After spinal cord injury, life satisfaction did not simply collapse and stay there. In this New Zealand cohort, satisfaction was higher at ten years than at eighteen months—but important differences appeared much earlier. The study examines life satisfaction outcomes after spinal cord injury and identifies factors associated with life satisfaction at eighteen months and ten years post-SCI in New Zealand.

That two-timepoint design matters because it asks both what satisfaction looks like after injury and which characteristics are associated with it later on. Spinal cord injuries result from neurological damage to the spinal cord, causing temporary or permanent change in function.

That damage can produce partial or complete loss of function below the site of the spinal cord injury. Spinal cord injury can result from traumatic injury or non-traumatic causes such as haemorrhage or cancer. The World Health Organization estimates the annual global incidence of spinal cord injury to be forty to eighty million.

In New Zealand, the incidence is approximately one hundred and sixty people per year. New Zealand rates differ by ethnicity, with higher rates among Māori and Pacific people than among European and other ethnicities. Spinal cord injuries can have large impacts on people’s lives, including their levels of life satisfaction.

Here, life satisfaction means the degree to which people positively perceive their overall quality of life, state of mind, and contentment with the life they lead. Previous international research found life satisfaction to be generally positive among people with spinal cord injury, although not as high as in the general population.

A United States longitudinal study followed two thousand one hundred and eighty-three people from one to twenty years post-SCI and found that life satisfaction increased as time post-SCI increased. Post-SCI life satisfaction has been associated with socio-demographic and SCI-related characteristics, physical and mental health, and social and environmental characteristics.

Those relationships had not appeared to be explored in New Zealand, where the health and Accident Compensation Corporation system is unique. This research analyses data previously collected by the Longitudinal study of the life histories of people with spinal cord injury.

The study was led by a researcher with lived experience of SCI, interviewers had lived experience, and questionnaires were developed in consultation with others with lived experience of SCI. Individuals were recruited between two thousand and seven and two thousand and nine from New Zealand’s two spinal units following first admission for spinal cord injury.

Participants were New Zealand citizens or permanent residents aged sixteen to sixty-four years with traumatic or non-traumatic spinal cord injury. Eligible participants had an American Spinal Injury Association Impairment Scale grade of A, B, C, or D; people with grade E, significant cognitive injury or communication impairment, or life expectancy under six months were ineligible.

Data were collected from structured interviews undertaken approximately six months, eighteen months, and ten years post-SCI. Clinical information was collected by research nurses in each spinal unit. The interviews covered demographic, physical, psychosocial, economic, and environmental characteristics.

The first interview asked about pre-SCI and six-month characteristics, while later interviews explored outcomes at later timepoints, with life satisfaction as the outcome of interest. Figure one maps the study’s longitudinal data collection across three post-SCI timepoints.

The initial interview, collected six months after SCI, covered pre-SCI, SCI-related, and six-month characteristics, with one hundred eighteen participants; later interviews measured life satisfaction at eighteen months and ten years, with one hundred three and sixty-three participants respectively.

This timeline matters because it shows how the authors connect early characteristics with life-satisfaction outcomes over time. Life satisfaction at eighteen months and ten years was assessed by asking, “Overall, how would you rate your life as a whole,” on a five-item scale.

Responses were categorised as satisfied when participants were completely or mostly satisfied, and not satisfied for the remaining three response options. SCI-related characteristics included AIS grade, SCI aetiology, wheelchair usage, and ACC support.

Wheelchair usage was recorded as always, sometimes, or never, while ACC support was recorded as yes or no. The six-month post-SCI characteristics included job security, health-related quality of life, cognitive function, disability, secondary health conditions, satisfaction with social support, and sexual activity.

These characteristics included whether participants had no or any problems with cognitive function, whether disability was present, and whether sexual activity had decreased or not. Descriptive statistics were calculated for pre-SCI, SCI-related, and six-month post-SCI characteristics, using counts and percentages for categorical variables and means with standard deviations for continuous variables.

Univariable analyses assessed associations between potential predictors and life satisfaction at eighteen months and ten years post-SCI. Chi-squared tests, or Fisher’s exact tests where appropriate, were used for categorical variables, while unpaired t-tests were used for continuous variables.

