Distinguishing grief from depression during acute recovery from spinal cord injury.
OBJECTIVE
To examine whether grief is a psychometrically sound construct that is distinct from depression in individuals who have recently sustained a spinal cord injury (SCI).


METHODS
Cross-sectional survey.


METHODS
Inpatient rehabilitation units at 3 geographically diverse, university-affiliated medical centers.


METHODS
Patients with SCI (N=206) were recruited (163 men [79.1%]). Most patients were non-Hispanic whites (n=175 [85.0%]). Most patients sustained a cervical SCI (n=134 [64.4%]). Various injury etiologies were represented, with the majority being accounted for by falls (n=72 [31.5%]) and vehicle-related accidents (n=69 [33.5%]). The mean time since injury was 53.5±40.5 days.


METHODS
Not applicable.


METHODS
An adapted version of the 12-item structured clinical interview for Prolonged Grief Disorder was used to assess symptoms of grief, and the Patient Health Questionnaire-9 was used to measure depression. Demographic and injury-related data were also collected.


RESULTS
A principal component analysis (with direct oblimin rotation) of the grief measure suggested a 2-component solution. The content of items loading on the separate components suggested 2 subscales: loss (6 items; Cronbach α=.810) and trauma (6 items; Cronbach α=.823). Follow-up principal component analyses including both grief and depression measures suggested clear differentiation of grief-related loss from depression. The prevalence of clinically significant levels of grief was low (6%), and levels of depression were consistent with previous findings related to inpatient rehabilitation (23.5%).


CONCLUSIONS
The items used to assess grief symptoms in patients participating in inpatient rehabilitation for recently sustained SCI appear to capture a psychometrically reliable construct that is distinct from that of depression. Research is needed on the predictive validity of early grief symptoms after SCI and the relation of grief to other psychological constructs over time.
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: dwklyce@vcu.edu.
Daniel W
DW
Klyce
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
Charles H
CH
Bombardier
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
Trevor J
TJ
Davis
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
Narineh
N
Hartoonian
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
Jeanne M
JM
Hoffman
Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Psychiatry, University of Washington School of Medicine, Seattle, WA.
Jesse R
JR
Fann
Department of Physical Medicine and Rehabilitation, University of Michigan School of Medicine, Ann Arbor, MI.
Claire Z
CZ
Kalpakjian
D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006117:Grief; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D011594:Psychometrics; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation*
Depression; Grief; Principal Component Analysis; Rehabilitation; Spinal Cord Injuries