Quality of Life Research

, Volume 23, Issue 10, pp 2693–2705 | Cite as

Modeling life satisfaction in spinal cord injury: the role of psychological resources

  • Claudio Peter
  • Rachel Müller
  • Alarcos Cieza
  • Marcel W. M. Post
  • Christel M. C. van Leeuwen
  • Christina S. Werner
  • Szilvia Geyh



The aims of the study were (1) to examine the associations between the psychological resources general self-efficacy (GSE) and purpose in life (PIL), appraisals, coping and life satisfaction, and (2) to examine whether the effects of the psychological resources on life satisfaction are mediated by appraisals and coping, as proposed by the spinal cord injury adjustment model (SCIAM).


Cross-sectional multicenter study conducted with persons with spinal cord injury (SCI) living in the community in Switzerland (N = 516). Pearson’s correlations were calculated for aim 1, and structural equation modeling was conducted to address aim 2.


GSE (r = .48) and PIL (r = .58) were positively related to life satisfaction. The initial model corresponding to the SCIAM yielded a poor model fit. The final model had a good model fit [χ 2 = 66.0, df = 21, p < .01, RMSEA = .065 (90 % confidence interval .048–.082), CFI = .97] explaining 57 % of variance of life satisfaction. PIL had a direct large effect on life satisfaction (β = .54). The influence of GSE on life satisfaction was mediated by loss appraisals. Avoidance, active and humor coping had small effects on life satisfaction.


Psychological resources have a substantial effect on life satisfaction in persons with SCI. Our results correspond with the SCIAM and its conceptualization of adjustment as a multifactorial process, but did not fully support the hypothesized mediation. PIL was strongly related to higher life satisfaction and may be a suitable intervention target to support persons with SCI.


Spinal cord injuries Psychological adjustment (= adaptation, psychological) Self-efficacy Purpose in life Quality of life Structural models 



This study has been financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI, www.swisci.ch), supported by the Swiss Paraplegic Association. The members of the SwiSCI Steering Committee are: Olivier Dériaz (Clinique Romande de Réadaptation, Sion); Michael Baumberger and Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt and Martin Schubert (University Clinic Balgrist, Zürich); Kerstin Hug and Margret Hund-Georgiadis (REHAB Basel, Basel); Hans Georg Koch and Urs Styger (Swiss Paraplegic Association, Nottwil); Hardy Landolt (representative for persons with SCI, Glarus); Rita Schaumann-Von Stosch (SUVA, Luzern); Mirjam Brach and Gerold Stucki (Swiss Paraplegic Research, Nottwil); and Martin Brinkhof and Christine Thyrian (SwiSCI Study Center at Swiss Paraplegic Research, Nottwil). We are indebted to study participants and to the personnel of the SwiSCI study center.


