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  2. Appraisals of Disability: Primary and Secondary Scale

Appraisals of Disability: Primary and Secondary Scale

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Purpose

The ADAPSS (Dean & Kennedy, 2009) is self-rated measure designed to capture appraisals specific to spinal cord injury/disorder (SCI/D).  There are two versions: a shortform (ADAPSS-sf) and a long form (ADAPSS).  Appraisals concern people’s thinking and their evaluation of stress and the resources available to cope with the event and have been represented in a model of adjustment (Duff & Kennedy, 2003). As Duff (2008) states, “It is this interpretation of the event, rather than the injury and trauma per se, which determine an individual’s reaction. The reaction is determined by either a threat to core positive belief about the self or the activation of core negative self-beliefs” (p.72).

Link to Instrument

Link to instrument

Acronym ADAPSS and ADAPSS-sf

Area of Assessment

Cognition
Mental Functions

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE -- last searched 07/08/2025

Populations

Spinal Cord Injuries

Key Descriptions

  • There are two different versions of the ADAPSS: a short form (ADAPSS-sf) and a long form (ADAPSS). Both measures are scored on a 6-point Likert scale with 3 agree responses (strongly, moderately, and mildly) and 3 disagree responses (strongly, moderately, and mildly).
  • The short version of the ADAPSS (the ADAPSS-sf) is one of the quality indicators for psychological wellbeing on the NHS England SCI/D dashboard. The ADAPSS-sf includes 6 items, each representing a domain/subscale from the long form; fearful despondency, overwhelming disbelief, determined resolve, negative perceptions of disability, growth and resilience, and personal agency. Total scores are generated by adding responses for each of the 6 items (minimum score = 6, maximum score = 36). It should be noted that items representing determined resolve, growth and resilience, and personal agency are reverse scored. In this way, for all items it is the case that the higher the score the more likely someone will have increased loss and decreased resilience appraisals and therefore possible difficulties adjusting to SCI/D. The ADAPSS-sf is generally used for screening purposes, and if someone scores 22 or over it is recommended to complete the long form ADAPSS.
  • The long form ADAPSS can be used following the administration of the ADAPSS-sf or as a standalone measure. The long form contains 33 items. Items relate to the same 6 subscales as in the ADAPSS-sf: fearful despondency (FD; 9 items, maximum score of 54), overwhelming disbelief (OD; 5 items, maximum score of 30), determined resolve (DR; 4 items, maximum score of 24), negative perceptions of disability (NPD; 5 items, maximum score of 30), growth and resilience (GR; 5 items, maximum score of 30) and personal agency (PA; 5 items, maximum score of 30).
  • The 6 subscales can be further grouped into two superordinate factors: Catastrophic Negativity (Loss) and Determined Resilience (Resilience)1. The Catastrophic Negative (Loss) factor includes the subscales fearful despondency, overwhelming disbelief and negative perceptions of disability. The Determined Resilience factor includes determined resilience, growth and resilience and personal agency.
  • In the full ADAPSS, scores are calculated for each of the sub-scales by summing scores of the relevant items. As in the ADAPSS-sf, items from DR, GR and PA subscales are reverse scored. In the ADAPSS long form, scores of 51-54 (FD), 28-30 (OD), 21-24 (DR), 25-30 (GR), 27-30 (NPD) and 26-30 (PA) are considered high, and indicative of maladaptive appraisals in that domain.

Number of Items

ADAPSS-sf: 6 items
ADAPSS: 33 items

Equipment Required

  • Pen/papers based on PDF

Time to Administer

5-20 minutes

ADAPSS-sf: 5-10 minutes; ADAPSS: 10-20 minutes

The psychology team at the National Spinal Injuries Centre, UK, have developed an excel tool* which automates scoring for the ADAPSS and ADAPSS-sf to save administration time:
• https://docs.google.com/spreadsheets/d/1tUYjDZ68To4O-scPECILQj6Ld6MJuAFt/edit?gid=242269262#gid=242269262

The scoring tool contains the instructions for the scale, references the literature and the scale itself. Scores are inputted electronically and the total scores/interpretations of scores are automatically generated. Details regarding scoring interpretation are also included. Please note that you need to enable macros for these scoring tools to work properly.

*Please note that you need to download a copy of the scoring tool, instead of using it directly on the google drive.

Required Training

No Training

Required Training Description

Link to YouTube tutorial about how to administer the ADAPSS: https://youtu.be/DxYFGxSmC4k

Age Ranges

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Philippa Unthank, Assistant Psychologist, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK.

