title: Predictors of participation enfranchisement after spinal cord injury: the mediating role of depression and moderating role of demographic and injury characteristics.
abstract: OBJECTIVE
  (1) To examine the mediating effects of depressive symptoms on the relations between employment, grief, depression treatment, and participation enfranchisement after spinal cord injury (SCI); and (2) to examine the moderating role of demographic and injury characteristics, including sex, race, marital status, education, and injury level, and completeness on these relations.
  
  
  METHODS
  Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS).
  
  
  METHODS
  Rehabilitation facilities.
  
  
  METHODS
  Persons with SCI (N=522; average age, 42 y; 76% men; 64% white; 64% completed at least a high school education) enrolled from 2007 to 2011.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Participation enfranchisement.
  
  
  RESULTS
  The final model fit the data relatively well (comparative fix index=.939; Tucker-Lewis Index=.894; root mean square error of approximation=.066; 90% confidence interval, .043-.089), explaining 32% of the variance in participation enfranchisement. Enfranchisement was positively related to employment and negatively related to depression. Grieving the loss of a loved one and the use of an antidepressant or psychotherapy were related to participation enfranchisement; these relations were mediated by depressive symptoms. Multigroup analyses supported the model's invariance across sex, marital status, severity of injury, and level of injury.
  
  
  CONCLUSIONS
  Depression appears to mediate the influence of employment, grief, and depression treatments on participation enfranchisement after SCI. These relations are applicable regardless of sex, marital status, and injury completeness and level. These findings highlight efforts to improve the detection and treatment of depression in SCI rehabilitation programs that may enhance participation.
authors.affiliation: Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL. Electronic address: wwong@ric.org.
authors.forename: Alex W K
authors.initials: AW
authors.lastname: Wong
authors.affiliation: Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.affiliation: Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; James A. Haley Veterans' Hospital, Tampa, FL.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wilson
authors.affiliation: Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Holly
authors.initials: H
authors.lastname: Neumann
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Denise G
authors.initials: DG
authors.lastname: Tate
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Martin
authors.initials: M
authors.lastname: Forchheimer
authors.affiliation: Department of Psychiatry, University of Alabama at Birmingham School of Medicine, Birmingham, AL; Spain Rehabilitation Center, Birmingham, AL.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Richards
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006117:Grief; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D011594:Psychometrics; D012047:Rehabilitation Centers; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Depression; Employment; Grief; Rehabilitation; Spinal cord injuries