Adjustment Following Spinal Cord Injury 427conceptualizations of the self„expressed as goal instability
and measured with a psychometrically sound instrument„
may offer some explanations about adjustment following
SCI. In a series of studies, a greater goal orientation was
associated with less depression, greater acceptance of dis-
ability, and increased life satisfaction one year later among
persons with recent-onset physical disability. Goal orienta-
tion was also associated with less perceived social stigma
and increased mobility among community-residing persons
(Elliott, Uswatte, Lewis, & Palmatier, 2000). We have known
for years that persons who have many as compared to few
goals evidence more optimal adjustment (Kemp & Vash,
1971). Goal-directed behavior may be indicative of a greater
proclivity for optimal adjustment.
Other personality traits are predictive of adjustment
as well. Krause and Rohe (1998) found that elements of
neuroticism and extraversion were associated with life satis-
faction among community-residing persons with spinal cord
injuries. Speci“cally, a greater proclivity for depression
was predictive of less life satisfaction. Similarly, Rivera and
Elliott (2000) found that lower neuroticism and higher agree-
ableness were predictive of greater acceptance of disability
among persons with a spinal cord injury after controlling for
level of injury, completeness of injury, depression, and de-
mographic variables. Men with SCI have signi“cantly higher
excitement-seeking facet scores, lower conscientiousness
factor, and lower assertiveness and activity facet scores than
normative samples on a measure of the “ve factor model
of personality (Rohe & Krause, 1999). Because this sample
(n 105) averaged 17.9 years postinjury, it seems that
excitement-seeking tendencies may not necessarily be a func-
tion of younger age among persons with recent onset SCI.
Stable personality traits appear to be signi“cant correlates of
depression and acceptance of disability in persons with ac-
quired SCI. Evidence indicates that nonpathological person-
ality traits are not adversely affected by long-term SCI
(Hollick et al., 2001).
Social and Interpersonal Environment
Following SCI, people face a complicated social and inter-
personal landscape that can have direct effects on their health
and adjustment. Married persons are often more involved
in productive activity outside the home (Krause, 1990) and
report greater life satisfaction than single persons with SCI
(Putzke, Elliott, & Richards, 2001). However, persons in dis-
tressed marriages report fewer activities alone and with their
spouse, and report greater dissatisfaction and more negative
communications (Urey & Henggeler, 1987). The onset of
SCI compels family members to directly confront issues of
trust, mortality, and values, and those who adapt often forge
deeper commitments and restructure the meaning of marriage
or kinship (Olkin, 1999). Some family members report a
greater sense of closeness after SCI, with a greater em-
phasis on shared family values and personal relationships
(Crewe, 1993).
Social support has been associated with well-being among
persons with SCI (Rintala, Young, Hart, Clearman, & Fuhrer,
1992). The ”uid nature of social support may re”ect the var-
ious types of assistance (e.g., informational, emotional) re-
quired to complement speci“c coping ef forts (McColl, Lei, &
Skinner, 1995). Elements of social support can have positive
and negative effects on other aspects of adjustment. For ex-
ample, assertive persons may be able to marshal available so-
cial support in certain situations; however, this direct style
also may alienate others in the social support system (Elliott,
Herrick, et al., 1991). Others who have more proactive
problem-solving styles may bene“t from other types of sup-
port such as formal service provision (Elliott, Herrick, &
Witty, 1992). Social support that provides a sense of intimacy
and attachment is associated with more satisfactory leisure
activities (Elliott & Shewchuk, 1995), and satisfaction with
recreational activities is a major component of overall life
satisfaction following SCI (Kinney & Coyle, 1992).
Family members who are forced to assume caregiving
roles have an impact on the psychological and physical ad-
justments of persons with disabilities. Caregiver tendencies
to solve problems carelessly and impulsively were signi“-
cantly predictive of lower acceptance of disability among
patients who were leaving a rehabilitation hospital (Elliott,
Shewchuk, & Richards, 1999). A year following discharge,
caregiver impulsivity carelessness toward solving problems
measured during initial rehabilitation correctly classi“ed
87.88% of those persons with and without a sore. It is con-
ceivable that the persons with SCI were aware of their care-
givers• problem-solving styles and these issues complicated
their ability to adjust optimally. A signi“cant percentage of
family members meet clinical criteria for a depressive
episode when they assume caregiving duties for a person who
has incurred a SCI (Elliott & Shewchuk, in press). Family
caregivers may face increasing problems with their physical
health and well-being in the initial year of caregiving, partic-
ularly if they have a negative orientation toward solving
problems (Elliott, Shewchuk, & Richards, 2001) and as their
sources of emotional support dwindle throughout the year
(Shewchuk, Richards, & Elliott, 1998).
The social environment can yield considerable stress
because persons with disabilities are impeded from being in-
tegrated, and mobility is limited in society at large. Factors
ranging from architectural barriers, transportation dif“culties,