sensory and autonomic dysfunctions of those injured.

However, in recent years, it has been well established, perhaps unsurprisingly, that those who have suffered SCI are at significantly greater risk of developing psychological disorders and being detrimentally impacted socially. A multidisciplinary approach is needed to ensure that those suffering with SCI have the best opportunity to thrive post injury.

Psychological factors

It is understood in the school of psychiatry that feeling anxious or low and having nightmares or flashbacks after a traumatising incident is perfectly normal. But it is when those symptoms continue for an extended period of time - roughly 8-12 weeks, though the timescale can vary significantly - that investigations for a psychiatric diagnosis might be rightly considered.

Unfortunately, for many people with SCI, those symptoms do develop into disorders. There are multiple studies that highlight the link between SCI and psychological disorders. A US study in 2020 found that adults with spinal cord injuries had a higher incidence of anxiety disorders (19.3% vs 14.1%), depressive disorders (29.3% vs 9.3%), and psychological multimorbidity, which is having more than two mental health conditions (37.4% vs 23.9%), than adults without SCI.  

Various studies have found myriad causes for depression in SCI, including those related to loss of independence and function, altered self-image, loss of career, financial hardship, marriage and relationship problems, loss of the ability to have children and loss of physical function.

Symptoms of depression can include difficulty sleeping, loss or increased appetite, change in libido, feelings of helplessness, fatigue and a sense of worthlessness. Symptoms of anxiety meanwhile can include hypervigilance, panic attacks and impaired sleep.

Social factors

It is also common for the person with SCI, and their family, to exhibit extreme negative emotions post injury. This can manifest as becoming extremely angry or dissociating, and this can impact on social integration. There is some research to indicate that family members or friends of those suffering with spinal cord injuries may experience emotions analogous to grief following the loss of a loved one, including frustration, anger, and numbness.

There is a clear link between psychosocial dimensions such as personality, perception and ability to adjust, and the development of psychological disorders for those with SCI. A 2020 American longitudinal study showed that low self-efficacy, which is the belief about one’s ability to cope with difficult situations, of the person with an SCI, and of their family members, is a risk factor for the development of psychosocial difficulties.

What can be done?

Given there is now increased understanding about the psychosocial factors involved in the management of SCI, as well as the risk factors associated with a more severe psychosocial reaction, it is imperative that psychosocial factors are identified and managed by a multidisciplinary team to ensure expeditious access to psychological and social support is available. This can include psychiatric input, clinical psychology, occupational therapy, peer counselling, and life coaching, amongst others.  

At Penningtons Manches Cooper we are experts in both spinal cord injury claims and claims involving psychiatric disorders caused by trauma. Our dual expertise engenders a holistic approach to implementing rehabilitation for our clients where possible, including a consideration of all physical, psychological and social factors. 


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