  1. 1.
    Kirshblum, S., Campagnolo, D. I., & DeLisa, J. A. (2002). Spinal Cord Medicine. Philadelphia: Lippincott Williams & Wilkins.Google Scholar
  2. 2.
    Post, M. W., Van Dijk, A. J., Van Asbeck, F. W., & Schrijvers, A. J. (1998). Life satisfaction of persons with spinal cord injury compared to a population group. Scandinavian Journal of Rehabilitation Medicine, 30(1), 23–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Dijkers, M. (1997). Quality of life after spinal cord injury: A meta analysis of the effects of disablement components. Spinal Cord, 35(12), 829–840.PubMedCrossRefGoogle Scholar
  4. 4.
    van Leeuwen, C. M., Post, M. W., Hoekstra, T., van der Woude, L. H., de Groot, S., Snoek, G. J., et al. (2011). Trajectories in the course of life satisfaction after spinal cord injury: Identification and predictors. Archives of Physical Medicine and Rehabilitation, 92(2), 207–213.PubMedCrossRefGoogle Scholar
  5. 5.
    Stensman, R. (1994). Adjustment to traumatic spinal cord injury. A longitudinal study of self-reported quality of life. Paraplegia, 32(6), 416–422.PubMedCrossRefGoogle Scholar
  6. 6.
    Putzke, J. D., Barrett, J. J., Richards, J. S., Underhill, A. T., & Lobello, S. G. (2004). Life satisfaction following spinal cord injury: Long-term follow-up. Journal of Spinal Cord Medicine, 27(2), 106–110.PubMedGoogle Scholar
  7. 7.
    Chevalier, Z., Kennedy, P., & Sherlock, O. (2009). Spinal cord injury, coping and psychological adjustment: A literature review. Spinal Cord, 47(11), 778–782.PubMedCrossRefGoogle Scholar
  8. 8.
    North, N. T. (1999). The psychological effects of spinal cord injury: A review. Spinal Cord, 37(10), 671–679.PubMedCrossRefGoogle Scholar
  9. 9.
    Post, M. W., de Witte, L. P., van Asbeck, F. W., van Dijk, A. J., & Schrijvers, A. J. (1998). Predictors of health status and life satisfaction in spinal cord injury. Archives of Physical Medicine and Rehabilitation, 79(4), 395–401.PubMedCrossRefGoogle Scholar
  10. 10.
    Peter, C., Muller, R., Cieza, A., & Geyh, S. (2012). Psychological resources in spinal cord injury: A systematic literature review. Spinal Cord, 50(3), 188–201.PubMedCrossRefGoogle Scholar
  11. 11.
    van Leeuwen, C. M., Kraaijeveld, S., Lindeman, E., & Post, M. W. (2012). Associations between psychological factors and quality of life ratings in persons with spinal cord injury: A systematic review. Spinal Cord, 50(3), 174–187.PubMedCrossRefGoogle Scholar
  12. 12.
    Mona, L. R., Krause, J. S., Norris, F. H., Cameron, R. P., Kalichman, S. C., & Lesondak, L. M. (2000). Sexual expression following spinal cord injury. NeuroRehabilitation, 15(2), 121–131.PubMedGoogle Scholar
  13. 13.
    de Roon-Cassini, T. A., de St Aubin, E., Valvano, A., Hastings, J., & Horn, P. (2009). Psychological well-being after spinal cord injury: Perception of loss and meaning making. Rehabilitation Psychology, 54(3), 306–314.Google Scholar
  14. 14.
    Middleton, J., & Craig, A. (2008). Psychological challenges in treating persons with spinal cord injury. In A. Craig & Y. Tran (Eds.), Psychological aspects associated with spinal cord injury rehabilitation: New directions and best evidence (pp. 3–53). New York: Nova Science Publishers Inc. Google Scholar
  15. 15.
    Frankl, V. E. (1959). Man’s search for meaning. NewYork: Washington Square Press.Google Scholar
  16. 16.
    Schwarzer, R., & Jerusalem, M. (1995). Generalized self-efficacy scale. In J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35–37). Windsor, UK: NFER-NELSON.Google Scholar
  17. 17.
    van Leeuwen, C. M., Post, M. W., Westers, P., van der Woude, L. H., de Groot, S., Sluis, T., et al. (2012). Relationships between activities, participation, personal factors, mental health, and life satisfaction in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 93(1), 82–89.PubMedCrossRefGoogle Scholar
  18. 18.
