Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships

Zürcher, Carmen; Tough, Hannah; Fekete, Christine (2019). Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships PLoS One, 14(2), e0206069. Public Library of Science (PLoS) 10.1371/journal.pone.0206069

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Objectives To evaluate socioeconomic inequalities in social relationships, and to assess whether socioeconomic conditions and social relationships are independently related to mental health problems in individuals with a physical disability due to spinal cord injury (SCI). Methods We analyzed cross-sectional data from 511 individuals with SCI aged over 16 years who participated in the community survey of the Swiss SCI Cohort Study (SwiSCI). Indicators for socioeconomic conditions included years of formal education, household income, and financial strain. Social relationships were operationalized by three structural (partner status; social contact frequency; number of supportive relationships) and four functional aspects (satisfaction with: overall social support; family relationships; contacts to friends; partner relationship). General mental health was assessed by the Mental Health Inventory (MHI-5) of SF-36 and depressive symptoms were measured by the Hospital Anxiety and Depression Scale (depression subscale, HADS-D). Established cut-offs for general mental health problems (MHI-5 ≤56) and depressive symptomatology (HADS-D ≥8) were used to dichotomize outcomes. Associations were assessed using logistic regressions. Results Lower household income was predominantly associated with poor structural social relationships, whereas financial strain was robustly linked to poor functional social relationships. Financial strain was associated with general mental health problems and depressive symptomatology, even after controlling for social relationships. Education and household income were not linked to mental health. Poor structural and functional social relationships were related to general mental health problems and depressive symptomatology. Notably, trends remained stable after accounting for socioeconomic conditions. Conclusion This study provides evidence for socioeconomic inequalities in social relationships as well as for independent associations of financial strain and poor social relationships with mental health problems in individuals with SCI. Further research may develop strategies to improve mental health in SCI by strengthening social relationships. Such interventions may be especially beneficial for individuals with low income and financial strain.

Item Type:

Journal Article (Original Article)


School of Health Professions > Midwifery
School of Health Professions > G Teaching


Zürcher, Carmen;
Tough, Hannah and
Fekete, Christine


B Philosophy. Psychology. Religion > BF Psychology
H Social Sciences > H Social Sciences (General)
R Medicine > RA Public aspects of medicine




Public Library of Science (PLoS)


[UNSPECIFIED] Swiss Paraplegic Foundation


[UNSPECIFIED] Swiss Spinal Cord Injury Cohort Study (SwiSCI)




Jean Anthony Grand-Guillaume-Perrenoud

Date Deposited:

24 Sep 2019 10:18

Last Modified:

03 Nov 2023 09:53

Publisher DOI:





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