Psychosocial wellbeing after spinal cord injury 

Rehabilitation after a spinal cord injury (SCI) aims to address both medical needs and psychosocial adjustment, as both are crucial for delivering effective, person-centred care. Psychosocial adjustment includes psychological factors—such as cognitive, behavioural and emotional aspects—as well as social factors, including family, community, cultural, environmental and spiritual influences.

A SCI is a life-changing event that can have a profound impact on mental health, significantly increasing the risk of psychological disorders such as depression, anxiety and post-traumatic stress disorder. Research indicates that suicide rates are approximately three times higher in this population. People can sometimes struggle to cope with the complex and ongoing changes resulting from their injury, which can impede rehabilitation progress and overall health outcomes.

How does spinal cord injury impact mental health? 

Physical, psychological and social changes following SCI can each contribute to a decline in mental health.

Physical changes 

• experiencing sensory and mobility impairments   
• managing bladder and bowel incontinence  
• living with sexual dysfunction  
• experiencing pain and muscle spasms
• managing fatigue or sleep disurbances
• adjusting to medications and their side effects.  

Psychosocial changes 

• experiencing grief and loss   
• adjusting to changes in physical appearance and the use of assistive equipment (e.g., wheelchairs)
• feeling isolated from family and support networks, particularly during long hospital stays
• adapting to changes in life roles and sense of identity
• feeling anxious about future health, independence or potential complications.

Social changes 

• experiencing changes in ability to work, earning potential or role as carer or provider within the family unit (which may impact financial security)  
• having reduced participation in previously enjoyed activities or community life
• adjusting to changes in family dynamics, caregiving relationships or ability to care for dependents.

How can mental health difficulties present in a person with spinal cord injury? 

Mental health difficulties can present in various ways in people with a spinal cord injury:

• experiencing heightened emotional distress, such as tearfulness, sadness, anxiety, irritability or emotional numbness
• having difficulty coping with physical changes, including spasms, fatigue or pain
• developing body image concerns
• experiencing changes in self-confidence or self-esteem
• showing behavioural changes, such as increased substance use or physical or verbal aggression
• feeling less motivated to engage in rehabilitation activities or struggling to make suggested lifestyle adjustments
• having a reduced ability or motivation to manage self-care, whether this involves providing direction to caregivers or attending to personal needs
• avoiding, withdrawing or disengaging from social interactions, places or activities previously enjoyed
• experiencing changes in appetite, which may lead to weight gain or weight loss
• having sleep difficulties that impact energy levels, pain, concentration or ability to engage in daily activities
• finding it difficult to make decisions about their care.