    Kennedy, P., Lude, P., Elfström, M. L., & Smithson, E. (2010). Sense of coherence and psychological quality of life in people with spinal cord injury: Appraisals and behavioural responses. British Journal of Health Psychology, 15, 611–621.PubMedCrossRefGoogle Scholar
  19. 19.
    Peter, C., Müller, R., Post, M. W., van Leeuwen, C. M., Werner, C. S., & Geyh, S. (2014). Psychological resources, appraisals and coping and their relationship to participation in spinal cord injury: A path analysis. Archives of Physical Medicine and Rehabilitation.Google Scholar
  20. 20.
    Post, M. W., Brinkhof, M., von Elm, E., Boldt, C., Brach, M., Muff, C., et al. (2011). Design of the swiss spinal cord injury cohort study. American Journal of Physical Medicine and Rehabilitation, 90(11 Suppl 2), S5–S16.PubMedCrossRefGoogle Scholar
  21. 21.
    Schulenberg, S. E., Schnetzer, L. W., & Buchanan, E. M. (2011). The purpose in life test-short form: Development and psychometric support. Journal of Happiness Studies, 12, 861–876.CrossRefGoogle Scholar
  22. 22.
    Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. Journal of Clinical Psychology, 20(2), 200–207.PubMedCrossRefGoogle Scholar
  23. 23.
    Schwarzer, R., Bäßler, J., Kwiatek, P., & Schröder, K. (1997). The assessment of optimistic self-beliefs: Comparison of the German, Spanish, and Chinese versions of the General Self-efficacy Scale. Applied Psychology International Review, 46(1), 69–88.CrossRefGoogle Scholar
  24. 24.
    Spungen, M. I., Libin, A., Ljungberg, I., & Groah, S. (2009). Self-efficacy mediating the occurrence of secondary conditions after spinal cord injury. SCI Psychosocial Process, 22(1), 16–22.Google Scholar
  25. 25.
    Mortenson, W. B., Noreau, L., & Miller, W. C. (2010). The relationship between and predictors of quality of life after spinal cord injury at 3 and 15 months after discharge. Spinal Cord, 48(1), 73–79.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Kennedy, P., Taylor, N., & Hindson, L. (2006). A pilot investigation of a psychosocial activity course for people with spinal cord injuries. Psychology, Health & Medicine, 11(1), 91–99.CrossRefGoogle Scholar
  27. 27.
    Ferguson, E., Matthews, G., & Cox, T. (1999). The appraisal of life events (ALE) scale: Reliability and validity. British Journal of Health Psychology, 4(Part 2), 97–116.Google Scholar
  28. 28.
    Gourounti, K., Anagnostopoulos, F., & Vaslamatzis, G. (2010). Primary appraisal of infertility: Evaluation of the psychometric properties of a Greek version of the appraisal of life events scale (ALE) in a sample of infertile women undergoing fertility treatment. Women and Health, 50(7), 688–704.PubMedCrossRefGoogle Scholar
  29. 29.
    Kennedy, P., Lude, P., Elfstrom, M. L., & Smithson, E. (2010). Cognitive appraisals, coping and quality of life outcomes: A multi-centre study of spinal cord injury rehabilitation. Spinal Cord, 48(10), 762–769.PubMedCrossRefGoogle Scholar
  30. 30.
    Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4(1), 92–100.PubMedCrossRefGoogle Scholar
  31. 31.
    WHOQOL Group (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychological Medicine, 28(3), 551–558.Google Scholar
  32. 32.
    Geyh, S., Fellinghauer, B. A. G., Kirchberger, I., & Post, M. W. M. (2010). Cross-cultural validity of four quality of life scales in persons with spinal cord injury. Health and Quality of Life Outcomes, 8(94), 1–16.Google Scholar
  33. 33.
    R Core Team. (2012). R: A language and environment for statistical computing. http://www.R-project.org/.
  34. 34.
    Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36.Google Scholar
  35. 35.
    Schumacker, R. E., & Lomax, R. G. (2010). A beginner’s guide to structural equation modeling (3rd ed.). New York: Routledge Academic.Google Scholar
  36. 36.
    Weston, R., Gore, P. A, Jr, Chan, F., & Catalano, D. (2008). An introduction to using structural equation models in rehabilitation psychology. Rehabilitation Psychology, 53(3), 340–356.CrossRefGoogle Scholar
