Psychological morbidities and positive psychological outcomes in people with traumatic spinal cord injury in Mainland China

Published online:


Study design

Cross-sectional survey.


To explore the prevalences of three psychological morbidities (posttraumatic stress disorder, anxiety, and depression) and two positive psychological outcomes (resilience and posttraumatic growth) in people with spinal cord injury (SCI). To examine the relationships between the five aforementioned variables and to determine the predictors of the three psychological morbidities.


Shanghai Sunshine Rehabilitation Center, Mainland China.


Participants included 300 adults with SCI in one rehabilitation center in Shanghai. Standardized self-report measures were used. Sociodemographic, injury, and psychological variables were assessed. Descriptive analyses were used to calculate the prevalences of five psychological outcome variables. Pearson correlation analyses were conducted to examine the relationships between the five psychological variables and regression analyses were conducted to determine the predictors of posttraumatic stress disorder (PTSD), anxiety, and depression.


Of the 300 respondents, 35%, 29%, and 27% exceeded the clinical cutoff score for PTSD, anxiety, and depression, respectively. About 32% reported good resilience, and 51% reported moderate to high levels of posttraumatic growth (PTG). Three psychological morbidities showed positive correlations between each other while significant negative relationships with the resilience and PTG. Hierarchical regressions indicated that both the extent of environmental barriers and resilience were the significant predictors of PTSD, anxiety, and depression.


High prevalences of psychological morbidities were found in the SCI population in Mainland China. They should be identified and intervened early in the rehabilitation process. Some positive psychological techniques that focus on increasing resilience and promoting PTG would likely be beneficial for the SCI population.

Additional access options:

Already a subscriber?  Log in  now or  Register  for online access.


  1. 1.

    Devivo M. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50:365–72.

  2. 2.

    World Health Organization. International Perspectives on Spinal Cord Injury. Geneva: World Health Organization; 2013.

  3. 3.

    Dickson A, Ward R, O’Brien G, Allan D, O’Carroll R. Difficulties adjusting to post-discharge life following a spinal cord injury: an interpretative phenomenological analysis. Psychol Health Med. 2011;16:463–74.

  4. 4.

    Byrnes M, Beilby J, Ray P, McLennan R, Ker J, Schug S. Patient-focused goal planning process and outcome after spinal cord injury rehabilitation: quantitative and qualitative audit. Clin Rehabil. 2012;26:1141–9.

  5. 5.

    Craig A, Tran Y, Middleton J. Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord. 2009;47:108–14.

  6. 6.

    Williams R, Murray A. Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil. 2015;96:133–40.

  7. 7.

    Le J, Dorstyn D. Anxiety prevalence following spinal cord injury: a meta-analysis. Spinal Cord. 2016;54:570–8.

  8. 8.

    Lim SW, Shiue YL, Ho CH, Yu SC, Kao PH, Wang JJ, et al. Anxiety and depression in patients with traumatic spinal cord injury: a nationwide population-based cohort study. PLoS ONE. 2017;12:14.

  9. 9.

    Otis C, Marchand A, Courtois F. Risk factors for posttraumatic stress disorder in persons with spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18:253–63.

  10. 10.

    Quale AJ, Schanke AK. Resilience in the face of coping with a severe physical injury: a study of trajectories of adjustment in a rehabilitation setting. Rehabil Psychol. 2010;55:12–22.

  11. 11.

    Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76–82.

  12. 12.

    Guest R, Craig A, Tran Y, Middleton J. Factors predicting resilience in people with spinal cord injury during transition from inpatient rehabilitation to the community. Spinal Cord. 2015;53:682–6.

  13. 13.

    Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9:455–71.

  14. 14.

    Chun S, Lee Y. The experience of posttraumatic growth for people with spinal cord injury. Qual Health Res. 2008;18:877–90.

  15. 15.

    Griffiths HC, Clinpsy D, Kennedy P. Continuing with life as normal: positive psychological outcomes following spinal cord injury. Top Spinal Cord Inj Rehabil. 2012;18:241–52.

  16. 16.

    Kalpakjian CZ, McCullumsmith CB, Fann JR, Richards JS, Stoelb BL, Heinemann AW, et al. Post-traumatic growth following spinal cord injury. J Spinal Cord Med. 2014;37:218–25.

  17. 17.

    Feng Y, Zhu H, Liu Y. Treatment of spinal cord Injury. Chin J Neurosurg Dis Res. 2008;7:279–80.

  18. 18.

    Wang Y, Wang H, Wang Z, Xie H, Shi J, Zhao X. The process of posttraumatic growth in individuals with traumatic spinal cord injury in Mainland China: An interpretative phenomenological analysis. J Health Psychol. 2017;22:637–49.

  19. 19.

