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Cited by 11Mindfulness and Compassion InterventionsSpinal Cord Injury ResearchCancer survivorship and care

Association of mindfulness to resilience, anxiety, and depressive symptoms after spinal cord injury-a correlational study

Open access
Pincock, Jace S., Terrill, Alexandra L.·2020·Spinal cord series and cases
DOI 10.1038/s41394-020-0256-yPMC PMC7000774
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Abstract

STUDY DESIGN: Online survey of individuals with spinal cord injuries (SCI). OBJECTIVE: This pilot study examined associations between mindfulness factors, resilience, and levels of depression and anxiety after SCI. SETTING: Community-based; United States. METHODS: A survey was posted online and shared with individuals with recent SCI (≤5 years). RESULTS: Thirty-four individuals responded to the survey. The Five Facet Mindfulness Questionnaire (FFMQ) measures mindfulness with the following subscales: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity of inner experience. Nonjudgment of inner experience was significantly associated with depression (β = -0.74, p = 0.007) and anxiety (β = -0.60, p = 0.01). Nonreactivity to inner experience was significantly associated with anxiety (β = -0.57, p = 0.007) and resilience (β = 0.55, p = 0.004); and there was a trend with depression (β = -0.45, p = 0.07). Higher resilience was significantly associated with less anxiety (r = -0.62, p = 0.04) and less depression (r = -0.75, p < 0.001). Depression and anxiety were significantly correlated (r = 0.84, p < 0.001). When comparing those who are employed to those who are not, they differed significantly in terms of anxiety (t(32) = 2.53, p = 0.02). CONCLUSIONS: These findings suggest that factors of mindfulness, specifically the practice of acting nonjudgmentally and nonreactively to one's inner experience, may act as protective factors against depression and anxiety following SCI. These preliminary data support the literature that individuals with lower resilience are more susceptible to depression following SCI. Interventions aimed at maximizing mental well-being following SCI may benefit from incorporating these factors of mindfulness practice.

Integrity signals

Registry

Crossref · 10.1038/s41394-020-0256-y

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

8 tests recomputed · 1 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

5 of 25 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Mindfulness has been shown to be associated with reduction in psychological distress.

    “Mindfulness has been shown to be associated with increased well-being [11] and reduction in psychological distress [11,12].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [11] Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31:23–33. source
    • cites [12] Coffey KA, Hartman M. Mechanisms of action in the inverse relationship between mindfulness and psychological distress. Complement Health Pract Rev. 2008;13:79–91. source
  • Premisecitation

    Mindfulness-based stress-reduction training programs have been shown to decrease depression compared to control.

    “Research findings have shown decreased stress [13], anxiety [14], depression [15], fatigue, anger and.stress-related cortisol [16] after exposure to various stress-reduction mindfulness-based training programs in comparison to a control group.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Rosenzweig S, Reibel DK, Greeson JM, Brainard GC, Hojat M. Mindfulness-based stress reduction lowers psychological distress in medical students. Teach Learn Med. 2003;15:88–92. source
  • Premisecitation

    Individuals who are unemployed are more susceptible to developing anxiety and depression.

    “Our findings are consistent with the literature that individuals who are unemployed are more susceptible to developing anxiety and depression [29].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [29] Pharr JR, Moonie S, Bungum TJ. The impact of unemployment on mental and physical health, access to health care and health risk behaviors. ISRN Public Health. 2012;2012:1–7. source
  • Findingown data

    Nonreactivity to inner experience was significantly associated with resilience (β = 0.55, p = 0.004) in individuals with SCI.

    “Nonreactivity to inner experience was significantly associated with anxiety (β = -0.57,p = 0.007) and resilience (β = 0.55, p = 0.004); and there was a trend with depression (β = -0.45,p = 0.07).”
    • Also stated in: § Regression · plain
      “Of the five subscales trends existed in the describing category with resilience (β = -0.40,p = 0.08), acting with awareness as associated with resilience (β = 0.38, p = 0.06), nonjudging of inner experience was associated with resilience (β = 0.36, p = 0.08) and nonreactivity to inner experience was significantly associate with resilience (β = 0.55, p = 0.004).”
    Quote in the paperSubstantial claim
  • Findingown data

    Depression and anxiety were significantly correlated (r = 0.84, p < 0.001) in individuals with SCI.

    “Depression and anxiety were significantly correlated (r = 0.84, p < 0.001).”
    • Also stated in: § Group differences and associations · plain
      “Analyses show that depression and anxiety were significantly correlated (r = 0.84, p < 0.001).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 18
  • May combine two claims. 15

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Individuals with cervical SCI typically have more complications, a longer hospital stay and substantial multidisciplinary treatments.