At six months post-SCI, there was considerable worsening in the EQ-5D-3L health-related quality-of-life dimensions compared with pre-SCI. Most participants reported problems with mobility, self-care, usual activities, and pain or discomfort: ninety-two percent, sixty-six percent, ninety percent, and eighty-six percent.

Problems with anxiety or depression affected forty-nine percent, and cognitive-function problems affected forty-three percent at six months, both higher than pre-SCI. Most participants were also experiencing considerable disability at six months, and the average number of secondary health conditions was six.

Table two reports univariable associations between pre-SCI characteristics and life satisfaction at eighteen months and ten years after spinal cord injury. For each characteristic, it lists satisfied and not-satisfied counts and percentages, alongside a p value for each follow-up period.

Most reported p values are above zero point zero five, while ethnicity and prior chronic conditions have p values of zero point zero four six and zero point zero four nine, respectively, at ten years. Of the one hundred and three participants at eighteen months, sixty-eight, or sixty-seven percent, were satisfied with life and thirty-four, or thirty-three percent, were not satisfied.

Of the sixty-three participants at ten years, forty-nine, or seventy-eight percent, were satisfied and fourteen, or twenty-two percent, were not satisfied. Thirty-six participants, or fifty-seven percent, were satisfied at both timepoints.

Overall, a greater proportion were satisfied at ten years than at eighteen months, although the percentage not satisfied at ten years remained higher than pre-SCI. After considering other SCI-related variables, people who never or only sometimes used a wheelchair were one point six two times as likely to be satisfied at eighteen months as those who always used a wheelchair.

At six months post-SCI, participants reporting any EQ-5D-3L self-care problems were less likely to be satisfied at eighteen months than those reporting no problems. The same pattern appeared for anxiety or depression: participants reporting any problems were less likely to be satisfied at eighteen months than those reporting no problems.

Table two compares characteristics of people satisfied and not satisfied with life at eighteen months and ten years after spinal cord injury. At eighteen months, significant p values appear for self-care, usual activities, anxiety or depression, disability, secondary health conditions, social support, and decreased sexual activity; the EQ-5D-3L visual analog scale also reports sixty point three plus or minus twenty point four versus forty-six point one plus or minus nineteen point eight.

At ten years, the listed p values are not significant at the reported threshold. After adjustment for age, ethnicity, pre-SCI life satisfaction, and other explanatory variables, only SCI-related secondary health conditions showed an association with eighteen-month life satisfaction.

The result indicated a five percent reduction in satisfaction at eighteen months with each additional secondary health condition experienced. Table three presents separate multivariable mini-models for life satisfaction at eighteen months and ten years after spinal cord injury, reporting relative risks, confidence intervals, and p values.

At eighteen months, not using a wheelchair or using one sometimes had a relative risk of 1.62, with a ninety-five percent confidence interval from 1.20 to 2.18 and a p value of 0.002, while considerable disability was associated with 0.74. At ten years, considerable disability was associated with 0.78, with a ninety-five percent confidence interval from 0.63 to 0.97 and a p value of 0.028.

A strength is the large number of variables, which allowed life satisfaction to be assessed against a wide range of aspects from all areas of life. The ten-year follow-up is also a strength because few studies have longitudinally followed the same participants from the onset of SCI to ten years post-SCI and beyond.

People with lived experience of SCI contributed to the study design and interview questions, and interviewers also had lived experience of SCI. Although this was the largest study undertaken in New Zealand and included one hundred and eighteen participants at baseline, the sample size was small, particularly at ten years post-SCI.

The ten-year sample was reduced because participants changed contact details and became uncontactable, rather than because they declined participation; only one person declined. This made ten-year analyses difficult because only a limited number of variables could be included in the multivariable analyses.

Future research with a larger sample would be valuable, and further research is also needed on older adults and young people with spinal cord injuries. Most participants were satisfied with life at both follow-ups, while disability, wheelchair use, self-care, anxiety or depression, and secondary health conditions were linked with lower satisfaction at key timepoints.

These are potential targets for support.