Abuse and health in individuals with spinal cord injury and dysfunction.Individuals with spinal cord injury Spinal Cord Injury Definition Spinal cord injury is damage to the spinal cord that causes loss of sensation and motor control. Description Approximately 10,000 new spinal cord injuries (SCIs) occur each year in the United States. and dysfunction dysfunction /dys·func·tion/ (dis-funk´shun) disturbance, impairment, or abnormality of functioning of an organ.dysfunc´tional erectile dysfunction impotence (2). (SCI/D) are at risk for abuse in multiple and complex ways. This population experiences abuse from many sources, including but not limited to, intimate partners, caregivers, and health care providers (Hassouneh-Phillips, 2003; Hassouneh-Phillips & McNeff; 2004). Abuse of individuals with SCI/D is defined as any intentional in·ten·tion·al adj. 1. Done deliberately; intended: an intentional slight. See Synonyms at voluntary. 2. Having to do with intention. act that results in, or is likely to result in harm or suffering, including threats of such acts, coercion coercion, in law, the unlawful act of compelling a person to do, or to abstain from doing, something by depriving him of the exercise of his free will, particularly by use or threat of physical or moral force. or arbitrary deprivations of liberty, whether occurring in public or private life (United Nations, 1993; World Health Organization, 2002). Based on our previous work and review of the literature we conceptualized five distinct domains of abuse including physical, psychological, sexual, financial, and disability-related abuse (Hassouneh-Phillips & McNeff; 2004; Hassouneh-Phillips, 2005; McFarlane, Hughes, Nosek, Groff, Swedlund, & Mullen, 2001; Nosek, Foley fo·ley n. 1. A technical process by which sounds are created or altered for use in a film, video, or other electronically produced work. 2. A person who creates or alters sounds using this process. & Howland, 2001; Oktay & Thompkins, 2004; Powers, Curry, Oschwald, Saxton, & Eckels, 2002; Saxton, Curry, Powers, Maley, Eckels, & Gross, 2001; Saxton, McNeff, Powers, Lilnont, & Benson, 2006). Disability-related abuse is a form of abuse that individuals are vulnerable to by virtue of having a disability. Examples of disability-related abuse include refusal to provide essential personal care and blaming an individual for his or her disability. The prevalence of abuse of individuals with SCI/D is unknown. However, studies of women with physical disabilities generally using convenience samples have reported lifetime rates for any type of abuse ranging from 40-66% (Powers, Curry, Oschwald, Saxton, & Eckels, 2002; Riddington, 1989; Young, Nosek, Howland, Changpon, & Rintala, 1997). Aside from studies of intimate partner abuse in men with HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. which typically do not include disability as a variable, we are aware of only one study that has estimated rates of abuse in men with physical disabilities. Powers and colleagues conducted a study of caregiver care·giv·er n. 1. An individual, such as a physician, nurse, or social worker, who assists in the identification, prevention, or treatment of an illness or disability. 2. abuse in a convenience sample of 342 men with physical and cognitive disabilities (Powers, Curry, McNeff, Saxton, & Orstrogorsky, 2008). The authors reported that 37% of men in the study had been physically abused and greater than 12% had been sexually abused while disabled. Also of note, the lifetime incidence of caregiver abuse or neglect reported by men was 50.6%. Although little is known about abuse of individuals with SCI/D specifically, an in-depth qualitative study of abuse of women with SCI (Scalable Coherent Interface) An IEEE standard for a high-speed bus that uses wire or fiber-optic cable. It can transfer data up to 1GBytes/sec. (hardware) SCI - 1. Scalable Coherent Interface. 2. UART. (n=12 with a total of 24 interviews) indicated that abuse negatively affected participants' abilities to optimally manage their disabilities and severely compromised their health, including the onset of co-morbid mood disorders The mood or affective disorders are mental disorders that primarily affect mood and interfere with the activities of daily living. Usually it includes major depressive disorder (MDD) and bipolar disorder (also called Manic Depressive Psychosis). and declining physical health resulting in a loss of functional ability, employment, and the ability to live independently (Hassouneh-Phillips, 2003; Hassouneh-Phillips & McNeff, 2004). Given these qualitative findings, we sought to further explore abuse of individuals with SCI/D, quantitatively. Theoretical Framework The variables explored in this study were derived from the Abuse Pathways Model (Hassouneh-Phillips, 2005). This model