    “Individuals with cervical SCI typically have more complications, a longer hospital stay and substantial multidisciplinary treatments [30,32].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [30] Whiteneck G, Gassaway J, Dijkers M, Jha A. New approach to study the contents and outcomes of spinal cord injury rehabilitation: the SCIRehab project. J Spinal Cord Med. 2009;32:251–9. source

      The Effectiveness of SCI Rehabilitation section says SCI often affects multiple body systems, requires lengthy rehabilitation, and involves multidisciplinary care. It does not say that people with cervical SCI typically have more complications or longer hospital stays than people with other SCI levels; its discussion of length of stay concerns rehabilitation generally. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [32] Teunissen FR, Verbeek BM, Cha TD, Schwab JH. Spinal cord injury after traumatic spine fracture in patients with ankylosing spinal disorders. J Neurosurg: Spine. 2017;27:709–16. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationcitation

    The higher mindfulness in traumatic SCI may be due to extensive rehabilitation therapy regimens associated with survival of traumatic SCI, which may include fostering self-awareness and reflection.

    “This may be due to the extensive rehabilitation therapy regimens associated with survival of traumatic SCI, which may include fostering self-awareness and reflection Significant, p < 0.05.[30].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [30] Whiteneck G, Gassaway J, Dijkers M, Jha A. New approach to study the contents and outcomes of spinal cord injury rehabilitation: the SCIRehab project. J Spinal Cord Med. 2009;32:251–9. source

      The “Effectiveness of SCI Rehabilitation” section says that SCI can require a lengthy rehabilitation program to develop remaining abilities and support adjustment to a changed life. It does not say that rehabilitation fosters self-awareness or reflection, or link rehabilitation to higher mindfulness in people with traumatic SCI. Page numbers are unavailable in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participants were primarily middle-aged adults (Median = 47, SD = 9.87), with ages ranging from 22 to 62 years.

    “Participants were primarily middle-aged adults (Median = 47, SD = 9.87); however, ages ranged from 22 to 62 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When comparing traumatic and nontraumatic SCI, there was a trend in mindfulness (t(27) = 1.54, p = 0.14); those with traumatic injuries scored higher in mindfulness.

    “When comparing those with a traumatic and nontraumatic SCI, there was a trend in mindfulness t(27) = 1.54, p = 0.14; those with traumatic injuries scored higher in mindfulness.”
    • Also stated in: § Discussion · plain
      “Those who reported having a traumatic SCI also scored higher on mindfulness compared to nontraumatic SCI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Although there is a higher risk of distress and depression after trauma, the most common response is resilience.

    “Although there is a higher risk of distress and depression after trauma, the most common response is resilience [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Bonanno GA, Kennedy P, Galatzer-Levy IR, Lude P, Elfström ML. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilitation Psychol. 2012;57:236–47. https://doi.org/10.1037/a0029256. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Symptoms of acute anxiety and depression are common following SCI.

    “Symptoms of acute anxiety and depression are common following SCI [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Bonanno GA, Kennedy P, Galatzer-Levy IR, Lude P, Elfström ML. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilitation Psychol. 2012;57:236–47. https://doi.org/10.1037/a0029256. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The FFMQ is a reliable and valid comprehensive tool for assessing different aspects of mindfulness in community and student samples.

    “It is a reliable and valid comprehensive tool for assessing different aspects of mindfulness in community and student samples [10,22].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Baer RA, Smith GT, Lykins E, Button D, Krietemeyer J, Sauer S, et al. Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment. 2007;15:329–42. source
    • cites [22] Bohlmeijer E, ten Klooster PM, Fledderus M, Veehof M, Baer R. Psychometric properties of the five facet mindfulness questionnaire in depressed adults and development of a short form. Assessment. 2011;18:308–20. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness researchers have found a negative correlation with negative psychological symptoms and overall quality of life after mindfulness training.

    “Mindfulness researchers have also found a negative correlation with negative psychological symptoms and overall quality of life after mindfulness training [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Tang Y, Ma Y, Wang J, Fan Y, Feng S, Lu Q et al. Short-term meditation training improves attention and self-regulation. Proc Natl Acad Sci USA. 2007;104:17152–6. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness has been shown to be associated with increased well-being.

    “Mindfulness has been shown to be associated with increased well-being [11] and reduction in psychological distress [11,12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31:23–33. source

  • May combine two claims.

