title: How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?
abstract: To understand the role of cultural and psychosocial factors in the outcomes of veteran wheelchair users with spinal cord injury (SCI) to help clinicians identify unique factors faced by their patients and help researchers identify target variables for interventions to reduce disparities in outcomes.
  
  
  
  Cross-sectional cohort study.
  
  
  
  Three urban Veterans Affairs medical centers affiliated with academic medical centers.
  
  
  
  Of the patients (N=516) who were eligible to participate, 482 completed the interview and 439 had SCI. Because of small numbers in other race groups, analyses were restricted to white and African American participants, resulting in a final sample of 422.
  
  
  
  Not applicable.
  
  
  
  Quality of life (QOL, Veterans RAND 12-Item Health Survey); satisfaction (Client Satisfaction Questionnaire); and participation (Craig Handicap Assessment and Reporting Technique Short Form).
  
  
  
  African American Veterans reported poorer physical QOL but better mental QOL than did white Veterans. No other significant race differences were found in unadjusted analyses. Multivariable analyses showed that psychosocial factors were predominantly associated with patients' QOL outcomes and satisfaction with service, but demographic and medical factors were predominantly associated with participation outcomes. Interaction analyses showed that there was a stronger negative association between anxiety and mental QOL for African Americans than for whites, and a positive association between higher self-esteem and social integration for whites but not African Americans.
  
  
  
  Findings suggest that attempts to improve the outcomes of Veterans with SCI should focus on a tailored approach that emphasizes patients' demographic, medical, and psychosocial assets (eg, building their sense of self-esteem or increasing their feelings of mastery), while providing services targeted to their specific limitations (eg, reducing depression and anxiety).
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA. Electronic address: larissa.myaskovsky@va.gov.
authors.forename: Larissa
authors.initials: L
authors.lastname: Myaskovsky
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Shasha
authors.initials: S
authors.lastname: Gao
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Leslie R M
authors.initials: LRM
authors.lastname: Hausmann
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Kellee R
authors.initials: KR
authors.lastname: Bornemann
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Burkitt
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.affiliation: James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Phillips
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Pennsylvania State University Medical Center, Hershey, PA.
authors.forename: David
authors.initials: D
authors.lastname: Gater
authors.affiliation: National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Departments of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Spungen
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Center of Excellence in Wheelchairs and Associated Rehabilitation Engineering, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D001007:Anxiety / Q000523:psychology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology; D012649:Self Concept; D013119:Spinal Cord Injuries / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans / Q000523:psychology*; D014910:Wheelchairs / Q000523:psychology*; D044465:White People / Q000523:psychology*
keywords: Healthcare disparities; Quality of life; Rehabilitation; Spinal cord injuries