describes the abuse trajectories of women with physical disabilities, vulnerability factors for abuse, and negative health outcomes related to abuse. Key vulnerability factors and health outcomes were selected from the model for use in this study based on previous qualitative findings. Vulnerability factors included adult and child abuse history, physical dependency, health behavior, sexual and body-esteem, and substance abuse. Health outcomes included symptoms of depression and post-traumatic stress disorder post-traumatic stress disorder (PTSD), mental disorder that follows an occurrence of extreme psychological stress, such as that encountered in war or resulting from violence, childhood abuse, sexual abuse, or serious accident. (PTSD PTSD posttraumatic stress disorder. PTSD abbr. posttraumatic stress disorder Post-traumatic stress disorder (PTSD) ). In two previous qualitative studies of abuse of women with physical disabilities including women with SCI/D, we found that women who had been previously abused either during childhood or as an adult were more likely to report repeated victimization victimization Social medicine The abuse of the disenfranchised–eg, those underage, elderly, ♀, mentally retarded, illegal aliens, or other, by coercing them into illegal activities–eg, drug trade, pornography, prostitution. (Hassouneh-Phillips, 2005; Hassouneh-Phillips & McNeff, 2004). Women who were physically dependent on others to provide essential personal care were also at risk for victimization by caregivers and other perpetrators. When experiencing abuse, women tended to focus on their survival and basic needs, often neglecting care of the primary disabilities and failing to engage in healthy behaviors such as exercise, proper nutrition proper nutrition, n in Tibetan medicine, a therapeutic concept that begins with a digestive formulation because it is believed that a medical condition is primarily the result of a nutritional dysfunction or disturbance in the process of delivering nutrients. , and seeking preventative health care. We also found that women were more likely to experience repeated intimate partner abuse when they had low body image and sexual self esteem combined with a perceived need to be partnered (Hassouneh-Phillips & McNeff, 2005). In these instances, women often openly admitted that they would "lower their standards" in terms of selecting intimate partners rather than face the possibility of being alone. Another vulnerability factor for abuse included in our theoretical framework was substance abuse including both alcohol abuse and abuse of illicit Not permitted or allowed; prohibited; unlawful; as an illicit trade; illicit intercourse. ILLICIT. What is unlawful what is forbidden by the law. Vide Unlawful. 2. and prescription drugs prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, . Women with substance abuse problems were more likely to also have intimate partners and/or caregivers who abused substances and describe experiences that reflected impaired decision-making. Finally, abused women also frequently reported current or past histories of depression and PTSD. Using this theoretical framework to select predictor and outcome variables, the study aims were to: 1) estimate the percentage of individuals with SCI/D who experience abuse; 2) explore predictors of abuse in individuals with SCI/D; and 3) explore the impact of abuse on health in members of this population. For aim two, we explored predictors of current abuse including, gender, number of secondary conditions, substance abuse, body self-esteem, physical dependency, childhood abuse, and adult history of abuse. For aim three, we examined whether participants who reported no abuse had better health outcomes (depression, PTSD, and health promoting behavior) than participants who were currently experiencing abuse or had experienced abuse in the past controlling for age, gender and physical dependency. Method Study Sample Adults age 18 and older with self-identified SCI/D were eligible for participation in this study. Two-hundred and ninety individuals with SCI/D including 166 women and 125 men (57.1% female; 42.9% male) participated in the study. The average age of participants was 44.47 years old (SD = 13.01). With regard to the ethnic composition of the sample the majority were White (74.8%), followed by Black (7.9%), Native American (6.2%), Hispanic (4.9%), and individuals from other ethnic groups (6.2%). The most common form of disabilities reported were various forms of spinal cord spinal cord, the part of the nervous system occupying the hollow interior (vertebral canal) of the series of vertebrae that form the spinal column, technically known as the vertebral column. impairment Impairment 1. A reduction in a company's stated capital. 