Causal factors in spinal cord injury: patients' evolving perceptions and association with depression

Do spinal cord injured patients who accept responsibility for their injury cope better than those who blame others? Previous investigations have yielded conflicting answers to this question. On the assumption that some portion of the disparity in earlier findings derives from the failure of early investigators to conceptualize "blame" as a dynamic phenomenon, the present study approached the question via a longitudinal study. Specifically, we examined: (1) the evolution of patients' perceptions of responsibility for spinal cord injury, and (2) the changing association of this factor with depression over a 2-year period, beginning with inpatient rehabilitation. Eighteen men with traumatic spinal cord injury were evaluated during acute rehabilitation and again at 18 to 24 months following discharge. Patients assigned proportions of blame for their injury to four possible causal factors (self, environment, chance, others). Three indices of depression were derived from the Beck Depression Inventory (BDI). Eighty-nine percent of the subjects displayed shifts in pattern of blame assignment between initial and follow-up evaluations. Individuals whose self-blame score increased over time exhibited increased depression, as did those who came to attribute to "chance" lesser blame for their injury. During inpatient rehabilitation, no aspect of blame correlated significantly with any of the three BDI indices, although "other blame" and the cognitive/affective BDI index just failed to reach conventional levels (r = .43, p = .07). By contrast, at follow-up evaluation, "self blame" was positively correlated with both the cognitive/affective (r = .51, p = .03) and Total (r = .46, p = .05) BDI scores. All other correlations were not statistically meaningful.(ABSTRACT TRUNCATED AT 250 WORDS)