Final Comments

This chapter has summarized research highlighting several promising approaches to the management of post-SCI mental health. There is some evidence for the effectiveness of physical and psychological approaches for treating anxiety and self-esteem in people with SCI. However, many of the studies cited note limitations that may introduce caution regarding the generalizability of conclusions to other samples and settings. These have included:

• Small samples sizes and high rates of attrition (due to illness or other factors)
•  Possible selection biases
• Ethical concerns that may preclude randomized designs
•  Multifaceted interventions complicate understanding of most relevant component(s)
• Impact of social contact in the intervention group often not accounted for in “standard treatment” or “wait list” controls
• Potential impact of adjunctive psychological interventions is unclear
• Use of antidepressant medications not consistently reported
• Lacking long term follow up
• Variability of outcome measures limit comparisons across studies

When leavened with clinical judgment, this research offers preliminary empirical support to guide the practitioner in employing evidenced-based therapeutic strategies. Future investigations, particularly those employing more stringent research designs, will continue to expand the options and confidence of clinical efforts to assist those individuals who have sustained spinal cord injuries. The reader is encouraged to also consider the following topic reviews of depression and SCI (Consortium for Spinal Cord Medicine 1998; Elliott & Frank 1996; Elliott & Kennedy 2004) and also, more generally, a review of SCI rehabilitation (Sipski & Richards 2006).