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J - Emotional Wellbeing

Current Practice: Addressing Emotional Wellbeing Following SCI Current services for emotional wellbeing most often focus on the detection and treatment of depression. The incidence of depression among individuals with SCI ranges from 7% to 31%3; estimates vary due to differences in the definitions and methods used to assess depression.4 Depression is four times more prevalent among individuals with chronic SCI living in the community, when compared to the general population.5 In addition, emerging evidence suggests that those individuals are not being diagnosed or treated, indicating the need for more intensive depression screening.6 Published research primarily reports on identifying symptoms of depression and anxiety.7 However, a broader concept of ‘emotional wellbeing’ is required to address the unmet needs for individuals with SCI. There is a growing recognition that many suffer from post- traumatic stress disorder (PTSD), a type of anxiety disorder that can occur following a life-threatening event. PTSD has been reported in approximately 10% of individuals with longstanding SCI. Furthermore, PTSD is usually most prominent during the initial phase of post-SCI recovery, and primarily occurs with depressive disorders.8 Use of substances such as alcohol, prescription medication or illicit drugs can also be a problem. Substance abuse prevalence rates are higher than 50%, in health conditions such as SCI, compared to the general population. Among individuals with SCI who drink alcohol, 40-50% are considered to be heavy drinkers.9 Using the International Classification of Functioning, Disability and Health (ICF)10 as a conceptual framework, measuring emotional wellbeing should include not only assessing impairments in body functions, such as depression, but environmental factors (e.g., social support) and personal factors (e.g., lifestyle, social background, psychological characteristics), as well. Geyh et al.11 recently proposed seven relevant domains to capture psychological sequelae in SCI, using the ICF that are relevant to the concept of emotional welbeing. These include: 1) Socio-demographic personal characteristics (e.g., age, sex) 2) Position in the immediate social and physical context (e.g., marital status) 3) Personal history and biography (e.g., post traumatic stress disorder) 4) Feelings (e.g., positive and negative affect) 5) Thoughts and beliefs (e.g., perceived stress, locus of control, self-efficacy) 6) Motives (e.g., purpose in life) 7) Patterns of experience and behavior (e.g., coping, lifestyle factors – physical activity, substance use, personality factors). Furthermore, there is a need to consider provision of emotional wellbeing services across the continuum of care, and to ensure access to services, following discharge from an inpatient rehabilitation setting. Individuals reporting clinically-significant levels of depression and anxiety at 12 weeks post SCI, are more likely to do so at 10 years post injury.12 Given decreasing lengths of inpatient rehabilitation (e.g., six to eight weeks duration), it is essential that long-term follow-up programs are created to accurately identify problems with emotional wellbeing, assess resilience, and assist with the development of coping skills. Figure 2.0: A diagram depicting a potential model for future Emotional Welbeing service provision. Monitor emotional wellbeing Provide education Inpatient Rehabilitation Screening Interview and diagnosis conducted by appropriate health care provider Intervention strategies Medication Counselling/ psychotherapy Exercise/ activation • Reassessment and follow-up as needed • Teach monitoring behaviour and relapse prevention strategies i.e., social work, psychology, psychiatry depending on the nature and severity of the emotional impairment Self-management Community 100 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


J - Emotional Wellbeing
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