    Study design and conductcitation

    The CDRISC is a brief, unidimensional measure of resilience with sound psychometric properties and has been used with SCI populations.

    “The CDRISC is a brief, unidimensional measure of resilience.”
    • Also stated in: § Measures · plain
      “This measure has sound psychometric properties and has been used with SCI populations [19][20][21].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. J Trauma Stress. 2007;20:1019–28. source
    • cites [19][20][21]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness-based stress-reduction training programs have been shown to decrease stress compared to control.

    “Research findings have shown decreased stress [13], anxiety [14], depression [15], fatigue, anger and.stress-related cortisol [16] after exposure to various stress-reduction mindfulness-based training programs in comparison to a control group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Ostafin BD, Chawla N, Bowen S, Dillworth TM, Witkiewitz K, Marlatt GA. Intensive mindfulness training and the reduction of psychological distress: a preliminary study. Cogn Behav Pract. 2006;13:191–7. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness-based stress-reduction training programs have been shown to decrease anxiety compared to control.

    “Research findings have shown decreased stress [13], anxiety [14], depression [15], fatigue, anger and.stress-related cortisol [16] after exposure to various stress-reduction mindfulness-based training programs in comparison to a control group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Shapiro SL, Brown KW, Biegel GM. Teaching self-care to caregivers: effects of mindfulness-based stress reduction on the mental health of therapists in training. Train Educ Prof Psychol. 2007;1:105–15. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness-based stress-reduction training programs have been shown to decrease fatigue, anger and stress-related cortisol compared to control.

    “Research findings have shown decreased stress [13], anxiety [14], depression [15], fatigue, anger and.stress-related cortisol [16] after exposure to various stress-reduction mindfulness-based training programs in comparison to a control group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998;21:581–99. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The PRO-A-SF has been shown to be clinically valid by measuring longitudinal changes in anxiety in medical populations.

    “This measure has been shown to be clinically valid by measuring longitudinal changes in anxiety in medical populations [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Schalet BD, Pilkonis PA, Yu L, Dodds N, Johnston KL, Yount S et al. Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical samples. J Clin Epidemiol. 2016;73:119–27. https://doi.org/10.1016/j.jclinepi.2015.08.036. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All data were double checked, cleaned, and examined for outliers and normal distribution.

    “All data were double checked, cleaned and, examined for outliers and normal distribution.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Participants were a small sample (n = 34); three began but did not fully complete the questionnaires.

    “Participants were a small sample (n = 34); three began but did not fully complete the questionnaires.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Participants were predominantly women (67%), Caucasian (91%), and well educated, with 87% having some education beyond high school.

    “Participants were predominantly women (67%), Caucasian (91%) and well educated, with 87% of participants having some education beyond high school.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Having these traits of mindfulness may aid in improving resilience and thereby act as protective factors for developing mental health disorders such as anxiety and depression after SCI.

    “Having these traits of mindfulness may aid in improving resilience and thereby act as protective factors for developing mental health disorders such as anxiety and depression after SCI.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    These findings may be associated with the nature of the injuries and/or therapies received.

    “These findings may be associated with the nature of the injuries and/or therapies received.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Individuals with cervical SCI are more mindful and have lower anxiety than those with thoracic/lumbar level injuries.

    “The data also suggest that individuals with cervical SCI are more mindful and have lower anxiety than those with thoracic/lumbar level injuries.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    This pilot study is limited due to its small sample size, and generalizability is limited as the sample was predominantly white and well educated.

    “This pilot study is limited due to its small sample size, and generalizability is limited as our sample was predominantly white, and well educated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Women are more prone to depression than men.

    “Our data are also consistent with findings across the literature suggesting that women are more prone to depression than men [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Leach LS, et al. Gender differences in depression and anxiety across the adult lifespan: the role of psychosocial mediators. Soc Psychiatry Psychiatr Epidemiol. 2008;43:983–98. source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    This study is considered exploratory and the cross-sectional design cannot make definitive statements concerning causality.

    “This study is considered exploratory and the cross-sectional design cannot make definitive statements concerning causality.”
    Quote in the paperSubstantial claim
23 of 23

  • The paper relies on this without support.

    There is a gap in the scientific literature regarding the relationship of mindfulness to resilience and aspects of psychopathology, including depressive and anxiety symptoms.

