Psychological Adjustment to Disability: Heterogeneous Trajectories of Resilience and Depression Following Physical Impairment or Amputation

Adjustment to disability is a foundational concept within rehabilitation psychology and
constitutes an important public health problem given the adverse outcomes associated with
maladjustment. While the disability literature has highlighted depressive elevations in response
to functional impairment, resilience and alternative patterns of psychological adjustment have
received substantially less empirical inquiry. This dissertation is comprised of three papers, the
first two of which are longitudinal studies utilizing distinct samples of individuals with acquired
disabilities: a population-sample of physically impaired older adults, and a convenience sample
of individuals with newly acquired amputations. The third paper summarizes current data science
and statistical findings regarding disability adjustment for patients and their providers. The two
longitudinal studies share a common statistical methodology, latent growth mixture modeling
(LGMM), allowing for the identification of distinct subgroups (classes) of individuals who share
similar symptom profiles over time. LGMM is well-poised to resolve fundamental questions
about whether psychological functioning after disability is best described by a population-level
archetypal response (i.e., distress and depression that remits over time), or alternatively, whether
the data suggest a variety of definable subgroups with distinct psychological trajectories. Results
of empirical papers 1 and 2 provide strong empirical evidence that the process of disability
adjustment is heterogeneous, with multiple pathways of symptom development and remission.
The third paper demonstrates how findings from current rehabilitation science can be utilized to
inform psychoeducational materials for practitioners and their patients with recent limb loss.
This chapter addresses gaps in dissemination of knowledge by describing various patterns of
psychological outcomes encountered by individuals following amputation surgery, as supported
by Study 2 and the broader resilience literature.