Abuse and health in individuals with spinal cord injury and dysfunction

Individuals with spinal cord injury and dysfunction (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 act that results in, or is likely to result in harm or suffering, including threats of such acts, coercion 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 & 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 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 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 (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 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 (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 (Hassouneh-Phillips, 2005; Hassouneh-Phillips & McNeff, 2004). …