title: Trajectories of resilience, depression, and anxiety following spinal cord injury.
abstract: OBJECTIVE
  To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories.
  
  
  METHODS
  A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, 1 year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories.
  
  
  RESULTS
  Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement.
  
  
  CONCLUSIONS
  Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors.
authors.affiliation: Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 218, New York, NY 10027, USA. gab38@columbia.edu
authors.forename: George A
authors.initials: GA
authors.lastname: Bonanno
authors.forename: Paul
authors.initials: P
authors.lastname: Kennedy
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Galatzer-Levy
authors.forename: Peter
authors.initials: P
authors.lastname: Lude
authors.forename: Mangus L
authors.initials: ML
authors.lastname: Elfström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology / Q000517:prevention & control*; D003866:Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D011788:Quality of Life; D055500:Resilience, Psychological; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*