The Impact of Marital Status on 20-Year Participation Trajectories in Individuals with Spinal Cord Injury.

Abstract

Background: Social participation following spinal cord injury (SCI) is associated with improved quality of life, but it may decline with age. While marital status supports greater social participation, the long-term impact as individuals age remains unclear.

Objectives: To identify the relationship of marital status with participation trajectories using 20 years of longitudinal data.

Methods: We conducted a cohort study of 343 participants with SCI who completed a self-report assessment 5 times in 2003, 2008, 2013, 2018, and 2023. Conditional growth models were used to assess trajectories of 4 participation indicators over the 5 repeated measurements.

Results: At baseline, those married or cohabitating (MC) had more work hours per week, more hours out of bed per day, and more nights away from home last year than those divorced, separated, or widowed (DSW). We did not find significant differences between DSW and single individuals at baseline. Average scores declined across all 4 participation indicators over the 20 years, but the MC's rate of change for days out of the house declined slower compared to DSW. MC individuals also spent more hours out of bed than DSW across all time points, with both groups showing similar rates of decline over time, suggesting that MC individuals maintained a relative advantage despite the overall decrease.

Conclusion: Our study showed declines in participation across all marital status groups, but critically a slower rate of decline for MC individuals, and they maintained higher participation levels at each time of measurement.