Ville I, Ravaud J F
CERMES, INSERM U.502, IFRH (Federative Research Institute on Disability), Paris, France.
Soc Sci Med. 2001 Feb;52(3):369-84. doi: 10.1016/s0277-9536(00)00140-4.
The purpose of the research described in this article is to study the effects of severe motor impairments on a person's well-being, by attempting to throw light upon the inconsistencies found in the previous literature, which are due to problems of a conceptual and methodological nature. The data were gathered during the Tetrafigap survey on the long-term outcome of tetraplegic persons in France. This survey involved 1668 tetraplegic spinal cord injured people. We examine the relationships between the overall assessment of well-being as expressed by the people interviewed, and a range of clinical, social and psycho-social factors. A progressive approach, along with the use of adjustments via linear regressions, has allowed us to identify certain confounding factors, and to analyse the respective effects of the different types of variables studied. Thus current age, the age at which the impairment occurred and having or not having a professional activity do not have any direct links with the assessment of well-being, whereas the existence of pain and the subjective assessment of one's own independence and of the severity of one's disability are predictive factors. The functional independence indicators are only linked to well-being when they relate to situations in which the dependence creates embarrassment due to socio-cultural taboos. The loss of autonomy only affects well-being in as much as it imposes limits to social activity, whether they be relational or occupational. Living as a couple is a negative predictive factor if the couple were together prior to the impairment occurring. The overall results demonstrate the importance of moving beyond any conception of the impact of the impairments on well-being that is too exclusively focused on the individual, and of integrating the socio-cultural meanings of handicap situations and the dynamics of the interactions which take place therein.
本文所述研究的目的是，试图阐明先前文献中发现的因概念和方法性质问题而产生的不一致之处，从而研究严重运动障碍对人的幸福感的影响。数据收集于法国进行的关于四肢瘫痪者长期预后的Tetrafigap调查。该调查涉及1668名脊髓损伤的四肢瘫痪者。我们研究了受访者表达的幸福感总体评估与一系列临床、社会和心理社会因素之间的关系。一种渐进的方法，以及通过线性回归进行调整的运用，使我们能够识别某些混杂因素，并分析所研究的不同类型变量的各自影响。因此，当前年龄、损伤发生时的年龄以及是否有职业活动与幸福感评估没有任何直接联系，而疼痛的存在以及对自身独立性和残疾严重程度的主观评估是预测因素。功能独立性指标只有在与因社会文化禁忌而导致依赖产生尴尬的情况相关时，才与幸福感相关。自主性的丧失仅在其对社会活动（无论是人际关系还是职业活动）施加限制的程度上影响幸福感。如果夫妻在损伤发生前就在一起，那么作为夫妻生活是一个负面预测因素。总体结果表明，超越任何过于片面关注个体的损伤对幸福感影响的观念，并整合残疾情况的社会文化意义以及其中发生的互动动态非常重要。
