Resilience Profile Among People with Spinal Cord Injury: A Cluster Analysis
White, Brian Dale
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BACKGROUND: Resilience is considered as an important coping attribute for people adjusting from trauma and loss such as spinal cord injury. Resilience has been found that it has moderate to high correlations with multiple psychosocial characters such as coping strategies, spiritual belief, and life satisfaction as well as mental health. However it is unclear if resilience could have developmental phases when people have adjusted to their trauma and distress over time, or if there are different types of resilience based on a person’s psychosocial characters. Therefore the present study aimed to explore if there are some phases of resilience among people with spinal cord injury (SCI). SUBJECTS: The 93 inpatients with SCI who were undergoing rehabilitation at Baylor Institute of Rehabilitation, Dallas, TX, 58 males (62.4%) and 35 females (37.6%), 77 Caucasians (82.8%) and other races (17.2%; i.e., African American, Hispanic), with mean age of the sample was 44.2 years (SD = 16.2), and the mean months since onset was 16.14 months (SD = 62.12). METHODS: Patients completed the Connor-Davidson Resilience Scale, Personal Health Questionnaire- 9, Satisfaction with Life Scale, Intrinsic Spirituality Scale at any time point since being hospitalized to discharge. Using SPSS 19.0, a hierarchical cluster analysis was performed to preliminarily explore optimal patterns of resilience based on the psychosocial evaluations. Further a two-step cluster was used as a post hoc test of cluster quality and predictor importance. ANOVA and chi-squared test were used to identify any differences of the above psychosocial components of resilience and related demographic characters between the identified patterns of resilience. RESULTS: A hierarchical cluster analysis found three clusters with appropriate differentiable dendrogram distance labeled Spontaneous Resilience (SR; n=28, 35.9%), Evolving Resilience (ER; n=28, 35.9%) and Rebounding Resilience (RR; n=22, 28.2%). Further using a two-step cluster analysis as a post hoc testing, the silhouette measure of cohesion and separation indicated that the cluster quality was fair (0.40). The predictor importance for the cluster formation showed spirituality had an importance of 1.00, the most important predictor, with depression and SWL each showing a predictor importance score of 0.46. The ANOVA found significant differences between groups on resilience, F(2,75) = 7.98, p < .001; depression, F(2, 75) = 23.86, p < .000; SWL, F(2,75) = 23.66, p < .000; and spirituality, F(2, 75) = 71.62, p < .000. Chi square test found no significant associations between the two resilience patterns of gender (X2(2, N = 78) = 1.997, p = 0.368), and marital status (X2( 8, N = 78) = 8.287, p = 0.406). Race results were significant (X2(4, N = 78) = 9.559, p = 0.049), but race was unable to be used due to the majority of participants being Caucasians. DISCUSSION: The current study suggested that there are three resilience patterns recognized in this sample of people with SCI. The hierarchical cluster analysis clustered participants into three clusters: Spontaneous Resilience (SR), Evolving Resilience (ER) and Rebounding Resilience (RR), three of which reflect the levels of resilience change over time and differences in depression, SWL and spirituality. Rehabilitation professionals could apply the present findings on understanding the status of patients’ resilience and design according adjustment psycho-educational therapy for growing patients’ optimal resilience.