TRAJECTORIES OF HAPPINESS FOLLOWING ACQUIRED DISABILITY A Dissertation by CARLY ELIZABETH MCCORD Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Chair of Committee, Timothy R. Elliott Committee Members, Daniel F. Brossart Oi-Man Kwok Rebecca Schlegal Head of Department, Victor L. Willson August 2013 Major Subject: Counseling Psychology Copyright 2013 Carly Elizabeth McCord ABSTRACT Current deficits in the rehabilitation psychology literature involving longitudinal studies investigating positive outcomes following acquired disabilities have deserved research attention. In the current study, data on happiness as an enduring mood tone, as measured by the Life Satisfaction Index (LSI) was collected from 1271 individuals (“insiders”) having incurred either a traumatic brain injury (TBI), spinal cord injury (SCI), severe burn, or intra-articular fracture (IAF) or from someone who felt close enough to speak on their behalf (“outsiders”). Data on happiness, functional independence as measured by the Functional Independence Measure (FIM), and other variables of interest were collected at 12 months, 24 months, 48 months, and 60 months after being medically discharged. Hierarchical Linear Modeling (HLM) analyses showed that trajectories of happiness remained stable across participants and did not change significantly over five years post-discharge regardless of injury type, FIM, or insider/outsider status. Happiness was significantly predicted by FIM, injury type, and whether the respondent was an insider or outsider. Those who were more impaired and less functionally independent were less happy. Those with a TBI were consistently less happy than those with an IAF or SCI and outsiders reported greater happiness on behalf of the insider than did the insiders themselves. This study shows that there is stability in happiness levels that can be sustained at least five years post-discharge and that there are discrepancies between insider and outsider reports of subjective happiness. Proxy ii reports can be used as valuable and valid secondary sources of information but should not be used as substitutes for first hand reports unless absolutely necessary. iii DEDICATION To my Lord and Savior by whom I am willingly commissioned to devote the fruits of my labor to further your kingdom. Take my feet and let them be swift and beautiful for Thee. iv ACKNOWLEDGEMENTS I am grateful to the entire team of people, including both personal and professional influences, who have given a piece of themselves to further my growth during graduate school. Your support has not gone unnoticed. I wish to thank my committee chair and mentor, Timothy Elliott, for accepting my past life as a cheerleader and choosing to invest in my development as a psychologist through the continual provision of opportunities for success. His zest for life and research are contagious and his commitment to his students is unparalleled. I would also like express thanks to my other committee members, Dan Brossart, Oi-Man Kwok, and Rebecca Schlegal, for their guidance and support throughout the course of this project. There is nothing like checking your email on Thanksgiving Day and seeing that your committee member has selflessly responded to a plea for help. I also want to extend my gratitude to Dr. Jack Berry and the Injury Control Research Center at the University of Alabama at Birmingham, for providing the data, and to all the individuals who were willing share about their experiences and give of their time and energy by participating in the study. Thanks also go to my friends, colleagues, professors, and supervisors in the Educational Psychology Department and the Student Counseling Service for making my time at Texas A&M University a fulfilling experience. In particular, I am eternally grateful to Kristin Clemens for introducing me to the present moment, both in therapy and in life. This gift has changed my life and certainly made the journey through v graduate school more tolerable. Also, I wish to thank James Degeear for his genuineness, his commitment to my development as a person and a clinician, and lastly, for all those “check-ins” that persisted throughout my years as a practicum student and intern. There are others outside the Texas A&M family who also deserve acknowledgement. I am especially grateful for my dearest friends and biggest cheerleaders, Sara Utterback and Amy Sauber. We’ve stumbled through numerous peaks and valleys in this life by leaning on each other. I can only hope our friendship, which makes my life immeasurably richer, will continue to stand the test of time. I also wish to thank Brent Kenney, who took me out to coffee as a psychology undergrad and told me I would be selling myself short if I did not shoot for a PhD. I’ve always loved a good dare and his confidence in me, which surpassed my own at the time, gave me the push I needed to reach for the stars. None have been as influential to my success as my family, who I would like to thank for their unconditional love and support. I would like to thank my sister for inspiring me, caring for me, and challenging me to be a better person by striving to do the same. I wish to thank my mom for the example she set to never quit fighting, to search my heart for truth and have an open mind, and to never give up on finding my purpose here on Earth. And I would like to thank my dad for his patience, wisdom, and undying commitment to my development as a whole person: mind, body, and spirit. vi Finally, I wish to thank my husband and my best friend with whom I can be my truest self. I could not have done this without you. Or as I’m sure you would say “You could have, it just would have taken you a whole lot longer.” vii TABLE OF CONTENTS Page ABSTRACT .................................................................................................................... ii DEDICATION................................................................................................................. iv ACKNOWLEDGEMENTS.............................................................................................. v TABLE OF CONTENTS................................................................................................viii LIST OF TABLES............................................................................................................ x CHAPTER I INTRODUCTION....................................................................................... 1 Happiness and Disability........................................................................................... 2 Role of Insider/Outsider Reporting........................................................................... 3 Purpose of This Study............................................................................................... 5 CHAPTER II LITERATURE REVIEW........................................................................... 7 Adjustment Following Acquired Disability.............................................................. 7 Positive Adjustment Following Disability................................................................ 9 Defining Happiness.................................................................................................. 11 Altering Happiness................................................................................................... 13 Happiness Matters.................................................................................................... 15 CHAPTER III METHODS.............................................................................................. 21 Participants............................................................................................................... 21 Procedures................................................................................................................ 22 Measures................................................................................................................... 24 Happiness.................................................................................................. 24 Functional Impairment.............................................................................. 25 Statistical Analysis................................................................................................... 26 CHAPTER IV RESULTS................................................................................................ 30 Preliminary Analyses.............................................................................................. 30 Age............................................................................................................ 30 viii Page Abbreviated Injury Scale........................................................................... 30 Insider/Outsider......................................................................................... 31 Happiness.................................................................................................. 31 Functional Independence........................................................................... 32 Missing Data............................................................................................. 32 Hierarchical Linear Modeling.................................................................................. 33 CHAPTER V CONCLUSIONS....................................................................................... 36 Time and Happiness................................................................................................. 36 Injury Type and Happiness....................................................................................... 38 Functional Independence and Happiness................................................................. 39 Insider/Outsider Reporting and Happiness............................................................... 40 Study Limitations and Future Research Directions.................................................. 45 REFERENCES................................................................................................................. 49 APPENDIX...................................................................................................................... 68 ix LIST OF TABLES Table Page 1 Injury Type.......................................................................................................... 68 2 Age Breakdown for the Total Sample at Time 1................................................. 69 3 Reported Ethnicity for the Total Sample at Time 1............................................ 70 4 Injury Severity by Injury Type for the Total Sample...........................................71 5 Tukey Post-Hoc Comparisons of Age by Injury Type........................................ 72 6 Tukey Post-Hoc Comparisons of AIS by Injury Type........................................ 73 7 Tukey Post-Hoc Comparisons of I/O by Injury Type......................................... 74 8 Average Happiness Scores Across Time..............................................................75 9 Tukey Post-Hoc Comparisons of Happiness by Injury Type at 12 Month Follow-Up................................................................... 76 10 Tukey Post-Hoc Comparisons of FIM by Injury Type....................................... 77 11 Percentages of Missing Data............................................................................... 78 12 Estimates of Fixed Effects for FIM, Insider/Outsider (IO), Injury Type, and Time on Happiness.................................................................. 79 13 Estimates of Interaction Effects for FIM, Insider/Outsider (IO), Injury Type, and Time on Happiness ................................................................. 80 x