ICF Domain

Participation

Measurement Domain

Emotion

Professional Association Recommendation

None found -- last searched 07/08/2025

Considerations

It is possible that reading and thinking about the statements may lead some individuals to think more about their injury and become upset. In most cases, this should not last long; but if this persists for more than a day individuals should be encouraged to seek psychological support.

Used in UK, US, Australia, Germany and Poland. Available and validated in English, German, and Polish.

Spinal Cord Injuries

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Cut-Off Scores

Spinal cord injury (ADAPSS Short Form): (Eaton et al., 2018; n = 371 (261 male, 110 female), mean age at injury = 53, age range = 15 to 91 years; injury type: 179 participants reported having tetraplegia, 192 participants reported having paraplegia) 

  • ≥ 27 found to indicate catastrophic negativity (loss appraisals) based on an 85th percentile cutoff; however, this sample had a much higher mean than the studies below.

Pediatric-onset spinal cord injury (ADAPSS Short Form): (Deane et al., 2020; n = 115 (67 male, 48 female), mean age at injury = 13.39 (4.92),   mean age at interview = 37.44 years (7.85), injury type: 50.4% reported having tetraplegia, 49.6% reported having paraplegia)

  • ≥ 22 found to represent clinically elevated catastrophic negativity (loss appraisals) based on an 85th percentile cutoff. 

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (Russell et al., 2021; n = 90; mean age = 55.6 years; mean years since injury = 17.6 years; 95.6% male)

  • ≥ 22 suggested if wanting to maximise specificity and conserve clinical resources (specificity 98%, sensitivity 57%, Youden’s index score 55%, diagnostic odds ratio distinguishing between adjustment types = 68.25).
  • ≥ 19 suggested if wanting to maximise Youden’s Index (sensitivity 73%, specificity 85%, Youden’s Index 58%,  diagnostic odds ratio distinguishing between adjustment types = 16.32)
  • ≥ 11 suggested if wanting to weight sensitivity above specificity if clinical resources are plentiful and wanting to avoid false negative results (sensitivity 95%, specificity 43%, Youden’s index score 38%, diagnostic odds ratio distinguishing between adjustment types = 7.17).

 

Normative Data

Veterans with Spinal cord injuries (ADAPSS Short Form): (Mignogna et al., 2015; n = 98 (94 male, 4 female), mean age = 56.17 (12.9) years, mean years since SCI/D = 18.3 (13.1); injury type: 14.3% reported having low tetraplegia, 6.1% reported having high tetraplegia, 37.8% reported having paraplegia)  

  • Mean score for the full sample = 15.87 (7.38)

Spinal cord injury (ADAPSS Long Form): (Kennedy et al., 2016; n = 22 (19 male, 3 female), mean age at injury = 27.9 (8.7) years, mean number of years since injury = 23.1 years (range = 16-54), injury level: 40.9% reported having cervical injuries, 36.4% reported having thoracic injuries, 22.7% reported having lumbar injuries, with 63.5% reported having complete and 31.8% incomplete injuries)

  • Mean score for Fearful Despondency subscale = 31.27 (9.43).
  • Mean for Overwhelming Disbelief subscale = 13.18 (5.32)
  • Mean for Determined Resolve subscale = 8.36 (3.82)*
  • Mean for Growth and Resilience subscale = 12.32 (4.79)*
  • Mean for Negative Perceptions of Disability subscale = 17.59 (5.89)
  • Mean for Personal Agency subscale = 12.05 (SD = 4.37)*

*Negatively scored construct

Spinal cord injury (ADAPSS Short Form): (Eaton et al., 2018, n = 371) 

  • Mean for the full sample: 19.21 (6.96)

Pediatric-onset spinal cord injury (ADAPSS Short Form): (Deane et al., 2020; n = 115)

  • Mean for the full sample: 13.94 (6.10).

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (Russell et al., 2021; n = 90)

  • Mean Total Score on ADAPSS-sf for healthy adjustment group (n = 53) = 12.4 (5.03)
  • Mean Total Score on ADAPSS-sf for poor adjustment group (n = 37) = 21.92 (6.86).

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (McDonald et al., 2018; n = 262; male = 96%; mean age = 57.9 (13.12) years (age range = 24-90); mean age at SCI = 41.1 (15.11) years (age range = 19-79); injury level: 43% reported having paraplegia, 25% reported high (C1-C4) tetraplegia, and 32% reported low (C5-C8) tetraplegia).