2. The total capital that is less than the par value of the company's capital stock. Notes: 1. This is usually reduced because of poorly estimated losses or gains. 2. (33.4%), followed by individuals with multiple sclerosis multiple sclerosis (MS), chronic, slowly progressive autoimmune disease in which the body's immune system attacks the protective myelin sheaths that surround the nerve cells of the brain and spinal cord (a process called demyelination), resulting in damaged areas (19.0%), Cerebral Palsy cerebral palsy (sərē`brəl pôl`zē), disability caused by brain damage before or during birth or in the first years, resulting in a loss of voluntary muscular control and coordination. (17.9%), quadriplegia quadriplegia: see paraplegia. SCI (14.8%), paraplegia paraplegia (pâr'əplē`jēə), paralysis of the lower part of the body, commonly affecting both legs and often internal organs below the waist. When both legs and arms are affected, the condition is called quadriplegia. SCI (9.3%), and Spina Bifida (5.5%). The percent of participants born with their disabilities was 21.8%, with 87.2% having acquired their disabilities at a mean age of 28.89 years (SD = 13.32). Seventy-nine percent of participants required some type of assistance with activities of daily living. Forty-five percent of the total sample reported annual income between 0 and 10,000 dollars, however, women reported significantly higher income than men (p=.004). This difference in income was likely due to the significantly greater number of years of education reported by women compared to men in the sample (p=.033). Procedure All study procedures were approved by the Oregon Health & Science University's (OHSU OHSU Oregon Health & Science University (Portland, OR, USA) ) internal review board. Recruitment of participants occurred in collaboration with four Centers for Independent Living (CILs) located in two urban and two rural sites in Oregon. The CILs advertised the study in their newsletters and handed out flyers to potential participants. Interested individuals contacted one of the investigators or another research team member who then described details about the study and briefly assessed study eligibility. Team members included representatives from each of the four collaborating CILs. Staff at local CILs who joined the research team completed Oregon Health & Science University's (OHSU) research training on responsible conduct of research prior to their involvement with the project. Following the initial contact, individuals who were interested in participating in the study scheduled an appointment for a quantitative data collection interview with one of the investigators or another member of the research team at a private and safe location. The vast majority of interviews were completed on the premises of one of the four collaborating CILs. An information sheet was reviewed with each potential participant, explaining the purpose of the study, its potential risks and benefits, as well as what study participation entailed prior to initiation of data collection as part of the informed consent process. Participation involved anonymous completion of an instrument package. The instrument package took an average of one hour to complete. All participants requiring physical assistance to complete the measure were provided with help as needed as needed prn. See prn order. . Remuneration REMUNERATION. Reward; recompense; salary. Dig. 17, 1, 7. in the amount of $50 was paid to each participant to compensate them for their time and express our appreciation for their support of the study. Measures In order to include data from as many participants as possible in the analyses, scores on multiple item scales were computed when participants answered 75% of the questions making up that scale by replacing missing items with the participant's mean score on the answered items. A demographic questionnaire was also administered inquiring inquiring, v to draw information from a client—whether by verbal questioning or physical examination—to assess the person's state of health. about age, gender, education, income, primary and secondary disability type(s), and use of personal assistance. Adult Abuse. Current abuse and adult history of abuse were measured using 31-items from the WPD WPD WordPerfect Document (file extension) WPD Western Power Distribution (UK) WPD Western Police District (local police authority in Manila, Philippines) Abuse Inventory. The WPD Abuse Inventory was developed by the authors primarily based on 72 in-depth life history interviews conducted with 37 women with physical disabilities including a large number of women with SCI/D. In addition to our qualitative work, items were also adapted from four existing abuse scales: the Trauma History Questionnaire (THQ THQ Toy Headquarters THQ Territorial Headquarters THQ Tehsil Headquarters (Pakistan) THQ The Holy