Laird, Vanessa Catherine (2017-06). Predicting Trajectories of Emotional Well-being Following Medical Discharge for Traumatic Injury: A Longitudinal Study Using Multilevel Modeling. Doctoral Dissertation.
Thesis
Prior research has shown that the impact of traumatic injury on subjective wellbeing (SWB) varies significantly depending on personal, environmental, and injury characteristics. Although SWB comprises both life satisfaction and emotional well-being, studies of SWB following traumatic injury have focused almost exclusively on life satisfaction. This dissertation examined trajectories of emotional well-being among 488 individuals admitted to a Level 1 trauma center for serious physical injury. Emotional well-being was measured prior to hospital discharge, and at three, six, and 12 months post-discharge, using the Mental Health scale of the Veterans RAND 12-Item Health Survey (VR-12). Multilevel modeling (MLM) was used to investigate whether initial demographic variables, injury characteristics, resilience [measured with the Connor-Davidson Resilience Scale 10 (CD-RISC 10)], and social support [measured with the Social Provisions Scale (SPS)] predicted the emotional well-being trajectories. Participants' change in resilience and social support over the 12-month period were also tested as predictors. Hierarchical linear modeling (HLM) software revealed that the optimal growth model was cubic with a random linear growth component. On average, emotional wellbeing decreased over time, but individual variability in linear growth remained significant. Meaningful changes in resilience and social support, both positive and negative, occurred during the 12 months. Emotional well-being was initially predicted by educational attainment but not by age, gender, racial/ethnic minority status, employment status, injury severity, or presence of mild traumatic brain injury (mTBI). When controlling for resilience and social support variables, education was no longer a significant predictor. In the final model, initial resilience, resilience change, initial social support, and social support change significantly predicted emotional well-being 12 months post-discharge, while resilience change and social support change predicted the linear growth in emotional well-being over time. This model accounted for 33.2% of the between-individual variance in final scores and 46.9% of the variance in linear growth. The findings challenge assumptions of hedonic adaptation following traumatic injury and indicate that emotional well-being trajectories are strongly associated with changes in resilience and social support, even when controlling for initial resilience and social support.