  • Mean total score for full sample: 16.32 (6.84)
  • Mean Catastrophic Negativity score for full sample: 9.14 (4.83)
  • Mean Determined Resilience score for full sample: 7.15 (3.86)
  • White/Caucasian individuals:
    • Mean total score = 15.29 (6.67)
    • Mean Catastrophic Negativity subscale score = 8.26 (4.26)
    • Mean Determined Resilience subscale score = 7.00 (3.50)
  • Black/African American’s:
    • Mean total score = 17.55 (6.87)
    • Mean Catastrophic Negativity subscale score = 10.12 (4.59)
    • Mean Determined Resilience subscale score = 7.39 (3.87)
  • Ethnic minority individuals
    • Mean total score = 17.42 (6.80).
    • Mean Catastrophic Negativity subscale score = 10.02 (4.58)
    • Mean Determined Resilience subscale score = 7.35 (3.82)

 

Test/Retest Reliability

Adult-onset (age > 16) spinal cord injury (ADAPSS Long Form): (Dean & Kennedy 2009; n = 93, mean age = 48 years, 63% men, 37% women; injury level: 64% reported having paraplegia, 33% reported having tetraplegia; test-retest interval = 2 weeks).  

  • Excellent test-retest reliability for Fearful Despondency subscale: (ICC = 0.88)
  • Excellent test-retest reliability for Overwhelming Disbelief subscale: (ICC = 0.86)
  • Acceptable test-retest reliability for Determined Resolve subscale: (ICC = 0.76)
  • Acceptable test-retest reliability for Growth and Resilience subscale: (ICC = 0.83)
  • Acceptable test-retest reliability for Negative Perceptions of Disability subscale: (ICC = 0.81)
  • Poor test-retest reliability for Personal Agency subscale: (ICC = 0.62)

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (McDonald et al., 2018; n = 51; test-retest interval = one year).

  • Poor test-retest reliability for Total Score: (ICC = 0.69)
  • Acceptable test-retest reliability for Catastrophic Negativity subscale scores: (ICC = 0.71)
  • Poor test-retest reliability for Determined Resilience subscale scores: (ICC = 0.30)

Pediatric-onset spinal cord injury (ADAPSS Short Form): (Deane et al., 2020; test-retest interval = one year)

  • Acceptable test-retest reliability for total score: (ICC = 0.81)

 

 

Internal Consistency

Adult-onset (age > 16) spinal cord injury (ADAPSS Long Form): (Dean & Kennedy 2009; n = 93, mean age = 48, 63% men, 37% women; injury level: 64% reported having paraplegia, 33% reported having tetraplegia)

  • Excellent: Cronbach’s alpha for Fearful Despondency subscale = 0.85
  • Excellent: Cronbach’s alpha for Overwhelming Disbelief subscale = 0.83
  • Adequate: Cronbach’s alpha for Determined Resolve subscale = 0.74
  • Adequate: Cronbach’s alpha for Growth and Resilience subscale = 0.73
  • Excellent: Cronbach’s alpha for Negative Perceptions of Disability subscale = 0.80
  • Adequate: Cronbach’s alpha for Personal Agency subscale = 0.70
  • Adequate: Cronbach’s alpha of > 0.70 for both superordinate factors (catastrophic negativity and determined resilience).

Veterans with Spinal cord injuries (ADAPSS Short Form): (Mignogna et al., 2015)  

  • Adequate:  Cronbach’s alpha for full scale = 0.79
  • Excellent:  Cronbach’s alpha = 0.81 for the superordinate factor of “fear and loss”
  • Adequate:  Cronbach’s alpha = 0.70 for superordinate factor of “resilience”.

Spinal cord injury (ADAPSS Short Form): (Eaton et al., 2018) 

  • Adequate: Cronbach’s alpha = 0.70 for resilience factor (includes the Determined Resolve (DR), Growth and Resilience (GR), and Personal Agency (PA) subscales)
  • Poor: Cronbach’s alpha = 0.63 for loss factor (includes the Fearful Despondency (FD), Overwhelming Disbelief (OD), and Negative Perception of Disability (NPD) subscales).

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (McDonald et al., 2018; n = 256)

  • Adequate: Cronbach’s alpha = 0.73.

Pediatric-onset spinal cord injury (ADAPSS Short Form): (Deane et al., 2020)

  • Adequate: Cronbach’s alpha = 0.74.

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (Russell et al., 2021)

  • Adequate: Cronbach’s alpha = 0.79.

 

Criterion Validity (Predictive/Concurrent)

Predictive validity:

 

Adult-onset (age > 16) spinal cord injury (ADAPSS Long Form): (Dean & Kennedy 2009; n = 180, mean age = 46 years (age range = 19-65), 69% men, 31% women; injury level: 60% of respondents reported paraplegic injuries, 37% reported tetraplegic injuries)

 

ADAPSS and concurrent depression/anxiety (regression)

  • The ADAPSS factors Fearful Despondency, Personal Agency, and Determined Resolve were found to predict unique variance in concurrent depression. These ADAPSS subscales were found to predict 62.9% of the variance in depression compared to 52.9% predicted by a non-SCI appraisal measure (The Appraisal of Life Events Scale; Ferguson et al., 1999).