    “Although more recent studies have started to examine these protective factors, there is still a gap in the scientific literature, in particular regarding the relationship of mindfulness to resilience and aspects of psychopathology, including depressive and anxiety symptoms.”
1 of 1

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value across alpha = .05: t(32) = -2.72,p = .11

    Major

    The paper reports p = .11 here; recomputing from the test statistic and its degrees of freedom gives p = .010 (two-tailed). The two fall on opposite sides of alpha = .05. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .11 · recomputed p = .010

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upt(32) = -2.72reported p = .11 · recomputed p = .010The two fall on opposite sides of .05

    “t(32) = -2.72,p = .11”

  • Consistentt(32) = 2.53reported p = .02 · recomputed p = .017

    “t(32) = 2.53, p = .02”

  • Consistentt(27) = 1.54reported p = .14 · recomputed p = .135

    “t(27) = 1.54, p = .14”

  • Consistentt(30) = 1.66reported p = .11 · recomputed p = .107

    “t(30) = 1.66, p = .11”

  • Consistentt(30) = 1.64reported p = .11 · recomputed p = .111

    “t(30) = 1.64, p = .11”

  • Consistentt(31) = 1.64reported p = .11 · recomputed p = .111

    “t(31) = 1.64, p = .11”

  • Consistentt(31) = -1.71reported p = .1 · recomputed p = .097

    “t(31) = -1.71,p = .10”

  • Consistentt(32) = 2.88reported p = .01 · recomputed p = .007

    “t(32) = 2.88, p = .01”

8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Nonjudging-depression result differs between abstract and results

    Major

    The abstract reports a significant association with depression (β = −0.74, p = 0.007), but the regression results report a smaller association that is not significant (β = −0.36, p = 0.09).

  • Cervical-injury anxiety direction conflicts with Table 2

    Major

    The discussion says cervical-injury participants had lower anxiety than thoracic/lumbar participants. In Table 2's cervical-versus-thoracic/lumbar comparison, their mean anxiety score is higher: 11.00 versus 8.8.

  • Nonreactivity-depression estimates disagree

    Major

    The abstract reports β = −0.45 with p = 0.07, whereas the regression results report β = −0.24 with p = 0.198 for the same association. Only the abstract's result falls within the paper's stated range for a trend.

  • Discussion reverses the direction of the describing coefficient

    Major

    The regression gives describing a negative coefficient for resilience, but the clinical implications interpret higher describing scores as indicating higher resilience.

  • Group comparisons above the stated trend cutoff are called trends

    Minor

    The paper says it considers trends only up to p = 0.1, yet calls the traumatic-injury comparison at p = 0.14 and the injury-level comparisons at p = 0.11 trends.

  • Employment-depression difference is called a trend despite p = 0.01

    Minor

    The employment comparison for depression is labeled a trend at p = 0.01, below the paper's stated p < 0.05 significance threshold.

  • Depression regression results exceed the trend cutoff

    Minor

    Acting with awareness (p = 0.19) and nonreactivity (p = 0.198) are listed among trends, although both exceed the paper's stated p = 0.1 limit for trends.

7 of 7

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Terrill AL, MacKenzie JJ, Einerson J, Reblin M. Resilience and disability: intra-personal, interpersonal, and social environment factors. In: Dunn DS, editor. Disability: social psychological perspectives. New York. NY: Oxford University Press; 2019. p. 313–5.
  2. Terrill AL, Molton IR, Ehde D, Amtmann D, Bombardier C, Jensen MP. Resilience, age, and perceived symptoms in persons with long-term physical disabilities. J Health Psychol. 2016;21:640–9. https://doi.org/10.1177/1359105314532973. · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Pincock, J. S., & Terrill, A. L.
Affiliations
University of Utah (US)
Corresponding author
Terrill, Alexandra L.
ORCID
Terrill, Alexandra L.
Venue
Spinal cord series and cases
Publisher
Springer Science and Business Media LLC
Published
2020-02-04
Volume
6
Issue
1
Pages
7-7
ISSN
2058-6124 (ISSN-L)
DOI
10.1038/s41394-020-0256-y
PMC
PMC7000774
OpenAlex
W3005149629
Semantic Scholar
26a4af9e95a355ed83341af6cacd16684ce4c1ef
Cited by
11
References
31
Citations by year
2025: 2 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 1
FWCI
0.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Spinal Cord Series and Cases (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
spinal cord injury, mindfulness, resilience, depression, anxiety, Five Facet Mindfulness Questionnaire, mental health, employment status, protective factors
MeSH terms
Adult, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Male, Middle Aged, Pilot Projects, Surveys and Questionnaires, Spinal Cord Injuries, Resilience, Psychological, Young Adult, Mindfulness

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

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Statistics and arithmetic are recomputed, not judged.

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