Sandalic Danielle, Arora Mohit, Pozzato Ilaria, Simpson Grahame, Middleton James, Craig Ashley
Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Psychol Res Behav Manag. 2022 Aug 5;15:1997-2010. doi: 10.2147/PRBM.S259712. eCollection 2022.
Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into "positive" or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with "outcomes" to better inform management of mental health after SCI.
脊髓损伤（SCI）会导致自主神经、运动和感觉功能障碍，进而可能损害心理健康。目前指导脊髓损伤后心理健康管理的指南涉及临床焦虑、抑郁、创伤后应激、物质使用障碍和自杀等方面。然而，有证据表明，多达70%的脊髓损伤患者并未发展出临床可诊断的心理健康障碍。因此，作者认为，了解脊髓损伤后适应的非临床认知和心理方面至关重要，将这些知识应用于制定增强适应能力的干预措施也至关重要。为了助力这一努力，我们审视了针对脊髓损伤的现有心理健康指南，并对关于适应、应对、悲伤和恢复力等未得到充分研究的主题的研究进行了叙述性综述。我们纳入了轻度认知障碍，它反映了一个可能影响适应的共同因素。丧失和压力会引发适应、应对、悲伤和恢复力的过程。脊髓损伤涉及丧失和压力引发这些过程，可以说无一例外。我们的研究采用叙述性综述方法，在谷歌学术和心理信息数据库中搜索适应、应对、悲伤、恢复力和认知障碍等术语。选择定性研究和定量研究以获取自下而上和自上而下的观点。对检索到的论文的参考文献列表进行了适当搜索。综述文献表明，现有的关于脊髓损伤后心理健康的指南忽视了积极的适应过程，并指出这种忽视导致了对脊髓损伤后心理健康基于缺陷的看法。对“积极”或增强适应能力的过程的研究大多是横断面的、异质性的，且对为未来指南制定提供信息的作用有限。研究人员应就基本过程的操作化达成共识，并克服对“结果”的执着，以便更好地为脊髓损伤后的心理健康管理提供信息。
