A cross-sectional study to investigate the effects of perceived discrimination in the healthcare setting on pain and depressive symptoms in wheelchair users with spinal cord injury.

Publication date: Available online 15 August 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Nathan Hogaboom, Denise C. Fyffe, Amanda L. Botticello, Lynn A. Worobey, Michael L. Boninger

Abstract

Objectives

In a sample of wheelchair users with spinal cord injury (SCI), the objectives were to investigate which subject characteristics are associated with greater perceived discrimination in the healthcare setting, and how such discrimination relates to health outcomes of pain and depressive symptoms.

Design

Survey, cross-sectional.

Setting

Spinal Cord Injury Model Systems Centers (SCIMS).

Participants

410 full-time wheelchair users with SCI from 9 SCIMS centers, with data collected between 2011 and 2016.

Interventions

N/A.

Main Outcomes

7-item questionnaire inquiring about perceived discrimination by hospital staff; self-reported pain severity over the past month using a 0-10 Numerical Rating Scale; depressive symptoms using the 2-question Patient Health Questionnaire screener.

Results

Participants who were Black or from the lowest income group were more likely to report experiencing more discrimination than those who were White or from the highest income group, respectively (IRR=2.2-2.6, p<.01). Those who reported more perceived discrimination had greater risk of severe pain compared to no pain (RR=1.11, 95% CI=1.01-1.23, p<.05), mild depressive symptoms (RR=1.09, 95%CI=1.02-1.17, p<.05), and severe depressive symptoms (RR=1.12, 95% CI=1.04-1.21, p<.05) compared to no symptoms.

Conclusions

Wheelchair users with SCI who were from more disadvantaged groups (Black, lower income levels) reported experiencing more discrimination in their healthcare setting. Furthermore, those who reported more discrimination were more likely to report worse mental and physical health outcomes. Attempts to reduce discrimination in healthcare settings may lead to better outcomes for people with SCI. These observations were correlational and not causal; a prospective analysis is necessary to prove causation. Future investigations should further explore the impact of discrimination on the many facets of living with a SCI.

from ScienceDirect Publication: Archives of Physical Medicine and Rehabilitation https://ift.tt/2N1D7MG
via IFTTT