1、rehabilitation psychology© 2000 by the educational publishing foundation february 2000 vol. 45, no. 1, 89-100for personal use only-not for distribution. psychological adaptation among racial and ethnic minority individuals following spinal cord injury a proposed culturally inclusive ecological

2、model helen a. nevilleblack studies program university of missouri abstractbuilding on the work of g. uswatte and t. r. elliott (1997) and recent rehabilitation counseling theoretical writings (e.g., d. b. hershenson, 1998 ), a culturally inclusive ecological model of spinal cord injury adaptation i

3、s proposed. the purpose of the model is to integrate and extend existing literature to better examine factors leading to differential psychosocial outcomes. an important component of the model is explicating general as well as socioracial and ethnic factors potentially influencing the adaptation pro

4、cess. consistent with national trends incorporating multiculturalism into specific fields of study, there has been a recent increase in both theoretical and empirical research on racial and ethnic minority issues related both to disabilities in general (e.g., belgrave, 1998 ; walker, turner, haile-m

5、ichael, vincent, & miles, 1995 ) and to specific conditions such as spinal cord injury (sci; e.g., krause & anson, 1997 ; waters, adkins, sie, & cressey, 1998 ). in a recent effort, uswatte and elliott (1997) reviewed relevant literature in the broader field of rehabilitation, with a foc

6、us on psychosocial adaptation among ethnic minority populations. a strength of this work was the articulation of specific socioenvironmental risk factors related to the rehabilitation process. although the authors outlined key variables related to adaptation, what appears to be missing in their comm

7、entary is a theoretical framework to conceptualize adaptation and inform rehabilitation practice. the purpose of this brief commentary is to build on the work of uswatte and elliott (1997) and also on recent theoretical advancements in rehabilitation psychology (e.g., hershenson, 1998 ) by proposing

8、 a model designed to systematically integrate the literature on sci psychosocial adaptation among racial and ethnic minority populations. the culturally inclusive ecological model of spinal cord injury adaptation (ciem-scia) is unique in that it provides a framework for examining socioracial and eth

9、nic factors potentially related to differential psychosocial outcomes. i have delimited the focus of discussion to traumatically sustained sci (as opposed to disability in general) for two main reasons: (a) it provides a focus, and (b) an unforeseen event is the cause of the injury, and thus adaptat

10、ion falls within the rubric of a stress and coping paradigm, a theoretical archetype consistent with the proposed model. to help contextualize the ciem-scia, i first provide brief definitions of race and ethnicity as well as an overview of sci incidence and etiology; this is followed by a brief expl

11、ication of psychosocial adaptation; i then describe and outline the specific components of the model. race, ethnicity, incidence, and etiology consistent with uswatte and elliott's (1997) definition, ethnicity here refers to the national origin of an individual, which has implications for cultur

12、al expressions, norms, values, language, and customs that are passed down from generation to generation (e.g., african american, filipino). this differs from pan-ethnic groups, a superordinate classification of individuals based on national origin with shared cultural practices, social experiences,

13、or both (e.g., asian american, latino). race, on the other hand, is becoming more accepted as a social construction as opposed to a biological marker. by social construction i mean that racial classifications differ depending on a given geohistorical location. for example, a light-complexioned perso

14、n considered black in the united states at this historical moment may have been classified as colored in south africa during the apartheid regime. whiteness has also been precarious. irish individuals, for instance, were not considered white in the early nineteenth century in the united states. the

15、point here is that there is no universally accepted racial category that has transcended time and space (see thompson & neville, 1999 , for a more detailed discussion). multicultural psychology expert janet helms (1994) prefers the term sociorace because it underscores the role of sociohistorica

16、l realities of groups that have been identified as minority and majority, and it encourages examination of nonnominal racial constructs (e.g., racial identity). for the purposes of this article, ethnicity refers to specific national groups (e.g., mexican american), and race refers to socioracial gro

17、ups (e.g., black) or pan-ethnic groups (e.g., native american) identified in the united states. i recognize that latinos can be of any race (white, black, asian, or a mixture thereof), but this population is typically treated as a separate social group in the literature, reflecting the ambiguous and

18、 inconsistent constructions of broad social classification systems. the racial and ethnic distribution of persons with sci is different from the general population. african americans and, to a lesser degree, native americans are overrepresented among persons with sci. nearly 20% of the persons with

19、sci during 19731992 in the national sci database were african american, whereas the general african american population reported in the 1990 u.s. census was a little over 12% ( go, devivo, & richards, 1995 ). on the other hand, although the majority of persons with sci are white, this population