    Weiss DS, Marmar CR. The impact of event scale-Revised. In: Wilson JP, Keane TM, editors. Assessing psychological trauma and PTSD. New York: Guilford Press; 1997. p. 399–411.

  20. 20.

    Weiss DS, Marmar CR. The impact of event scale-Revised. In: Wilson JP, Keane TM, editors. Assessing psychological trauma and PTSD. New York: Guilford Press; 2004. p. 168–89.

  21. 21.

    Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale-Revised. Behav Res Ther. 2003;41:1489–96.

  22. 22.

    Huang G, Zhang Y, Xiang H. The Chinese version of the impact of event scale-revised: reliability and validity. Chin Ment Health J. 2006;20:28–32.

  23. 23.

    Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361e70.

  24. 24.

    Arving C, Glimelius B, Brandberg Y. Four weeks of daily assessments of anxiety, depression and activity compared to a point assessment with the Hospital Anxiety and Depression Scale. Qual Life Res. 2008;17:95e104.

  25. 25.

    Zheng L, Wu Y, Li H. Application of Hospital Anxiety and Depression Scale in general hospital: an analysis in reliability and validity. Shanghai Arch Psychiatry. 2003;15:264–6.

  26. 26.

    Yu X, Zhang J. Factor analysis and psychometric evaluation of The Connor-Davidson Resilience Scale(CD-RISC) with Chinese people. Soc Behav Personal. 2007;35:19–30.

  27. 27.

    Wang Y, Wang H, Wang J, Wu J, Liu X. Prevalence and predictors of posttraumatic growth in accidentally injured patients. J Clin Psychol Med Settings. 2013;20:3–12.

  28. 28.

    Tang CS. Positive and negative postdisaster psychological adjustment among adult survivors of the Southeast Asian earthquake-tsunami. J Psychosom Res. 2006;61:699–705.

  29. 29.

    Schroevers MJ, Teo I. The report of posttraumatic growth in Malaysian cancer patients: relationships with psychological distress and coping strategies. Psychooncology. 2008;17:1239–46.

  30. 30.

    Kilic SA, Dorstyn DS, Guiver NG. Examining factors that contribute to the process of resilience following spinal cord injury. Spinal Cord. 2013;51:553–7.

  31. 31.

    Krause JS, Carter R, Zhai YS, Reed K. Psychologic factors and risk of mortality after spinal cord injury. Arch Phys Med Rehab. 2009;90:628–33.

  32. 32.

    Schonenberg M, Reimitz M, Jusyte A, Maier D, Badke A, Hautzinger M. Depression, posttraumatic stress, and risk factors following spinal cord injury. Int J Behav Med. 2014;21:169–76.

  33. 33.

    Heron-Delaney M, Kenardy J, Charlton E, Matsuoka Y. A systematic review of predictors of posttraumatic stress disorder (PTSD) for adult road traffic crash survivors. Injury. 2013;44:1413–22.

  34. 34.

    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR. Lifetime prevalence and age of onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.

  35. 35.

    January AM, Zebrack K, Chlan KM. Understanding post-traumatic growth following pediatric-onset spinal cord injury: the critical role of coping strategies for facilitating positive psychological outcomes. Dev Med Child Neurol. 2015;11:1143–9.

  36. 36.

    Pollock K, Dorstyn D, Butt L, Prentice S. Posttraumatic stress following spinal cord injury: a systematic review of risk and vulnerability factors. Spinal Cord. 2017;55:800-811.

  37. 37.

    Ying L, Wang Y, Lin C, Chen C. Trait resilience moderates the longitudinal linkage between adolescent posttraumatic stress disorder symptoms and posttraumatic growth. Sch Psychol Int. 2016;37:207–22.

  38. 38.

    Min JA, Lee CU, Hwang SI, Shin JI, Lee BS, Han SH, et al. The moderation of resilience on the negative effect of pain on depression and post-traumatic growth in individuals with spinal cord injury. Disabil Rehabil. 2014;36:1196–202.

  39. 39.

    Bonanno GA, Kennedy P, Galatzer-Levy IR, Lude P, Elfstrom ML. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabil Psychol. 2012;57:236–47.

Download references


We thank all the persons who participated in this study and the Shanghai Sunshine Hospital. This work was supported by the project of the Shanghai Disabled Person’s Federation (K2016027).

Author information


  1. Department of Psychosomatic Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

    • Yanbo Wang
    •  & Xudong Zhao
  2. Department of Occupational and Social Rehabilitation, Sunshine Rehabilitation Center, Shanghai, China

    • Haixia Xie


  1. Search for Yanbo Wang in:

  2. Search for Haixia Xie in:

  3. Search for Xudong Zhao in:

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding authors

Correspondence to Yanbo Wang or Xudong Zhao.