Quran THQ Theater Headquarters ) (Green, 1996), the Women's Personal Assistance Abuse (PASA PASA Purchasing and Supply Agency (UK NHS) PASA Pennsylvania Association for Sustainable Agriculture PASA Publications of the Astronomical Society of Australia PASA Pan African Sanctuary Alliance PASA Publishers’ Association of South Africa ) survey (Powers, Curry, Oschwald, Saxton, & Eckels, 2002), the Abusive Behavior abusive behavior Public health Any of various behaviors–aggressive, coercive or controlling, destructive, harassing, intimidating, isolating, threatening–which a batterer may use to control a domestic partner/victim. See Domestic violence. Inventory (ABI Abi (ā`bī) [short for Abijah], in the Bible, King Hezekiah's mother. (Application Binary Interface) A specification for a specific hardware platform combined with the operating system. ) (Shepard & Campbell, 1992), and the Psychological Abuse Inventory (PVI See Present Value Index. ) (Sonken, 2004). In total we adapted 26-items from other scales, 18 of which were validated by our qualitative findings. Our main goal was to achieve good content validity content validity, n the degree to which an experiment or measurement actually reflects the variable it has been designed to measure. by representing the four dimensions of abuse (i.e., psychological, physical, sexual, financial) common to abuse measures designed for use with non-disabled women, in addition to including abuse indicators specific to women with physical disabilities (i.e. disability-related abuse) (Hassouneh-Phillips & Curry, 2002; Hassouneh-Phillips & McNeff, 2004; Powers et al. 2002; Saxton et al. 2001). As noted earlier, disability-related abuse is a form of abuse that women with physical disabilities are vulnerable to by virtue of having a disability such as taking away assistive devices assistive device Public health Any device designed or adapted to help people with physical or emotional disorders to perform actions, tasks, and activities. See Americans with Disabilities Act, Architectural barriers, Assistive technology. or refusing to provide medications, food, or water to women who are dependent on others for essential personal care. Since we used dichotomous di·chot·o·mous adj. 1. Divided or dividing into two parts or classifications. 2. Characterized by dichotomy. di·chot variables in our study of abuse and health in men and women with SCI/D, to assess reliability we computed percent agreement between two administrations of the measure. Reliability data was collected two weeks apart. The percent agreement for both current abuse and adult history of abuse was 92.86%. The concurrent validity concurrent validity, n the degree to which results from one test agree with results from other, different tests. of the measure was demonstrated by expected patterns in correlates with measures of depression, and posttraumatic stress disorder Posttraumatic stress disorder An anxiety disorder in some individuals who have experienced an event that poses a direct threat to the individual's or another person's life. . In the WPD Abuse Inventory, each item asks about the occurrence of a specific abusive behavior both within the last year and prior to the last year, but only after the onset of disability. If participants indicated that they experienced any of the abusive behaviors within the last year they were coded as 1 on current abuse, otherwise they were coded as 0. If participants indicated that they experienced any of the abusive behaviors prior to the last year they were coded as 1 on adult history of abuse, otherwise they were coded as 0. Current abuse was also broken down into the five subscales referred to earlier: 1) disability related abuse, 2) psychological abuse, 3) sexual abuse, 4) physical abuse, and 5) financial abuse. Table 1 reports on the frequency each item was reported for current abuse and which items make up each subscales. These subscales were also coded 0 (did not occur) and 1 (occurred). For the final aim current abuse, and adult history of abuse were combined to form three mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time contradictory incompatible - not compatible; "incompatible personalities"; "incompatible colors" categories coded 0 (no abuse), 1 (past abuse but no current abuse), and 2 (current abuse). Childhood Abuse. Childhood abuse was measured using the Childhood Abuse and Trauma Scale (CATS) (Sanders San´ders n. 1. An old name of sandalwood, now applied only to the red sandalwood. See under Sandalwood. & Becker-Lausen, 1995). The Child Abuse & Trauma Scale (CATS) provides information on the frequency and extent of negative childhood experiences. The CATS consists of 38 items and asks respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. to indicate the general atmosphere of their home and the way they felt they