20、 is underrepresented among persons with sci. white individuals represented 70% of the sci population (from 19731992), yet the 1990 u.s. census indicated that whites were a little over 80% of the general population ( go et al., 1995 ). although some psychosocial research on sci reflects an almost all

21、-white sample, many contain significant numbers of racial and ethnic minorities, primarily african americans. amazingly, some researchers fail to report the racial or ethnic composition of their sample. many studies reporting a racially or ethnically diverse sample do little with this information co

22、nceptually or statistically. more recently, however, some researchers have begun to examine potential differences in psychological adaptation and predictors of adaptation between racialethnic groups. krause and anson (1997) , for example, found no differences between whites and racial minorities on

23、most psychological adjustment indicators; however, whites did report greater satisfaction with their career and fewer skills and financial deficits than racial minorities, primarily blacks. contradictory to findings with non-sci samples, some research findings suggest that compared with white person

24、s with sci, african americans with sci report lower levels of subjective well-being ( krause, 1998 ). predictors of psychosocial adaptation also appear to differ depending on the racial and ethnic group. for example, zea, belgrave, townsend, jarama, and banks (1996) found that perception of severity

25、 of one's disability was a significant predictor of depression for latinos, but not for african americans. data consistently indicate significant differences between racial and ethnic groups in etiologies of traumatic sci. vehicle accident is the leading cause of new injuries in white, native am

26、erican, and asian populations. however, this is not the case for african american and latino populations ( go et al., 1995 ). according to information from the national sci database, violence accounts for over 40% and over 37% of the african american and latino sci injuries, respectively, whereas mo

27、tor vehicle accidents have been reported to account for 27% (african american) and 34% (latino; see go et al. ). according to the same database, native americans have the highest motor vehicle sci incidence rates (upward of 67% of newly injured) and among the lowest violence incidence rates (about 9

28、%; see go et al. ). uswatte and elliott (1997) perceptively noted the importance of environmental hazards in sustaining an injury. for example, african americans and latinos are disproportionately represented among the urban poor and thus are more likely to live in economically depressed communities

29、 where violent crimes occur more often. thus, class appears to be an important factor. gender is also a critical variable to consider. it is well documented that the overwhelming majority of sci cases are menover 82% of the consumers enrolled in the national sci database are male ( go et al., 1995 )

30、. in fact, at one urban model sci system site, men constitute over 90% of sci incidents resulting from violence ( adkins, hume, nabor, & waters, 1998 ). it appears then that an interaction among raceethnicity, gender, and class play a role in understanding who gets injured and under what conditi

31、ons. it may be that poor african american and latino men are disproportionately more likely to sustain a traumatic sci, especially by violence, compared with other populations (including middle class racial and ethnic minority men and women). when considered alone, etiology of the injury appears to

32、have a negligible impact on psychosocial adaptation outcomes among racially diverse samples. for example, research suggests no differences in community integration, depression or post-traumatic stress ( adkins et al., 1998 ), or functional independence ( waters & adkins, 1997 ) between racially

33、mixed samples of persons sustaining an injury from a motor vehicle accident or a firearm. however, an interaction between race and etiology may play a factor in social perceptions of consumers and, consequently, the rehabilitation process. as part of the missouri model spinal cord injury system, we

34、conducted focus groups with racially diverse persons with sci to examine helpful and hindering aspects of rehabilitation. a few african american male participants perceived a difference in their treatment in the hospital, commenting that professional staff assumed they were injured as a result of a

35、gunshot wound and thus somehow deserving of their injury. this resulted in a perceived difference in the level of empathy expressed toward them compared with their white male and female counterparts injured in automobile accidents. psychosocial adaptation traumatically sustained sci has differing de

36、grees of acute or chronic psychosocial implications. it is important to note that not all individuals experience postrehabilitation trauma reactions such as depression. however, the overwhelming majority of persons experience employment consequences, economic consequences, or both. the bulk of the r

37、esearch in the area of psychosocial adaptation has focused on understanding risk and protective factors associated with psychological (e.g., depression, anxiety, life satisfaction), behavioral (e.g., drug abuse), work, and recreational functioning; this commentary focuses on the psychological adapta

38、tion literature. ciem-scia the ciem-scia is a modification of both an ecological model to describe the recovery process of women sexual assault survivors ( neville & heppner, 1999 ) and hershenson's (1998) systematic, ecological model for rehabilitation counseling. the former provides the st

39、ructure for systematically examining cultural factors related to a traumatic event, and the latter provides insight about the interaction of social systems and individuals on the rehabilitation process. the proposed model differs from hershenson's in the following three ways: (a) it focuses on c

40、ontextualizing psychosocial adaptation, as opposed to rehabilitation counseling, among a condition-specific population; (b) consistent with the intended purpose of ecological models, hershenson's model provides examples of socioracial and ethnic concerns; and (c) extending these periodic observa

