Stress and Coping Over the Life Course: A Perspective on

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Stress and Coping Over the Life Course A
Perspective on Women with Spinal Cord Injury

• Barbara Schoen, M.A.
• Sunny Roller, M.A. Reece Rahman, Ph.D.

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Study Overview

• Investigators
• Denise G. Tate, Ph.D. (Principal)
• Colette Duggan, Ph.D.
• Sunny Roller, M.A.
• Tara Jeji, M.D.
• Barbara Schoen, M.A.

• Staff and Consultants
• Reece Rahman, Ph.D.
• Claire Kalpakjian, Ph.D.
• Martin Forchheimer, MPH
• Jessica Scheer, Ph.D
• Marcel Dijkers, Ph.D.

• Funding
• Awarded to U-M in collaboration with RIM
• Field Initiated Research (FIR)
• National Institute of Disability and
  Rehabilitation Research (NIDRR)

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Research Goal

• To gain a greater understanding of the patterned
  behaviors and social processes by which women
  piece together a life after spinal cord injury

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Research Objectives

• To document from a contextual life course
  perspective the varied ways women with SCI
  perceive and respond to stressful situations in
  their lives
• To describe in greater depth the dynamics of
  stress appraisal and coping
• To assess the efficacy and impact of coping
  strategies on social roles, personal identities
  and life satisfaction

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Selected Research Questions

• How do women with SCI perceive, evaluate and cope
  with stressful life situations?
• What are their critical issues?
• How does social support and mentoring facilitate
  transition back into community?
• What kinds of community services and resources do
  women use to ease transition?
• How do participants reconfigure their roles to
  accommodate new physical limitations?
• How satisfied are women with the quality of their
  lives?

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Recruitment

• Sources
• Target Sample (n50)
• Successes and Issues

Purposive Sampling Matrix
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Methods and MeasuresQualitative

• Semi-Structured Interview
• One on one interviews
• Average 1 ½ to 2 hours in length
• Focus Group
• good and bad copers

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Methods and MeasuresQualitative

• NUDIST QSRN6
• Administration
• Site
• Interviewer
• Characteristics
• Clinical
• Demographics

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Methods and MeasuresQualitative

• Body Function/Structure
• SCI related medical complications/conditions
• Non-SCI related medical complications/conditions
• Activity Performance and Limitations
• Participation Current Involvement/Restrictions

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Methods and MeasuresQualitative

• Environmental Resources Access/Barriers
• Physical Natural or Built
• Informal Social Support System
• Formal Community Support System
• Cultural Generalized Social Environment

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Methods and MeasuresQualitative

• Personal Factors
• Biography (Past History)
• Self-Understanding
• Self-Perception
• Social Identity (Roles)
• Stress Appraisal
• Challenge, Threat, Loss
• Coping Style
• Emotion-focused, Problem-focused, Seeking social
  support, Meaning-focused

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Methods and MeasuresQualitative

• Quality of Life
• Definitions/indicators/concept
• QOL Rating
• Standards and Evaluation
• Subjective reactions to life events

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Methods and MeasuresQuantitative - WOCQ

• Ways of Coping Questionnaire
• Assess and identify thoughts and actions that
  individuals use to cope
• Consists of 66 questions measuring eight
  different coping processes or styles

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Methods and MeasuresQuantitative - WOCQ

• Each item is rated on a four point scale
• 0 does not apply and/or not used
• 1 used somewhat
• 2 used quite a bit
• 3 used a great deal
• Sample Items
• I criticized or lectured myself
• I hoped for a miracle
• I went along with fate sometimes I just have bad
  luck

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Methods and MeasuresQuantitative - WOCQ

• Eight Subscales
• Confrontive Coping describes aggressive efforts
  to alter the situation and suggests some degree
  of hostility and risk-taking
• Distancing describes cognitive efforts to
  detach oneself and minimize the significance of
  the situation
• Self-Controlling describes efforts to regulate
  ones feelings and actions
• Seeking Social Support describes efforts to
  seek social support, in the form of social
  interaction, information, and emotional support

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Methods and MeasuresQuantitative - WOCQ

• Accepting Responsibility acknowledges ones own
  role in the problem with a concomitant theme of
  trying to put things right
• Escape Avoidance describes wishful thinking and
  behavioral efforts to escape or avoid the problem
• Planful Problem Solving describes deliberate
  problem-focused efforts to alter the situation,
  coupled with an analytic approach to solving the
  problem
• Positive Reappraisal describes efforts to
  create positive meaning by focusing on personal
  growth, also has a religious dimension

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Methods and MeasuresQuantitative - PSS

• Perceived Stress Scale
• A measure of the degree to which situations in an
  individuals life are appraised as stressful
• Designed to tap how unpredictable,
  uncontrollable, and overloaded an individual
  perceives their life

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Methods and MeasuresQuantitative - PSS

• Consists of ten items, each rated on a five point
  scale
• 1 never 2 almost never 3 sometimes 4
  fairly often 5 very often
• Sample Items
• In the last month, how often have you felt that
  you were unable to control the important things
  in your life?
• In the last month, how often have you felt that
  you were on top of things?