were treated during childhood by their parents/caregivers on a 5-point scale ranging from 0=never to 4=always. A total score is obtained by computing computing - computer the mean of the items, high scores indicate more abuse. The internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. reliability of the items was .95. Substance Abuse. Drug and alcohol abuse was measured using a modified version of the RAPS4 (Rapid Alcohol Problems Screen). The RAPS4 consists of 4-items that ask about drug and alcohol use during the last year. For clinical purposes, a "yes" to any one of the items is considered positive (Cherpitel, 2002). Accordingly, we scored the variable as follows: 0 = (no drug or alcohol abuse) and 1 = (drug and/or alcohol abuse). The sensitivity of the RAPS as a screening tool for drug and alcohol abuse has been previously established (Barnett et al. 2003). Body Image and Sexual Self-Esteem. Body image and sexual self-esteem was measured using the Physical Disability. Sexual and Body Esteem Scale (PDSBE; Taleporos & McCabe, 2002). The scale is composed of 10-items with a 5-point response scale ranging from 1 (strongly agree) to 5 (strongly disagree). A total score is obtained by summing the items. Scores range from 10-50 with higher scores indicating better body self-esteem. The PDSBE has demonstrated strong concurrent validity both in our study as well as in previous studies. Moreover in the current study, the PDSBE demonstrated strong internal consistency reliability with a Conbach's alpha of .90. Physical Dependency. Physical dependency was assessed using the Stanford Health Assessment Questionnaire (HAQ HAQ Health Assessment Questionnaire HAQ Harvard Asia Quarterly ; Center, 2003). The HAQ is an 8-item measure of physical ability. Participants are asked to rate each item on a 4-point scale ranging from 0=without difficulty to 3=unable to do. The measure is scored using the mean of 8-items; higher scores indicate more physical dependency. The internal consistency reliability of the items was .92. Depressive de·pres·sive adj. 1. Tending to depress or lower. 2. Depressing; gloomy. 3. Of or relating to psychological depression. n. A person suffering from psychological depression. Symptoms. Depressive symptoms were assessed using the Center for Epidemiologic Studies epidemiologic study A study that compares 2 groups of people who are alike except for one factor, such as exposure to a chemical or the presence of a health effect; the investigators try to determine if any factor is associated with the health effect Depression Scale (CES-D CES-D Center for Epidemiologic Studies Depression (Scale) ; Radloff, 1977). The CES-D is a 20-item measure that assesses depressed mood during the past week using a 4-point scale ranging from 0=rarely or none (less than a day) to 3=most or all of the time (5-7days). Four of the 20-items are reverse scored, and the total measure is scored by summing all items (Radloff, 1977). A score of 16 or greater signals possible depression. The CES-D has demonstrated excellent reliability with Cronbach's alphas Cronbach's  (alpha) has an important use as a measure of the reliability of a psychometric instrument. It was first named as alpha by Cronbach (1951), as he had intended to continue with further instruments. ranging from .85 in community samples to .90 in
psychiatric psy·chi·at·ricadj. Of or relating to psychiatry. psychiatric adjective Pertaining to psychiatry, mental disorders samples (Stromborg & Olsen, 2004). In our study, Cronbach's alpha of the CES-D was .92 (Hassouneh-Phillips, 2006). The validity of the CES-D in samples of people with physical disabilities generally has also been demonstrated. In a study of the prevalence and correlates of depression as a secondary condition in adults with physical disabilities, Mitra and colleagues reported that the CES-D had a sensitivity and specificity of 77% and 75% respectively, in this population. PTSD Symptoms. The PTSD Checklist-Civilian (PCL-C) was used to assess symptoms associated with adult abuse that occurred after the onset of disability (PCL-C; Ruggerio et al. 2003). The PCL-C consists of 17-items that assess intrusive in·tru·sive adj. 1. Intruding or tending to intrude. 2. Geology Of or relating to igneous rock that is forced while molten into cracks or between other layers of rock. 3. Linguistics Epenthetic. , avoidance/numbing, and arousal arousal /arous·al/ (ah-rou´z'l) 1. a state of responsiveness to sensory stimulation or excitability. 2. the act or state of waking from or as if from sleep. 3. symptoms experienced in the past month using a 5-point scale (i.e. 1=not at all. 2-a little bit. 3=moderately. 