41、tions, the ciem-scia provides a framework to systematically examine socioracial and ethnocultural factors (see table 1 and figure 1 ). as indicated in the title, the ciem-scia is grounded in the ecological literature suggesting that human behavior is dynamic and results from the dialectic between pe

42、rsons and environments. ecological models underscore that human behavior is multiply determined by interrelations between subsystems within a larger ecosystem. bronfenbrenner (1977) identified four major subsystems influencing human behavior: (a) microsystem, or the interpersonal interactions within

43、 a given environment, including work, school, and home; (b) mesosystem, which comprises interactions between two or more microsystem environments, such as the relations between an individual's school and work environments; (c) exosystem, which consists of the linkages between subsystems that ind

44、irectly influence the individual, such as the police or health care systems' linkages with one's neighborhood; and (d) macrosystem, or the ideological components of a given society, including norms and values. directly applied to sci, adaptation is conceptualized as being multiply determined

45、 by factors both within and outside of the individual. figure 1 provides a pictorial depiction of the model. the concentric circles visually communicate the nested influence of subsystems. table 1 profiles individual and environmental factors contributing to psychosocial adaptational outcomes, highl

46、ighting general factors (e.g., social support) and culture-specific factors (e.g., acculturation). below is a brief discussion of key aspects of the model. macrosystem i begin the discussion of the model with a description of the macrosystem context because it influences every aspect of the adaptati

47、on process; individual, family, and other system responses to persons with sci exist within the broad sociocultural context of the united states. our political and economic climate and normative conceptions about physical disability, including sci, shape the type and quality of services provided, em

48、ployment opportunities, how one understands his or her disability, and individual (e.g., primary physical assistant support) and system responses (e.g., family or work site support; see hershenson, 1998 , for a more detailed discussion). within this broader macrosystem are specific sociocultural con

49、textual factors affecting the rehabilitation process of racial and ethnic minority consumers. the racial climate and practices in the united states, including racial discrimination, shape the lived experiences of socioracial groups. a form of racial discrimination in the united states is the creatio

50、n of a society in which most racial and ethnic minority groups are overrepresented among those living in poverty. this means that racial and ethnic minority groups have an increased chance of experiencing socioenvironmental barriers in the rehabilitation process, including restricted access to relia

51、ble transportation, vocational (re)training, and quality health care. uswatte and elliott (1997) underscored another role of sociocultural influences. they perceptively noted the cultural values and practices of ethnic groups may additionally affect the psychosocial adaptation of consumers. research

52、ers have begun to articulate the impact of worldviews or cultural value orientations on the rehabilitation process (e.g., alston & turner, 1994 ; fernandez & freer, 1996 ). for example, zea, quezada, and belgrave (1994) have outlined the role of latino cultural values (worldview) such as all

53、ocentrism, familialism, well-defined gender roles, and present-time orientation on consumer adaptation. additional empirical work is needed to further explicate the following: (a) what are the normative conceptions of persons with sci among specific socioracial and ethnic groups? there is little res

54、earch explicitly addressing how specific ethnic groups view persons with sci. are there similarities or differences between ethnospecific views of persons with sci compared with wider united states views? (b) are ethnogender role socializations (e.g., the notion of machismo in many latino cultures)

55、related to views on sci within specific ethnic or racial groups? (c) do the above cultural values and practices influence postinjury responses, including family caregiving, community integration, help-seeking, and consumer coping behaviors? microsystemindividual there is a relatively large body of l

56、iterature investigating individual difference variables on the sci adaptation process, primarily among white consumers, including age, gender, injury severity, time since injury, education level, and preinjury functioning. the role of coping and social support on psychosocial adaptation are two of t

57、he most researched variables within the individual and microsystem levels that have produced consistent findings. research with racially and ethnically diverse samples consistently suggests that more effective coping styles are associated with increased psychological health. results from elliott'

58、;s own systematic work in the area, with primarily white and african american samples, generally suggests that more effective problem-solving appraisal (a form of coping) is associated with less depressive behavior and psychosocial impairment ( elliott, godshall, herrick, witty, & spruell, 1991

59、; elliott, herrick, & witty, 1992 ). research on specific socioracial and ethnic populations is consistent with these findings. for example, greater active coping has been found to predict lower levels of depression in african americans and latinos with disabilities ( zea et al., 1996 ). consume

60、rs' interactions with their environments are also critical throughout the rehabilitation process. in particular, social support from family, friends, coworkers, and professionals (i.e., microsystems) significantly aid in psychological health expression. consistently, level and type of social support have been found to be associated with psycho