Study highlights facilitators for veterans with SCI to manage impacts
There are many times in a person’s life and various reasons why someone might feel lonely. But those feelings, especially for veterans and others with spinal-cord injury or disease (SCI/D), can have major health consequences. In fact, the problem of loneliness is so severe that in 2023, the U.S. Surgeon General identified it as a U.S. epidemic, and this year the World Health Organization recognized it as a global public health priority.
“In a study in the general population, 30 percent reported moderate to high levels of loneliness. But in a previous study that we have conducted, about 66 percent of veterans with spinal-cord injury had moderate to high levels of loneliness,” says Marissa Wirth, MPH, lead project manager at the Center of Innovation for Complex Chronic Healthcare at the Hines Department of Veterans Affairs (VA) Medical Center in Hines, Ill. “So, really highlighting that veterans with spinal-cord injury could really benefit from an intervention to help decrease loneliness. Loneliness and social isolation are also risk factors for some poor physical and mental health outcomes.”
Those outcomes include with about a 30% increased risk of heart attack or stroke, according to a late 2022 study by the American Heart Association.
To help develop an intervention, the center, with a grant from the Craig H. Neilsen Foundation, began gathering data in 2022 on facilitators to alleviate loneliness.
Wirth presented some of the study’s findings during the first day of the Paralyzed Veterans of America Healthcare Summit + Expo in Anaheim, Calif.
Wirth says barriers to social interaction in people with SCI/D can cause a disruption in social relationships and give perceptions of no longer belonging or feeling left out, which can increase the feelings of loneliness and social isolation. Barriers can include varying levels of disability due to an injury, reduced social network size and the impact of secondary health conditions, such as pain, bowel and bladder issues and excessive weight gain.
To get a better understanding of how to help individuals with SCI/D manage loneliness, the study included 60-minute interviews with 23 veterans with SCI who use the VA for their care and were injured for at least a year to gather information about their needs and what they felt would be most helpful to them to improve their outcomes.
Survey questions were developed to get at defining causes, impacts of loneliness and what makes them feel connected to others. The interviews were then coded and categorized into eight themes, “each of which may serve as a catalyst to ease the multidirectional impacts of loneliness,” Wirth says.
The themes were:
- Embrace acceptance. “Participants identified accepting of a new normal as a facilitator to help them with loneliness. So they stress that early after an injury, acceptance is difficult. But even as time passes, new challenges may occur that may require ongoing mental acceptance of a situation, but stressed that once they embrace acceptance, they can learn to appreciate new qualities of life,” Wirth says.
2. Find a purpose or accomplish a goal. “Participants suggest involving yourself in projects or something that could be finished,” Wirth says. “That gives you a purpose, whether that be a small or large goal. Participants describe feeling that their say it can make them feel like things are taken away from you, but that those positive moments, such as seeing progress in something of interest and finding a way to be useful, helped with them with their loneliness.”
3. Engaging in and pursuing interests. “Participants describe becoming involved in pre-injury interests or hobbies by making adaptations as needed or beginning new interests, so participants had a wide range of interests,” Wirth says.
4. Getting out of your residence/going outside, including learning what places are accessible.
5. Interact with and spend time with others, including friends, family, health care providers and others outside the normal routine or even using social media.
6. Interact with the SCI community or SCI peers.
7. Engage in reciprocity. “Participants describe that giving back, volunteering and being of service, particularly to other veterans with spinal cord injury, really helped them with their loneliness,” Wirth says. “They described that not being able to help others made them feel lonely, and that helping others provided them with a sense of connection.”
8. Seek help from mental health professionals if feelings of loneliness result in depression or suicidal ideation.
Wirth says some of the study’s limitations were that they only included veterans with SCI who received care at the VA; participants included only individuals who chose to contact the study team; the study’s older average age of participants may have different facilitators to alleviate loneliness than other participants with SCI; and the small sample size may also impact transferability of the findings.
“Overall, efforts are needed to help individuals with SCI manage loneliness,” Wirth says. “And the current study findings from veterans with spinal-cord injuries’ lived experiences provide a rich source of actionable facilitators that can be used in rehab settings. It is also possible that these findings could be extended to other rehab populations, particularly those who have mobility impairments. And this information can be used to help guide health care delivery in the development of interventions to target feelings of loneliness and social isolation in persons with SCI, particularly since there is a lack of published interventions to reduce loneliness among persons with SCI, which makes these findings a valuable source of information to develop novel interventions.”
Alicia Nunez, a nurse manager for the SCI long-term care center at the Tibor Rubin VA Medical Center in Long Beach, Calif., says the presentation was very relevant to her patient population.
“It’s something we notice some of our veterans struggle with, loneliness, depression … I think one of the ones she said was for them to get out into the community, and I think that one really stood out,” Nunez says.
However, Nunez says locating accessible transportation is sometimes a barrier for veterans to leave the facility for reasons other than medical appointments or organized group activities.
“There’s a lot of knowledge that I think needs to be shared, or awareness. That’s a big barrier for them to have access to their family and outings,” she says.