4=quite a bit. 5=extremely). Using the symptom method, a formal diagnosis of PTSD is considered likely if participants rate as "moderately," "quite a bit," or "extremely" bothersome one or more intrusion symptom items, three or more avoidance/numbing symptom items, and two or more arousal symptoms in correspondence with DSM-IV DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). This reference book, published by the American Psychiatric Association, is the diagnostic standard for most mental health professionals in the United States. symptom cluster criteria for PTSD. The total score is a sum of the items, with high scores being indicative of more severe PTSD symptoms. Using the cutoff method, a formal diagnosis of PTSD is considered likely if participants obtain a total score of 50 or greater. Cronbach's alpha in our study was .96. Health Behavior: Health promoting behaviors were measured using the Health Promoting Lifestyle Profile II (HPLPII). The HPLP HPLP Hp Laser Printer II is a 52-item global measure of health behavior using a 4 point scale ranging from 1=never to 4=routinely (Berger & Walker, 1997). We revised some items of the physical activity sub-scale to account for mobility limitations. The total score was obtained by calculating the mean of the 52 items. The internal consistency reliability of the items was .95. Statistical Analysis For aim one, percentages for each type of abuse as well as total abuse are reported. For aim two, logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. was used to explore the predictors of abuse in individuals with SCI/D. Aim three was analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. using one-way ANCOVAs with planned contrasts to investigate whether participants reporting no abuse had better health outcomes than participants reporting current abuse or past abuse. Results Aim one was to estimate the percentage of participants who experienced abuse. Nearly half (54.3%) reported some form of abuse within the last year. The most common type of abuse was disability-related abuse reported by 45.5% of participants, followed by psychological abuse (35.2%), financial abuse (27.0%), physical abuse (10.3%), and sexual abuse (9.0%). The frequency and type of specific abusive behaviors is reported in Table 1. To explore predictors of current abuse, gender, number of secondary conditions, substance abuse, body self-esteem, physical dependency, childhood abuse, and adult history of abuse were regressed onto current abuse. The overall model was significant ([c.sup.2](7) = 211.49, p < .001). Controlling for other variables in the model, physical dependency, childhood abuse, and adult history of abuse were all positively related to current abuse. With each one point increase in physical dependency (OR = 2.27, p = .002) participants were over two times more likely to report current abuse. Participants were also over two times more likely to report current abuse for every one point increase in childhood abuse (OR = 2.42, p = .004). Of note, participants who reported previous abuse as an adult with a disability were over 58 times more likely to report current abuse than participants who reported no adult abuse (OR = 58.46, p < .001). This odds ratio is very large. A crosstab of previous abuse as an adult and current abuse indicates that 84.3% of participants reporting previous abuse also reported current abuse. In addition, 93.7% of participants who reported no previous abuse also reported no current abuse. Table 2 below provides more detailed information about the logistic regression. As previously noted, one-way ANCOVAs using planned contrasts were used to investigate whether participants reporting no abuse as measured by the WPD Abuse Inventory had better health outcomes (depression, PTSD, and health promoting behavior) than participants who were currently experiencing abuse or had experienced abuse in the past controlling for age, gender and physical dependency. Adjusted means and standard deviations In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. are presented in Table 3. The results indicated that participants reporting no adult abuse were less depressed and had fewer PTSD symptoms than participants who reported current and past abuse histories. The results also indicated that participants reporting no abuse engaged in more health promoting behaviors than participants who reported current abuse. Discussion To our knowledge this is the first study to examine health outcomes related to abuse in a sample of individuals with SCUD specifically, or in individuals with physical disabilities generally. Our findings indicate that participants who reported current or past abuse as adults with disabilities were significantly more likely to experience co-morbid depression and PTSD symptoms than those who reported that they had never been abused. This finding is of great clinical significance since it is well documented that the presence of co-morbid psychiatric conditions in individuals with physical disabilities detrimentally det·ri·men·tal adj. Causing damage or harm; injurious. det  ri·men influences their