  37. 37.
    Kapsou, M., Panayiotou, G., Kokkinos, C. M., & Demetriou, A. G. (2010). Dimensionality of coping: An empirical contribution to the construct validation of the Brief-COPE with a Greek-speaking sample. Journal of Health Psychology, 15(2), 215–229.PubMedCrossRefGoogle Scholar
  38. 38.
    Sica, C., Magni, C., Ghisi, M., Altoè, G., Sighinolfi, C., Chiri, L. R., et al. (2008). Coping Orientation to Problems Experienced-Nuova Versione Italiana (COPE-NVI): uno strumento per la misura degli stili di coping. Psicoterapia Cognitiva e Comportamentale, 14(1), 27–53.Google Scholar
  39. 39.
    Revelle, W. (2012). psych: Procedures for psychological, psychometric and personality research. http://personality-project.org/r/psych.manual.pdf.
  40. 40.
    Coffman, D. L., & MacCallum, R. C. (2005). Using parcels to convert path analysis models into latent variable models. Multivariate Behavioral Research, 40(2), 235–259.CrossRefGoogle Scholar
  41. 41.
    Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8(3), 430–457.CrossRefGoogle Scholar
  42. 42.
    Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.CrossRefGoogle Scholar
  43. 43.
    MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149.CrossRefGoogle Scholar
  44. 44.
    Pornprasertmanit, S., Miller, P., & Schoemann, A. (2013). R package simsem: SIMulated structural equation modeling (version 0.5-3). http://cran.r-project.org/package=simsem.
  45. 45.
    Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.PubMedCrossRefGoogle Scholar
  46. 46.
    Hampton, N. Z. (2008). The affective aspect of subjective well-being among Chinese people with and without spinal cord injuries. Disability and Rehabilitation, 30(19), 1473–1479.PubMedCrossRefGoogle Scholar
  47. 47.
    Hampton, N. Z. (2004). Subjective well-being among people with spinal cord injuries: The role of self-efficacy, perceived social support, and perceived health. Rehabilitation Counseling Bulletin, 48(1), 31–37.CrossRefGoogle Scholar
  48. 48.
    Hampton, N. Z. (2000). Self-efficacy and quality of life in people with spinal cord injuries in China. Rehabilitation Counseling Bulletin, 43(2), 66–74.CrossRefGoogle Scholar
  49. 49.
    Kennedy, P., Lowe, R., Grey, N., & Short, E. (1995). Traumatic spinal cord injury and psychological impact: A cross-sectional analysis of coping strategies. British Journal of Clinical Psychology, 34(Pt 4), 627–639.PubMedCrossRefGoogle Scholar
  50. 50.
    Thompson, N. J., Coker, J., Krause, J. S., & Henry, E. (2003). Purpose in life as a mediator of adjustment after spinal cord injury. Rehabilitation Psychology, 48, 100–108.Google Scholar
  51. 51.
    Hampton, N. Z., & Marshall, A. (2000). Culture, gender, self-efficacy, and life satisfaction: A comparison between Americans and Chinese people with spinal cord injuries. Journal of Rehabilitation, 66(3), 21–28.Google Scholar
  52. 52.
    Galvin, L. R., & Godfrey, H. P. (2001). The impact of coping on emotional adjustment to spinal cord injury (SCI): Review of the literature and application of a stress appraisal and coping formulation. Spinal Cord, 39(12), 615–627.PubMedCrossRefGoogle Scholar
  53. 53.
    Livneh, H., & Martz, E. (2012). Adjustment to chronic illness and disability: Theoretical perspectives, empirical findings, and unresolved issues. In P. Kennedy (Ed.), The Oxford Handbook of Rehabilitation Psychology. New York: Oxford University Press.Google Scholar
  54. 54.
    Bonanno, G. A., Pat-Horenczyk, R., & Noll, J. (2011). Coping flexibility and trauma: The perceived ability to cope with trauma (PACT) scale. Psychological Trauma: Theory, Research, Practice, and Policy, 3(2), 117–129.CrossRefGoogle Scholar
  55. 55.
    Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common sense model of illness danger. In S. Rachman (Ed.), Medical psychology (Vol. 2, pp. 7–30). New York: Pergamon.Google Scholar
