Healthcare mistrust is associated with pain and perceived health among wheelchair users with spinal cord injury

Research Objectives: To determine whether wheelchair users with spinal cord injury (SCI) who report greater mistrust in the healthcare system have worse pain, depressive symptoms, and perceived health.

Design: Cross-sectional survey.

Setting: Nine SCI Model Systems (SCIMS) Centers.

Participants: Full-time wheelchair users (≥16 years old) with chronic SCI (duration of injury ≥1 year). Of the 520 survey respondents, n=407 had complete data on key measures and were included in this analysis.

Interventions: N/A

Main Outcome Measures: The focal independent variable, healthcare distrust, was measured using the nine-item healthcare system distrust scale.1 Other independent variables included race/ethnicity (non-Hispanic White, Hispanic White, non-Hispanic Black), marital status (single, married/living with partner, other), education level (did not complete High School, received Diploma, post-secondary education), sex, insurance payer (private, Medicare, Medicaid, other), years since injury, and age. Dependent variables included pain (measured with an 11-point numerical rating scale), depressive symptoms (measured with the 2-item patient health questionnaire screener2), and self-perceived health status.3

Results: Participants who reported greater mistrust in the healthcare system also reported higher pain scores (B=0.058, B SE=0.021, p<.01, R2=.019) and lower self-perceived health (B=0.017, B SE=0.008, p<.05, R2=.012). No relationships between mistrust and depressive symptoms were noted.

Conclusions: Wheelchair users with SCI report high levels of pain, which can negatively impact health-related quality of life.4 In this sample of wheelchair users with SCI, greater mistrust in the healthcare system was associated with greater pain levels and worse self-perceived health. Considering the impact of pain and perceived health on quality of life, interventions designed to ameliorate mistrust could be beneficial. The cause of distrust is not clear from these data. Further investigation into causes is needed in order to develop interventions designed to ameliorate its effects.

Author(s) Disclosures: N/A