overall health, quality of life, and ability to live independently
(Coyle, Santiago, Shank shank (shangk)1. leg (1). 2. crus ( 2). shank n. The part of the human leg between the knee and ankle. , Ma, & Boyd, 2000; Wilber et al. 2002). Moreover, our finding that abused participants were significantly less likely to engage in health promoting behaviors also has clinical significance. Individuals who begin to neglect their preventative health care needs and fail to optimally manage their primary disabilities may be experiencing abuse. Given these findings, it is important that clinicians screen for current or past abuse in individuals with SCI/D, thereby opening up potential windows of opportunity for intervention. When screening for abuse in individuals with SCI/D, clinicians may consider using tools such as the Abuse Assessment Screen-Disability (McFarlane et al. 2001). We also suggest that the risk factors identified in this study including physical dependency, a history of childhood abuse, and most significantly, a prior history of abuse as an adult with a disability should also be assessed as part of the screening process. In doing so, clinicians may not only be able to identify currently abused individuals, but may also be able to identify individuals at risk. Finally, the high frequency of disability-related abuse reported by both men and women in this study suggests that greater awareness of the nature of this problem as well as implementation of preventative intervention strategies such as caregiver management and abuse reporting training may be useful. Study Limitations Findings from this study should be interpreted with caution for three reasons. First, this study used a convenience sample. Second, the abuse measure, although demonstrating strong concurrent validity in both men and women in this study, was originally designed for use with women. More work is needed to further develop the psychometric psy·cho·met·rics n. (used with a sing. verb) The branch of psychology that deals with the design, administration, and interpretation of quantitative tests for the measurement of psychological variables such as intelligence, aptitude, and properties and applicability of this measure. Third, this study used a cross-sectional design. Despite these limitations, given the paucity pau·ci·ty n. 1. Smallness of number; fewness. 2. Scarcity; dearth: a paucity of natural resources. of information available about abuse of individuals with SCI/D, we stand by our clinical recommendations which are consistent with previously obtained qualitative findings. In summary, future research is needed to improve the availability and quality of abuse measures appropriate for use in individuals with SCI/D, replicate rep·li·cate v. 1. To duplicate, copy, reproduce, or repeat. 2. To reproduce or make an exact copy or copies of genetic material, a cell, or an organism. n. A repetition of an experiment or a procedure. findings from this study, and investigate other aspects of the phenomenon. Therefore, future studies, using mixed methods as well as qualitative and quantitative designs are needed to further build the knowledge base on abuse of individuals with SCI/D in the hopes of reducing not only the frequency and occurrence of abuse, but also of reducing the high number of co-morbid conditions that pose a serious threat to their overall health and quality of life. Acknowledgement We would like to thank the Paralyzed par·a·lyze tr.v. par·a·lyzed, par·a·lyz·ing, par·a·lyz·es 1. To affect with paralysis; cause to be paralytic. 2. To make unable to move or act: paralyzed by fear. Veteran's of America Clinical Research Foundation for their support of this project. References Barnett, N., Monti, R, Cherpitel, C., Bendtsen, P., Borges, G., Colby, S., Nordqvist, C. & Johansson, K. (2003). Identification and brief treatment of alcohol problems with medical patients; an international perspective. Alcoholism alcoholism, disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is , 27(2), 262-270. Berger, A., & Walker, S. (1997). Measuring Healthy Lifestyle. In M. Frank-Stromborg & S. Olsen (Eds.), Instruments for clinical health care research (2nd ed., pp. 363-377). Sudbury, MA: Jones and Bartlett Publishers. Coyle, C., Santiago, M., Shank, J., Ma, G., & Boyd, R. (2000). 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Dena Hassouneh San Francisco State University • • [ Nancy Perrin Oregon Health & Science University Ginger Hanson Oregon Health & Science University Elizabeth McNeff Portland State University Dena Hassouneh, Ph.D., Associate Professor, Oregon Health & Science University School of Nursing, SN-637, 3455 S.W. U.S. Veteran's Hospital Rd, Portland, Oregon 97239-29412.
