Psychological Adjustment to Disability: Heterogeneous Trajectories of Resilience and Depression Following Physical Impairment or Amputation

Adjustment to disability is a foundational concept within rehabilitation psychology and constitutes an important public health problem given the adverse outcomes associated with maladjustment. While the disability literature has highlighted depressive elevations in response to functional impairment, resilience and alternative patterns of psychological adjustment have received substantially less empirical inquiry. This dissertation is comprised of three papers, the first two of which are longitudinal studies utilizing distinct samples of individuals with acquired disabilities: a population-sample of physically impaired older adults, and a convenience sample of individuals with newly acquired amputations. The third paper summarizes current data science and statistical findings regarding disability adjustment for patients and their providers. The two longitudinal studies share a common statistical methodology, latent growth mixture modeling (LGMM), allowing for the identification of distinct subgroups (classes) of individuals who share similar symptom profiles over time. LGMM is well-poised to resolve fundamental questions about whether psychological functioning after disability is best described by a population-level archetypal response (i.e., distress and depression that remits over time), or alternatively, whether the data suggest a variety of definable subgroups with distinct psychological trajectories. Results of empirical papers 1 and 2 provide strong empirical evidence that the process of disability adjustment is heterogeneous, with multiple pathways of symptom development and remission. The third paper demonstrates how findings from current rehabilitation science can be utilized to inform psychoeducational materials for practitioners and their patients with recent limb loss. This chapter addresses gaps in dissemination of knowledge by describing various patterns of psychological outcomes encountered by individuals following amputation surgery, as supported by Study 2 and the broader resilience literature. Socioeconomic Resources Predict Trajectories of Depression and Resilience Abstract Objective : Adjustment to chronic disability is a topic of considerable focus in the rehabilitation sciences and constitutes an important public health problem given the adverse outcomes associated with maladjustment. While existing literature has established an association between disability onset and elevated rates of depression, resilience and alternative patterns of adjustment have received substantially less empirical inquiry. The current study sought to model heterogeneity in mental health responding to disability onset in later life, while exploring the impact of socioeconomic resources on these latent patterns of adaptation. Methods : Latent Growth Mixture Modeling (LGMM) was utilized to identify trajectories of depressive symptoms surrounding physical disability onset in a population sample of older adults. Individuals with verified disability onset ( n = 3,204) were followed across four measurement points representing a 6-year period. Results : Four trajectories of depressive symptoms were identified: resilience (56.5%), emerging depression (17.2%), remitting depression (13.4%), and chronic depression (12.9%). Socioeconomic resources were then analyzed as predictors of trajectory membership. Prior education and financial assets at the time of disability onset robustly predicted class membership in the resilient class compared to all other classes. Conclusion : The course of adjustment in response to disability onset is heterogeneous. Our results confirm the presence of multiple pathways of adjustment surrounding late-life disability, with the most common outcome being near-zero depressive symptoms for the duration of the study. Socioeconomic resources strongly predicted membership in the resilient class compared with all other classes, indicating that such resources may play a protective role during the stress of physical disability onset. Abstract Objective : Limb Loss (LL) is a significant and disabling physical impairment with important health, mobility, and psychological consequences. Nevertheless, individuals can adapt and lead happy and healthy lives. The empirical literature has historically focused upon elevated rates of depression and other psychopathologies after limb loss, while resilience and other alternative patterns of adaptation have received substantially less empirical inquiry. Methods : Individuals ( n = 203) were followed across 3 measurement points representing a 6-month period following the onset of new limb loss. Trajectories of depression symptoms beginning directly after amputation were identified using Latent Growth Mixture Modeling (LGMM) and then explored as potential predictors of the development of posttraumatic stress (PTS) as a distal outcome. Results : Four trajectories of depression were identified: resilience (73.2%), chronic depression (11.2%). emerging depression (8.9%), and recovery (6.7%). A chronic depression trajectory predicted significantly elevated PTS symptoms compared to all other classes in post hoc comparisons; the resilient class predicted significantly less PTS burden than the emerging depression class but did not differentiate from the recovery trajectory. Conclusion : The current analysis confirms that psychological adaptation following amputation is a heterogeneous process, with varying pathways of symptom development and remission. Further, the derivation of latent classes of mood symptoms in longitudinal data (performed here using LGMM), may prove useful as a risk surveillance tool, especially with respect to clinical outcomes like PTS with unique time course requirements. Identifying predictors of resilience and other longitudinal profiles is a crucial goal above and beyond the monitoring of risk, in order to advance the scientific understanding of the complex process of adaptation to limb loss.