Significant Predictors of Concurrent Depression

Variable

Standardized Coefficients

β

t

p

Fearful Despondency

(ADAPSS)

0.209

2.717

0.007

Personal Agency

(ADAPSS)

0.188

3.179

0.002

Determined Resolve

(ADAPSS)

0.257

4.222

0.001

Loss Appraisals (ALE)

0.113

1.252

0.212

Challenge Appraisals (ALE)

-0.078

-1.402

0.163

Threat Appraisals (ALE)

0.152

1.741

0.084

Type of spinal cord injury

0.105

2.214

0.028

Age at injury

 

0.072

1.438

0.153

ALE = Appraisal of Life Events scale

 

  • The ADAPSS factors Personal Agency and Fearful Despondency were found to significantly predict 46.9% of the variance in concurrent anxiety when controlling for a non-SCI appraisal measure (The Appraisal of Life Events Scale; Ferguson et al., 1999). As the largest standardized beta coefficient was 0.332 for the threat subscale of The Appraisal of Life Events Scale (53.7% of the variance in concurrent anxiety), this suggests that in the sample this variable had the largest impact on level of concurrent anxiety.

Significant Predictors of Concurrent Anxiety

Variable

Standardized Coefficients

β

t

p

Fearful Despondency

(ADAPSS)

0.222

2.821

0.005

Personal Agency

(ADAPSS)

0.244

4.243

0.001

Threat appraisals (ALE)

0.332

3.617

0.001

Loss appraisals (ALE)

0.142

1.500

0.136

ALE = Appraisal of Life Events scale

 

Spinal cord injury (ADAPSS Long Form): (Kennedy et al., 2016)

 

Coping styles and psychological distress (regression)

  • Multiple regressions showed associations between coping strategies in week 12 and appraisals 21 years later:

    • Found the coping strategies Acceptance and Positive Reinterpretation and Growth at Week 12 significantly predicted 54.6% of the variance in Fearful Despondency at 21-plus years later, F(2,16) = 9.64, p = 0.002.

    • The coping strategy Positive Reinterpretation and Growth at week 12 significantly predicted 24.6% of the variance in Determined Resolve 21-plus years later, F(1,17) = 5.55, p = 0.031.

  • Associations between psychological distress reported at week 12 and appraisals 21 years later:

    • Depression at week 12 was found to significantly predict 36.2% of the variance in Negative Perceptions of Disability at 21 plus years, F(1,17) = 9.64, p = 0.006.

 

Veterans with Spinal cord injuries (ADAPSS Short Form): (Mignogna et al., 2015)  

 

ADAPSS-sf and life satisfaction (linear regression)

  • ADAPSS-sf total scores were negatively associated with life satisfaction (β = -0.72, p < 0.001), and uniquely contributed to 27.7% of the explained variance, after controlling for depressive symptoms (β = 0.05, p = 0.604) and level of injury (β = 0.153, p = 0.051). The total model explained 55.5% of the variance in life satisfaction, F(3, 91) = 37.88, p < 0.001. The ADAPSS-sf total score uniquely contributed to 27.7% of the explained variance.

  • Factor 1 (loss appraisals) was negatively associated with life satisfaction, and uniquely contributed to 16.0% of the explained variance, after controlling for depressive symptoms and level of injury. The model explained 43.8% of the variance in life satisfaction.

  • Factor 2 (resilience appraisals) was negatively associated with life satisfaction, and uniquely contributed to 14.0% of the explained variance, after controlling for depressive symptoms and level of injury. The model explained 43.8% of the variance in life satisfaction.

 

Spinal cord injury (ADAPSS Short Form): (Eaton et al., 2018)

 

ADAPSS and concurrent anxiety/depression (regression analysis)

  • A hierarchical stepwise regression was conducted to examine whether ADAPSS-sf factors were predictors of variance in concurrent anxiety and depression.

  • Resilience and loss factors were significant predictors of concurrent depression and accounted for 44.2% of the variance.

Final model for concurrent depression (adjusted R squared = 0.442)

Variable

Standardised Coefficients

β

t

p

ADAPSS-SF resilience

0.361

8.33

0.000

ADAPSS-SF loss

0.408

9.35

0.000

*p = 0.01 (one-tailed)

 

  • Resilience and loss factors were significant predictors of concurrent anxiety, and alongside gender accounted for 36.9% of the variance.