Table 1
Percentage of-Participants Reporting Current Abuse Items
N Mean
Intentionally hurt you by coming late,
not showing up, or leaving early? 286 22.4%
Been unable to provide you with good care
because he or she was drunk or high? 285 11.9%
Abandoned or threatened to abandon you? 284 18.0%
Intentionally hurt you by not doing the
work you needed done? 285 22.1%
Hurt you by making decisions without asking
you or restricting choices such as when to
eat or go to bed? 284 21.8%
Hurt you by ignoring requests or refusing
to talk to you? 286 25.2%
Kept you from getting your physical needs met
such as food, sleep, medications or hygiene? 286 16.8%
Hurt you by gossiping or sharing your personal
information with others? 288 28.5%
Hurt you intentionally by handling you roughly
or pushing you beyond your limits? 287 21.3%
Engaged in sexual or obscene behavior in
front of you against your wishes? 288 6.6%
Touched you sexually during bathing, dressing,
or other care-related activities without
your permission? 288 6.6%
Blamed you for your disability? 286 22.0%
Tried to control or hurt you by taking away,
damaging, or putting out of reach a
telephone, walker, cane, wheelchair,
or other assistive device? 286 13.3%
Threatened to damage or destroy your property? 290 19.0%
Intentionally damaged or destroyed things
that belong to you? 289 20.1%
Threatened to hurt or batter you? 290 21.4%
Threatened you with a weapon? 286 14.0%
Threatened to kill you? 285 13.3%
Hurt or threatened to hurt or batter 287 9.1%
your pet or your child?
Kept you from seeing your family, friends, or 289 12.1%
health care provider?
Yelled at you, called you names, degraded or
humiliated you, or tried (with intent) to
make you feel bad about yourself in some
other way? 285 42.1%
Harassed you by calling or visiting you
repeatedly against your wishes? 288 16.0%
Tried to pressure you to have unwanted
sexual contact? 287 14.6%
Made you have intercourse, oral, or anal
sex against your will? 288 10.1%
Touched private parts of your body or made
you touch theirs against your will? 288 15.6%
Attacked you with a gun, knife, or some
other weapon? 288 9.4%
Beaten, hit, pushed, kicked, or slapped you? 287 24.0%
Attacked you without a weapon and injured you? 287 16.4%
Stolen anything from you such as money,
valuables, medications, checks or credit
cards? 289 38.1%
A caregiver, family member, friend, and/or
intimate partner prevented you from
getting or keeping a job? 287 15.3%
Taken control of or prevented you from having
access to your money against your wishes? 289 10.7%
Disability--related abuse (1-13, psychological abuse (14-22), sexual
abuse (23-25), physical abuse (26-28), financial abuse (29-31).
Table 2
Odds Ratios from Logistic Regressions Predicting Any Type of
Current Abuse
95% CI
OR Lower Upper p
Gender 1.07 .48 2.42 .865
Number of secondary conditions 1.08 .80 1.45
.625
Substance abuse 1.70 .65 4.43 .281
Body self-esteem .98 .94 1.03 .470
Physical dependency 2.27 1.34 3.84 .002
Childhood abuse 2.42 1.33 4.40 .004
Adult history of abuse 58.46 22.61 151.10 <0.001
Table 3
Differences between Participants Reporting No Abuse and
Participants Reporting Past or Current Abuse Controlling for Age,
Gender and Physical Dependency
No Abuse Past Abuse Current Abuse
M (a) (SD) M (a) (SD) M (a) (SD)
Depression (CESD) .77 (.68) .86 (.66) 1.24 (.68)
PTSD (PCL-C) 29.48 (15.97) 30.46 (15.28) 41.83 (15.89)
Health promoting
behaviors (HPLPII) 2.60 (.50) 2.48 (.48) 2.47 (.49)
No Abuse No Abuse
vs vs
Past Abuse Current Abuse
Depression (CESD) .007 .000
PTSD (PCL-C) .000 .000
Health promoting
behaviors (HPLPII) .947 .043
(a) Means adjusted to control for age, gender, and physical dependency
(HAQ).
CESD ranges from 0-3 with high scores indicating more depression.
PCL-C ranges from 17-85 with high scores indicating worse PTSD. HPLPII
ranges 1-4 with high scores indicating more health promoting behaviors.
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