  56. 56.
    Maes, S., Leventhal, H., & De Ridder, D. T. D. (1996). Coping with chronic diseases. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research, applications (pp. 221–251). Oxford: Wiley.Google Scholar
  57. 57.
    Anderson, C. J., Vogel, L. C., Chlan, K. M., & Betz, R. R. (2008). Coping with spinal cord injury: Strategies used by adults who sustained their injuries as children or adolescents. Journal of Spinal Cord Medicine, 31(3), 290–296.PubMedCentralPubMedGoogle Scholar
  58. 58.
    McCreaddie, M., & Wiggins, S. (2008). The purpose and function of humour in health, health care and nursing: A narrative review. Journal of Advanced Nursing, 61(6), 584–595.PubMedCrossRefGoogle Scholar
  59. 59.
    Proyer, R. T., Ruch, W., & Buschor, C. (2013). Testing strengths-based interventions: A preliminary study on the effectiveness of a program targeting curiosity, gratitude, hope, humor, and zest for enhancing life satisfaction. Journal of Happiness Studies, 14(1), 275–292.CrossRefGoogle Scholar
  60. 60.
    de Vries, M. J., Schilder, J. N., Mulder, C. L., Vrancken, A. M., Remie, M., & Garssen, B. (1997). Phase II study of psychotherapeutic intervention in advanced cancer. Psychooncology, 6(2), 129–137.PubMedCrossRefGoogle Scholar
  61. 61.
    Vaughan, S. M., & Kinnier, R. T. (1996). Psychological effects of a life review intervention for persons with HIV disease. Journal of Counseling & Development, 75(2), 115–123.CrossRefGoogle Scholar
  62. 62.
    Ruiz, F. J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology & Psychological Therapy, 10(1), 125–162.Google Scholar
  63. 63.
    Ruiz, F. J. (2012). Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence. International Journal of Psychology & Psychological Therapy, 12(3), 333–357.Google Scholar
  64. 64.
    Sharp, K. (2012). A review of acceptance and commitment therapy with anxiety disorders. International Journal of Psychology & Psychological Therapy, 12(3), 359–372.Google Scholar
  65. 65.
    Zahl, M. L., Compton, D. M., Kim, K., & Rosenbluth, J. P. (2008). SCI/D forum to increase active living: The effect of a self-efficacy and self-affirmation based SCI/D forum on active living in adults with spinal cord injury/disease. SCI Psychosocial Process, 21(2), 5–13.Google Scholar
  66. 66.
    Rose, A., Piatt, J. A., Zahl, M., & Kim, K. (2008). The effect of a self-efficacy based forum on life satisfaction for individuals with spinal cord injury or disease. Annual in Therapeutic Recreation, 16, 49–56.Google Scholar
  67. 67.
    Perry, K. N., Nicholas, M. K., & Middleton, J. W. (2010). Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain. Clinical Journal of Pain, 26(3), 206–216.PubMedCrossRefGoogle Scholar
  68. 68.
    Kennedy, P., Duff, J., Evans, M., & Beedie, A. (2003). Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. British Journal of Clinical Psychology, 42(Pt 1), 41–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Claudio Peter
    • 1
    • 2
  • Rachel Müller
    • 1
    • 2
  • Alarcos Cieza
    • 1
    • 2
  • Marcel W. M. Post
    • 1
    • 3
  • Christel M. C. van Leeuwen
    • 1
    • 3
  • Christina S. Werner
    • 4
  • Szilvia Geyh
    • 1
    • 5
  1. 1.Swiss Paraplegic Research (SPF)NottwilSwitzerland
  2. 2.Unit for Biopsychosocial Health, Department of Medical Informatics, Biometry and Epidemiology, Chair for Public Health and Health Care ResearchLudwig-Maximilians-UniversityMunichGermany
  3. 3.Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation MedicineUniversity Medical Center Utrecht and De HoogstraatUtrechtThe Netherlands
  4. 4.Psychological Methods, Evaluation and Statistics, Department of PsychologyUniversity of ZurichZurichSwitzerland
  5. 5.Department Health Sciences and Health PolicyUniversity of Lucerne and at SPFNottwilSwitzerland

Personalised recommendations