Final model for concurrent anxiety (adjusted R squared = 0.369)

Variable

Standardised Coefficients

β

t

p

ADAPSS-SF resilience

0.207

4.50

0.000

ADAPSS-SF loss

0.459

9.90

0.000

*p = 0.01 (one-tailed)

 

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (Russell et al., 2021)

  • ADAPSS-sf total score remained a significant predictor of SWLS scores (satisfaction with life) after controlling for participant demographics and emotional factors (PHQ-9, GAD-7, PC-PTSD Scales) (standardized β = -0.66; t = 6.54; p ≤ 0.001, two-tailed)

 

Concurrent validity:

 

Adult-onset (age > 16) spinal cord injury (ADAPSS Long Form): (Dean & Kennedy 2009; n = 180, mean age = 46 years (age range = 19-65), 69% men, 31% women; injury level: 60% of respondents reported paraplegic injuries, 37% reported tetraplegic injuries)

  • Excellent positive correlation between Fearful Despondency subscale and the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-Anxiety) (r = 0.649, p = 0.01).

  • Excellent positive correlation between Overwhelming Disbelief subscale and HADS-Anxiety (r = 0.597, p = 0.01).

  • Adequate positive correlation between Determined Resolve subscale and HADS-Anxiety (r = 0.347, p = 0.01).

  • Poor positive correlation between Growth and Resilience subscale and HADS-Anxiety (r = 0.187, p = 0.01).

  • Excellent positive correlation between Negative Perceptions of Disability subscale and HADS-Anxiety (r = 0.496, p = 0.01).

  • Adequate positive correlation between Personal Agency subscale and HADS-Anxiety (r = 0.393, p = 0.01).

  • Adequate to Excellent positive correlations between scores on catastrophic negativity appraisal subscales (Fearful Despondency, Overwhelming Disbelief, and Negative Perceptions of Disability) of the ADAPSS and HADS-Anxiety (r = 0.496-0.649, p = 0.01).

 

Traumatic Spinal cord injuries (ADAPSS Long Form): (Byra et al., 2020; n = 163 (63 female, 100 male); mean age = 39.6 (9.38) years, average time since injury = 12.05 (4.22) years; injury level: C1-C4 nonambulatory = 16%, C5-C8 nonambulatory = 64%, non-cervical nonambulatory = 20%; Polish translation of ADAPSS)

  • Appraisals of disability were found to mediate the relationship between forgiveness and acceptance of disability.

  • Adequate negative correlations between Heartland Forgiveness scale and all ADAPSS subscales (r = -0.450 to 0.585).

Correlations Between Forgiveness and ADAPSS Subscales

 

FD

OD

NPD

DR

GR

PA

HFS 

-0.470*

-0.585*

-0.450*

-0.561*

-0.532*

-0.583*

HFS = Heartland Forgiveness Scale; ADAPSS subscales: FD = Fearful Despondency, OD = Overwhelming Disbelief, NPD = Negative Perception of Disability, DR = Determined Resolve, GR = Growth and Resilience, PA = Personal Agency

*p < 0.001 

 

Spinal cord injury (ADAPSS Long Form): (Kennedy et al., 2016)

  • Excellent positive correlation between depression and overwhelming disbelief subscale (r = 0.697, p = 0.001).

  • Excellent positive correlation between depression and fearful despondency subscales (r = 0.660, p = 0.001).

  • Adequate positive correlation between depression and negative perceptions of disability subscale (r = 0.509, p = 0.016).

  • Excellent positive correlation between depression and determined resolve (r = 0.814, p = 0.001).

  • Excellent positive correlation between depression and personal agency (r = 0.627, p = 0.002).

  • Depression was measured by the Beck Depression Inventory; Beck & Steer, 1987. Correlations between depression and determined resolve/personal agency are positive because these constructs were negatively scored (thus higher scores represent less agreement with these appraisals).

 

Veterans with Spinal cord injuries (ADAPSS Short Form): (Mignogna et al., 2015)

  • Excellent correlations between the ADAPSS-sf Total Score and PHQ-9 (r = 0.69, p = 0.01), and ADAPSS-sf Total Score and The Diener Satisfaction with Life Scale (r = -0.73, p = 0.01).

  • Excellent correlation between loss subscale on ADAPSS-sf and PHQ-9 (r = 0.65, p = 0.01).

  • Excellent correlation between loss subscale on ADAPSS-sf and Life Satisfaction (r = 0.64, p = 0.01).

  • Adequate correlation between resilience subscale on ADAPSS-sf and PHQ-9 (r = 0.54, p = 0.01).

