Potentially debilitating illness or injury elicits psychological and behavioral responses that are peculiar to each individual. Despite the diversity of responses, the stresses and other forces that persons with disabling conditions must confront are often quite similar. The two examples given in the second box are illustrative. The similarities between the two patients are striking; yet the first patient appears to be adapting positively, whereas the second patient exhibits symptoms of major depressive disorder. The second patient's psychological state underlies his failure to comply with his prescribed dietary and exercise regimen, which elevates the risk of developing a secondary condition.
The finding by Wells and colleagues (1989) that "depression and chronic medical conditions had unique and additive effects on patient dysfunctioning" is especially pertinent to the care of people with disabling conditions. Depression following the loss of function is common and usually treatable. Krueger (1981) describes depression as a normal and expected response. "If it does not occur, even transiently," Krueger advises, "an alarm should sound because its absence indicates the reality of the loss has not been emotionally recognized." Prolonged depression is not inherent, and in most patients it abates within weeks or months without intervention. Careful psychiatric monitoring can alert the physician to the danger of prolonged depression, permitting early intervention.
Krueger also points out that the more a person's disabling condition interferes with his or her work, recreation, self-esteem, or normal coping mechanisms, the more psychologically devastating the condition will be. While finding that there is no characteristic pattern of psychological response based on type of disabling condition, Gallagher and Stewart (1987) report that anger, depression, and anxiety increase with the severity of the disabling condition. Researchers (Gallagher and Stewart, 1987; Castelnuovo-Tedesco, 1981) also have found that the severity of the psychological response is inversely related to the age at which the disabling condition is acquired. In terms of psychological vulnerability, according to Castelnuovo-Tedesco, the least unfavorable time for a disabling condition to develop tends to be after stable adult integration has occurred.
A person's mental health prior to the onset of a disabling condition and other antecedent variables appears to influence the likelihood and intensity of psychological complications. Factors predictive of depression following physical illness or injury include a personal history of depression, a family history of depression, and a predisposition to depression based on a personal history of early parental loss or childhood trauma (Krueger, 1981).
Brodsky's (1987) examination of motivational issues in a population of people who sustained job-related injuries elucidated several nonmedical factors