RESUMEN
OBJECTIVE: To examine whether grief is a psychometrically sound construct that is distinct from depression in individuals who have recently sustained a spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: Inpatient rehabilitation units at 3 geographically diverse, university-affiliated medical centers. PARTICIPANTS: Patients with SCI (N=206) were recruited (163 men [79.1%]). Most patients were non-Hispanic whites (n=175 [85.0%]). Most patients sustained a cervical SCI (n=134 [64.4%]). Various injury etiologies were represented, with the majority being accounted for by falls (n=72 [31.5%]) and vehicle-related accidents (n=69 [33.5%]). The mean time since injury was 53.5±40.5 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: An adapted version of the 12-item structured clinical interview for Prolonged Grief Disorder was used to assess symptoms of grief, and the Patient Health Questionnaire-9 was used to measure depression. Demographic and injury-related data were also collected. RESULTS: A principal component analysis (with direct oblimin rotation) of the grief measure suggested a 2-component solution. The content of items loading on the separate components suggested 2 subscales: loss (6 items; Cronbach α=.810) and trauma (6 items; Cronbach α=.823). Follow-up principal component analyses including both grief and depression measures suggested clear differentiation of grief-related loss from depression. The prevalence of clinically significant levels of grief was low (6%), and levels of depression were consistent with previous findings related to inpatient rehabilitation (23.5%). CONCLUSIONS: The items used to assess grief symptoms in patients participating in inpatient rehabilitation for recently sustained SCI appear to capture a psychometrically reliable construct that is distinct from that of depression. Research is needed on the predictive validity of early grief symptoms after SCI and the relation of grief to other psychological constructs over time.
Asunto(s)
Depresión/psicología , Pesar , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Estudios Transversales , Trastorno Depresivo/psicología , Femenino , Hospitales Universitarios , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Análisis de Componente Principal , PsicometríaRESUMEN
Electrophysiological recordings were made in 21 observers to investigate whether differences in signature components (P1, N1, selection negativity [SN]) would be revealed during perceptual reversals of three different multistable figures. Using a lattice of Necker cubes as a stimulus, J. Kornmeier and M. Bach (2004, 2005) reported differences in P1 amplitudes as well a broad reversal-related negativity occurring 200-400 ms poststimulus. The current study investigated whether these event-related potentials of Necker cube reversals represent general "perceptual switching" mechanisms and would, therefore, be common to other types of multistable figures. Three different types of multistable stimuli were utilized: a modified Rubin's face/vase, a modified Schröder's staircase, and a novel natural stimulus, Lemmo's cheetahs. Results revealed the broad reversal-related negativity for the face/vase and the reversible staircase but not for the cheetahs. This component is comparable to the SN in polarity, latency, and scalp topography. An effect of early visual spatial attention on figure reversals was suggested by an analysis of the occipital P1 and N1 components. The P1, N1, or both were enhanced for trials in which the observer reported perceptual reversals compared with trials in which no reversals were reported for the face/vase and reversible staircase stimuli. These results support a model of multistable perception in which changes in early spatial attention (indicated by P1 and N1 enhancement) modulate perceptual reversals (indicated by the reversal negativity or SN).