  • Excellent correlation between resilience subscale of ADAPSS-sf and life satisfaction (r = -0.61, p = 0.01).

  • Adequate (r = < 0.6) to Excellent (r = ≥ 0.6) correlations between ADAPSS-sf,  ADAPSS-sf Factors, and other scales

Correlations Between ADAPSS-sf, ADAPSS Factors, PHQ-9, and Life Satisfaction Scale

 

Life satisfaction

ADAPSS-sf

ADAPSS-sf, Factor 1

ADAPSS-sf, Factor 2

PHQ-9

 

-0.51**

0.69**

0.649**

0.539**

Satisfaction with Life

--

-0.73**

-0.64**

-0.61**

ADAPSS-sf Total

--

--

0.89**

0.80**

ADAPSS-sf Factor 1

--

--

--

0.45**

PHQ-9 = Patient Health Questionnaire-9; Satisfaction with Life = Diener Satisfaction with Life Scale 

**p = significant at the 0.01 level (2-tailed)

 

Spinal cord injury (ADAPSS Short Form): (Eaton et al., 2018) 

  • Adequate correlation between ADAPSS-sf Total and HADS anxiety subscale (r = 0.597, p = 0.01)

  • Excellent correlation between ADAPSS-sf Total and HADS depression subscale (r = 0.633, p = 0.01).

  • Adequate correlations between resilience subscale on ADAPSS-sf and HADS anxiety subscale (r = 0.398, p = 0.01) and HADS Depression subscale (r = 0.520, p = 0.01).

  • Excellent correlation between loss subscale on ADAPSS-sf and HADS anxiety subscale (r = 0.605, p = 0.01).

  • Adequate correlations between loss subscale on ADAPSS-sf and HADS depression subscale (r = 0.597, p = 0.001).

 

Pediatric-onset spinal cord injury (ADAPSS Short Form): (Deane et al., 2020)

  • Adequate correlation between ADAPSS-sf Total Score and PHQ-9 Total Score (r = 0.46, p < 0.001).

  • Adequate correlation between ADAPSS-sf Total Score and Beck Anxiety Inventory Total Score (r = 0.48, p < 0.001).

  • Adequate correlation between ADAPSS-sf Total Score and PTSD Checklist- Civilian Total Score (r = 0.39, p < 0.01).

  • Excellent correlation between ADAPSS-sf Total Score and General Happiness Scale (r = -0.68, p < 0.001).

  • Adequate correlation between ADAPSS-sf Total Score and Post-traumatic Growth Inventory Total Score (r = -0.32, p < 0.01).

  • Excellent correlation between ADAPSS-sf Total Score and Satisfaction with Life Total Score (r = -0.67, p < 0.001).

  • Poor correlation between ADAPSS-sf Total Score and Pittsburgh Sleep Quality Index Total Score (r = 0.19, p < 0.05).

  • Poor correlation between ADAPSS-sf Total Score and pressure injury frequency (r = 0.26, p < 0.01).

  • Poor correlation between ADAPSS-sf Total Score and current pain (r = 0.12, p < 0.05).

  • Poor correlation between ADAPSS-sf Total Score and distress from pain (r = 0.21, p < 0.05).

 

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (McDonald et al., 2018; n = 262).

  • Adequate negative correlations between ADAPSS-sf total score and Short Form Health Survey (8-item) (SF-8 MCS, measure of mental health concerns) (r = -0.52, p < 0.001), the ADAPSS-sf total score and Connor-Davidson Resilience Scale, Two-Item Version (CD-RISC-2) (r = -0.51, p < 0.001), and the ADAPSS-sf total score and Satisfaction With Life Scale (SWLS) (r = -0.57, p < 0.001).

  • Adequate correlations between catastrophic negativity subscale on ADAPSS-sf and SF-8 MCS (r = -0.50, p < 0.001), and catastrophic negativity subscale on ADAPSS-sf and CD-RISC- 2 (r = -0.48, p < 0.001).

  • Excellent correlation between catastrophic negativity subscale on ADAPSS-sf and SWLS (r = -0.66, p < 0.001).

  • Adequate correlations between determined resilience subscale on ADAPSS-sf and SF-8 MCS (r = -0.36, p < 0.001) and between determined resilience subscale on ADAPSS-sf and CD-RISC-2 (r = -0.35, p < 0.001).