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Methods and MeasuresQuantitative SWLS

• Satisfaction With Life Scale
• Measures life satisfaction
• Widely used measure of quality of life

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Methods and MeasuresQuantitative SWLS

• Consists of five items, each rated on a seven
  point scale
• 1 strongly disagree 2 disagree 3 slightly
  disagree 4 neither agree nor disagree 5
  slightly agree 6 agree 7 strongly agree
• Sample Items
• In most ways my life is close to my ideal
• So far I have gotten the important things I want
  in life

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Preliminary Findings

• N 39
• 18 from UofM
• 21 from RIM
• Race
• 21 Caucasians
• 18 African Americans

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Preliminary Findings

• Etiology
• Vehicular Crash N18 46.2
• Violence N9 23.1
• Fall N3 7.7
• Sports N1 2.6
• Other N4 10.3
• Missing N4 10.3

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Preliminary Findings

• Level of Injury
• Paraincomplete N7 17.9
• Paracomplete N8 20.5
• Tetraincomplete N14 35.9
• Tetraincomplete N9 23.1
• Missing N1 2.6

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Preliminary Findings - WOCQ
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Preliminary Findings - PSS
P lt .010
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Preliminary Findings - SWLS

• Mean 20.84
• SD 7.64
• (35 - 31) Extremely satisfied
• (26 30) Satisfied
• (21 25) Slightly satisfied
• (20)         Neutral
• (15 19) Slightly dissatisfied
• (10 14) Dissatisfied
• (5 -  9)    Extremely dissatisfied

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Womens Voices

• Stressors
• Coping
• Quality of Life

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Future Directions

• Focus Groups
• Definition and Purpose
• Process
• Reporting
• Dissemination Progress and Plans
• Posters
• Articles
• Presentations

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Focus Groups- Definition and Purpose

• developed after World War II to evaluate audience
  response to radio programs
• adopted by social scientists and program
  evaluators
• useful in understanding how or why people hold
  certain beliefs about a topic or program of
  interest.

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Focus Groups - Process

• Consists of 7-10 interacting individuals having
  some common interest or characteristics
• Uses a moderator or interviewer to create a
  permissive and nurturing environment that
  encourages different perceptions and points of
  view, without pressuring participants to vote,
  plan or reach consensus
• lt 10 open-ended questions focused on the
  principal research
• Ideally groups are conducted several times with
  similar types of participants to identify trends
  and patterns in perceptions.

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Focus Group Reporting

• Raw data present statements as they were said by
  respondents. The data might be ordered or
  categorized by natural levels or themes in the
  topic.
• Descriptive statements summarize respondents'
  comments and provide illustrative examples using
  the raw data. Decisions must be made as to which
  quotes to include.
• Interpretation is most complex. Interpretation
  builds on the descriptive process by providing or
  presenting meaning of the data rather than simply
  summarizing the data. In giving meaning to the
  descriptions, one should be reflective about own
  biases in interpretation.

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Dissemination Progress and Plans

• Posters
• Articles
• Presentations

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Posters - 2004

• American Association of Spinal Cord Injury
  Psychologists and Social Workers - September 2004
• Alcohol and SCI The Myths of Safe Drinking
• Martin Forchheimer, MPH Denise Tate, Ph.D.
• Correlates of Quality-Of-Life in Individuals with
  SCI Race Related Differences
• Reece Rahman Denise G. Tate, Ph.D.
• The Impact of SCI on Social Networks
• Barbara Schoen, M.A., Claire Kalpakjian, Denise
  G. Tate, Ph.D. Tara Jeji, M.D.
• American Paraplegia Society September 2004
• Stress and Coping in the Lives of Inner-City
  African-American Women with Violence Related SCI.
  
• Tara Jeji, M.D., Colette Duggan, Ph.D., Barbara
  Schoen

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Presentations Articles

• Recent Presentations _at_ U-M
• Neurological Level of Injury and Satisfaction
  with Life
• Relationship to Race
• Correlates of Quality of Life Does Race Matter?
• Future Presentations targeted to disability
  related organizations and associations
• Proposed Articles
• Peer Reviewed Journals
• Non-Peer Reviewed Journals
• Consumer Magazines
• SCI Access Newsletter