Objective To examine the applicability of marital resource (marriage has substantial benefits for well being over not being married) or marital crisis models (marital dissolution leads to poorer well being) to the spinal cord injury (SCI) population by studying the effects of gender, marital status and marital transitions on well-being. Design Prospective cohort from the SCI Model Systems National Database. Setting Community. Participants 4,864 men and 1,277 women who sustained traumatic SCI and completed a minimum of one follow-up interview beginning at one year through 15 years post-injury. Interventions None. Main outcomes measures Life satisfaction, depressive symptomatology, and self-perceived health status using linear mixed models for longitudinal data. Results In general, well being improved over time since injury. Hypothesis testing supported the marital crisis model as marital loss through being or becoming separated or divorced and being or becoming widowed had the most consistent and negative impact across well-being outcomes, while being or becoming married only had an advantage for lower depression symptomatology over time. However, marital dissolution or loss did not have a uniformly adverse impact on well-being outcomes and this effect was often moderated by gender such that widows had higher depressive symptomatology and poorer self-perceived health than widowers, but separated or divorced women had higher life satisfaction and self-perceived health than men. Irrespective of gender, being separated or divorced vs. being single was associated with higher depression over time. Conclusions The results support the marital crisis model and that women and men can experience marital dissolution differently. Nor does all marital loss result in compromised well-being or marriage enhance well-being, highlighting complex dynamics worthy of further investigation in this population.

In general, depressive symptoms were not associated with pain severity in this sample. Etiology was associated with pain, those with traumatic SCI reporting more pain at admission. Among demographic characteristics, age was related to pain, with younger subjects reporting higher levels. These findings suggest that certain characteristics may predispose patients to pain and depression upon admission to rehabilitation. By determining who is at risk for these symptoms, clinicians can adopt treatments that prevent these from becoming chronic conditions.

Study design: Prospective cohort design of married persons with new spinal cord injury (SCI).Objectives: To examine the relationship of demographic and injury characteristics, self-rated health, physical functioning, and life satisfaction to the duration of marriage 1 to 15 years after SCI among individuals who were married at the time of injury. Setting: United States. Methods: Survival analysis was chosen to determine the predictors related to marital longevity, which is defined as non-occurrence of divorce after injury. In all, 2327 subjects were included in the analyses. Predictors were demographics and injury characteristics, level of handicap, self-perceived health, and functional independence. Results: Age at injury, being Caucasian vs African American, having a college education vs high school, having 'other' employment status vs being unemployed, having higher social integration and improved or stable self-rated health vs poor health were all significant factors that delayed the time of divorce after injury. Contrary to expectations, level of injury, function, mobility and independence were not significant predictors of marriage longevity. Conclusion: Social integration and health perception, the most powerful indicators of marriage longevity, can be addressed and facilitated by health care providers and rehabilitation programs.