  • Poor correlation between determined resilience subscale on ADAPSS-sf and SWLS (r = -0.26, p < 0.05)

 

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (Russell et al., 2021)

  • Excellent correlation between ADAPSS-sf Total Score and PHQ-9 Total Score (r = 0.71, p ≤ .001*) 

  • Excellent correlations between ADAPSS-sf Total Score and GAD-7 Total Score (r = 0.65, p ≤ .001*) 

  • Adequate correlations between ADAPSS-sf Total Score and PC-PTSD scale (r = 0.52, p ≤ .001*)

  • Excellent correlations between ADAPSS-sf Total Score and SWLS Scale (r = -0.75, p ≤ .001*)

*Two-tailed

 

Construct Validity

Convergent validity:

Adult-onset (age > 16) spinal cord injury (ADAPSS Long Form): (Dean & Kennedy 2009; n = 180, mean age = 46 years (age range = 19-65), 69% men, 31% women; injury level: 60% of respondents reported paraplegic injuries, 37% reported tetraplegic injuries)

  • Adequate to Excellent negative correlations between all six ADAPSS subscales and the Perceived Manageability Scale (r = -0.34 to -0.60).

  • Poor to Excellent positive correlations between all six ADAPSS subscales and the threat subscale of The Appraisal of Life Events Scale (r = 0.29 to 0.74).

  • Adequate to Excellent positive correlations between all six ADAPSS subscales and the loss subscale of The Appraisal of Life Events Scale (r = 0.31 to 0.74).

  • Poor to Adequate negative correlations between all six ADAPSS subscales and the challenge subscale of The Appraisal of Life Events Scale (r = -0.26 to -0.49).

Spearman’s Rho Correlations Between ADAPSS Subscales, the PMS, and the

ALE Subscales*

Variable

Fearful despondency

Overwhelming disbelief

Determined resolve

Growth and resilience

Negative perceptions of disability

Personal agency

PMS

-0.597

-0.468

-0.599

-0.345

-0.533

-0.519

ALE-Threat

0.738

0.712

0.442

0.287

0.609

0.361

ALE-Loss

0.739

0.721

0.473

0.310

0.614

0.458

ALE-Challenge

-0.402

-0.401

-0.292

-0.262

-0.490

-0.401

PMS = Perceived Manageability Subscale from the Needs Assessment Checklist (NAC; Kennedy & Hamilton, 1999); ALE = Appraisal of Life Events Scale (ALE; Ferguson et al., 1999)

*All correlations p = 0.01 (one-tailed)

 

Discriminant validity:

 

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (Russell et al., 2021)

  • Adequate ability of the ADAPSS-sf to discriminate between healthy adjusted and poorly adjusted groups (AUC = 0.863, p < 0.001)

 

 

Content Validity

Adult-onset (age > 16) spinal cord injury (ADAPSS Long Form): (Dean & Kennedy 2009; n = 180, mean age = 46 years (age range = 19-65), 69% men, 31% women; injury level: 60% of respondents reported paraplegic injuries, 37% reported tetraplegic injuries)

  • Six subscales were found on the ADAPSS from a principal components factor analysis. Correlation coefficients of 0.4 or higher were used to indicate an item loaded onto a subscale/factor.
  • Calculated correlations between the six ADAPSS subscales. Correlations between the three Loss subscales (overwhelming disbelief, fearful despondency, and negative perceptions of disability) were large (r ≥ 0.60). However, correlations between the other inter-subscale correlations were low to moderate (not exceeding r = 0.49).
  • The scree test indicated two definite superordinate factors: catastrophic negativity (overwhelming disbelief, fearful despondency, and negative perceptions of disability subscales) and determined resilience (determined resolve, growth and resilience, and personal agency subscales). 

 

Veterans with Spinal cord injuries (ADAPSS Short Form): (Mignogna et al., 2015)  

  • Principal components analysis of the six items of the ADAPSS-sf revealed 2 factors: appraisals of loss and appraisals of resilience.
  • Appraisals of fear and loss accounted for 49.5% of the variance with an eigenvalue of 2.97.
  • Appraisals of resilience accounted for 19.0% of the variance with an eigenvalue of 1.14.
  • Each item loaded heavily on one factor; with factor loadings between 0.72 and 0.85 for each item on its factor.
  • The two factors were moderately correlated (r = 0.45).

 

Spinal cord injury (ADAPSS Short Form): (Eaton et al., 2018) 

  • Conducted principle component analysis with oblique rotation.
  • Factor analysis revealed 2 factors: appraisals of loss and appraisals of resilience. Together, both factors accounted for 60.7% of the variance
    • Resilience appraisals accounted for 43.3% of the variance with an eigenvalue of 2.60.
    • Appraisals of loss accounted for 17.3% of the variance with an eigenvalue of 1.04.

