Psychosocial adaptation to chronic illness and disability: A preliminary study of its factorial structure

This study examined the factorial structure of psychosocial adaptation to chronic illness and disability in a sample of 313 individuals who sustained spinal cord injury (SCI). Three models were examined. The first model tested the hypothesis that psychosocial adaptation is composed of a single, global factor, in which positive (adaptive) and negative (nonadaptive) reactions define two opposing poles of the same dimension. The second model tested the validity of two distinguishable factors, representing adaptive and nonadaptive dimensions. The third model examined the relationship between the 2-factor model and a third dimension, that of denial. The data from the instruments measuring psychosocial adaptation to trauma and disability (the Reactions to Impairment and Disability Inventory and the Purdue Posttraumatic Stress Disorder-Revised) were submitted to a series of confirmatory factor analyses, and the results from the goodness of fit tests and fit indices provided strong support to the validity of the latter two models. The findings indicated that the structure of adaptation to SCI can be best conceptualized as representing two, moderately linked but clearly distinguishable, factors and that the construct of denial of disability further elucidates our understanding of the structure of adaptation to loss of body integrity.