1. Predictors of Stress Related Growth in people with SCI compared to the Stress Related Growth of their close persons Lude P 1,2,3, Kennedy P 4,5, Elfström ML 6, Ballert CS 1 Background Stress Related Growth (SRG) refers to the psychological growth after a stressful event. It is not the denial of a negative event but understood as the coping with and adjusting to a stressful event (Park, 2004). Enhanced social resources, enhanced personal resources and new or improved coping skills (Schaefer, 1992) are examples of the possible outcomes and can be explained among others by changes in the person’s worldview and cognitive processing strategies. In the spinal cord injury (SCI) population, SRG post-injury has been only little investigated. A SCI is a major disruptive event in a person’s life which requires adjustment processes of the person with SCI and also from the social environment and may result in SRG. Furthermore, the effects of the SCI on the close persons with respect to the SRG are still a field which needs empirical evidence and research to be better understood. The present poster proposes a statistical analysis to describe the SRG in persons with SCI and their close persons over a period of two years post injury and to show the predictors of growth over time in persons with SCI. Objective To investigate stress related growth (SRG) in people with SCI and their close persons at 6 weeks, 12 weeks, 1 year and 2 years post injury. Methods Design: Longitudinal multi-wave panel design. Participants: The samples consisted of 292 patients recruited from selected Austrian, British, German, Irish and Swiss specialist spinal cord injury rehabilitation centers, and of 55 close persons. Patients had sustained their injury between the age of 16 and 85. Data collection: Questionnaire booklets were administered on the average of 6 weeks, 12 weeks, 1 year and 2 years after injury to patients with newly acquired SCI and their close persons. Questionnaire: SRG-Short Version is a 15-item version of the original 50-item SRGS from Park et al, (1996). It was developed for the assessment of stress related growth. The instrument showed a good reliability in this study, Cronbach alphas were all >0.8 in each of the two groups and at each time point. Furthermore, the Rasch analyses over the four time points showed no ceiling or floor effects of the SRG in this SCI sample. Results The SRG scores did not differ significantly between the persons with SCI and their close persons at each time point (Figure 1). SRG increased a little but significantly from 6 weeks to 12 weeks, 1 year, and 2 years post injury in people with SCI (Table 1). The Rasch based DIF analysis of the SRG-items confirms to a large extent the absence of significant differences in SRG ratings for persons with SCI and their close persons. At 6 weeks, SRG 2 “I feel freer to make my own decisions” and SRG 15 “I learnt that there are more people who care about me than I thought”, at 12 weeks and 1 year post injury were the only items with DIF for persons with SCI and the close persons. The multivariate regression analyses for the close persons did not reveal any significant predictors for the adjusted SRG score at 1 year post-injury. Regarding the adjusted SRG scores for the persons with SCI at 1 and 2 years post- injury, some significant predictors were significant as shown in table 1. Important predictors during rehabilitation for the SRG at 1 and 2 years post injury were SCL-QL-Pro (problems regarding injury), anxiety and acceptance. Other variables assessed during rehabilitation which predicted the SRG on the long term were the depressivity at 6 weeks and at 12 weeks, physical aspects such as the completeness of injury and the FIM motor score as well as fighting spirit and social reliance. Conclusion The analyses of the SRG scores did not show any differences in the SRG ratings between the persons with SCI and their close persons. The SRG scores of the close persons remain stable over time. The ratings of the persons with SCI increase a little, but significantly from sixth weeks on. The coping strategy acceptance, injury related problems and anxiety appear to be the most stable predictors of stress related growth in the long term. “If you understand, things are just as they are; if you do not understand, things are just as they are.” (Zen Proverb) Analyses: The SRG-scores and the SRG-items were compared among the two groups with non-parametric Wilcoxon-tests for the SRG scores and with a Rasch- based differential item functioning (DIF-) analysis. The DIF-analyses were performed for 6 weeks, 12 weeks, and 1 year post-injury. At 2 years post injury, the number of close persons was to small to be reliable. Multiple multivariate regression analyses were performed to predict the Rasch adjusted SRG scores at 1 year and 2 years post-injury with measures and assessments at 6 weeks and 12 weeks post-injury, when the persons with SCI were still in rehabilitation. The close persons’ adjusted SRG scores were predicted with age, gender and employment status as well as their sense of coherence, satisfaction with social support, quality of life (QOL physical, psychological, environmental and social) and the HADS (anxiety and depression). For the persons with SCI additional predictors were included such as injury related variables, SCI-QOL, coping, appraisals and functional assessments. References Park, CL, Fenster JP (2004). Stress-Related Growth: Predictors of Occurrence and Correlates with Psychological Adjustment. Journal of Social and Clinical Psychology: Vol. 23, No. 2, pp. 195-215. Park., CL, Cohen, LH, Murch RL (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64, 71-105. Schaefer, J. A., & Moos, R. H. (1992). Life crises and personal growth. In B. N. Carpenter (Ed.), Personal coping: Theory, research, and application. (pp. 149-170). Westport, CT: Praeger. Figure 1: Boxplot of SRG-scores for SCI patients, and their close persons at 6 weeks, 12 weeks, 1 year and 2 years post injury. Affiliations 1 Swiss Paraplegic Research, Swiss Paraplegic Centre, Nottwil, CH 2 Zurich University of Applied Sciences, School of Applied Psychology, Zurich, CH 3 Private Practice, Psychological Psychotherapy, Bad Zurzach, CH 4 Oxford Doctoral Course in Clinical Psychology, University of Oxford, Isis Education Centre, Warneford Hospital, UK 5 Department of Clinical Psychology, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Buckinghamshire, HP21 8AL, UK 6 School of Health, Care, and Social Welfare, Department of Psychology, Mälardalen University, Sweden. Person with SCI Time Point N 1 st TPN 2 nd TPWp-value 1-2 237244247790.01* 1-3 237139144370.05* 1-4 23710710537.50.01* 2-3 244139172340.79 2-4 24410712632.50.63 3-4 1391077067.50.50 Close Relative Time Point N 1 st TPN 2 nd TPWp-value 1-2 4641787.50.19 1-3 46274840.12 1-4 4616283.50.18 2-3 41275200.68 2-4 4116301.50.64 3-4 2716214.50.98 Table 1: Comparison of SRG scores for the persons with SCI and their close persons across study time points with the Wilcoxon test. Table 2: Results of the multivariate regressions of the assessment of persons with SCI at 6 weeks and 12 weeks post-injury predicting adjusted Rasch scores at 1 year and 2 years post injury.