Pearson's correlations between ADAPSS-sf total and ADAPSS factors 

 

ADAPSS-SF resilience factor

ADAPSS-SF loss factor

ADAPSS-SF total

 

0.811*

0.864*

ADAPSS-SF resilience factor

-

0.438*

*p = 0.01

 

Veterans with Spinal Cord Injuries (ADAPSS Short Form): (McDonald et al., 2018; n = 262)

  • Supported a two-component structure through the scree test and eigenvalue above one criterion, which accounted for 63% of the variance.
  • Factor analysis revealed two components which corresponded with the “Catastrophic Negativity” and “Determined Resilience” subscales.

 

Pediatric-onset spinal cord injury (ADAPSS Short Form): (Deane et al., 2020)

  • Factor analysis revealed a one component structure (supported by the scree test and an eigenvalue above 1 criterion), unlike prior findings which have revealed the two principle components of Catastrophic Negativity and Determined Resilience. However, it is noted that the relatively small sample is a possible cause of the deviation from other findings.

 

Floor/Ceiling Effects

Veterans with Spinal cord injuries (ADAPSS Short Form): (Mignogna et al., 2015; n = 98 (94 male, 4 female), mean age = 56.17 years (12.9), mean years since SCI/D = 18.3 (13.1); injury type: 14.3% low tetraplegia, 6.1% high tetraplegia, 37.8% paraplegia)  

  • Excellent: No floor or ceiling effects
    • Participants’ scores were in the full range of possible scores (scores ranged from 6 to 32)

Pediatric-onset spinal cord injury (ADAPSS Short Form): (Deane et al., 2020)

  • Excellent: No floor or ceiling effects
    • Participants endorsed the full range of individual item scores from 6 to 36

 

Bibliography

Byra, S., Mroz, J. & Kaleta, K. (2020). Forgiveness and acceptance of disability in people with traumatic spinal cord injury—the mediating role of disability appraisal. A cross-sectional study. Spinal Cord, 58, 1317-1324. https://doi.org/10.1038/s41393-020-0507-6

Dean, R. E., & Kennedy, P. (2003). Spinal Cord Injury. In: S. Llewelyn & P. Kennedy (Eds.), Handbook of Clinical Health Psychology (pp. 251-278). John Wiley & Sons, Ltd.

Deane, K.C., Chlan, K.M., Vogel, L.C., & Zebracki, K. (2020). Use of Appraisals of DisAbility Primary and Secondary Scale-Short Form (ADAPSS-sf) in individuals with pediatric-onset spinal cord injury. Spinal Cord, 58, 290-297.  https://doi.org/10.1038/s41393-019-0375-0

Duff J, Kennedy P. (2003). Spinal Cord Injury. In: S. Llewelyn & P. Kennedy (Eds.), Handbook of Clinical Health Psychology (pp. 251-78). John Wiley & Sons, Ltd. 

Duff, J. (2008). Rehabilitation and Goal Planning Approaches Following Spinal Cord Injury: Facilitating Adjustment. In A. Craig & Y.Tran (Eds.), Psychological Aspects Associated with Spinal Cord Injury Rehabilitation: New Directions and Best Evidence (1st ed., pp. 71-88). Nova Science Publishers, Inc.

Eaton R., Jones K., Duff J. (2018). Cognitive appraisals and emotional status following a spinal cord injury in post-acute rehabilitation. Spinal Cord, 56(12),1151-7.  https://doi.org/10.1038/s41393-018-0151-6

Kennedy P., Kilvert A., Hasson L. (2016). A 21-year longitudinal analysis of impact, coping, and appraisals following spinal cord injury. Rehabilitation Psychology, 61(1), 92-101.  https://psycnet.apa.org/doi/10.1037/rep0000066 

McDonald, S. D., Goldberg-Looney, L. D., Mickens, M. N., Ellwood, M. S., Mutchler, B. J., & Perrin, P. B. (2018). Appraisals of Disability Primary and Secondary Scale-Short Form (ADAPSS-sf): Psychometrics and association with mental health among U.S. military veterans with spinal cord injury. Rehabilitation Psychology, 63(3), 372-382. https://doi.org/10.1037/rep0000230

Mignogna, J., Christie, A. J., Holmes, S. A., & Ames, H. (2015). Measuring disability-associated appraisals for veterans with spinal cord injury. Rehabilitation Psychology, 60(1), 99–104. https://doi.org/10.1037/rep0000022

Russell, M., Ames, H., Dunn, C., Beckwith, S., & Holmes, S. A. (2021). Appraisals of disability and psychological adjustment in veterans with spinal cord injuries. The Journal of Spinal Cord Medicine, 44(6), 958-965. https://doi.org/10.1080/10790268.2020.1754650

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