7636834_sHow often have you thought to yourself, “I would never be able to live with a disability?” Unfortunately, many individuals associate disability with dependency and with difficulty in being able to do things. At times we even feel sorry for individuals who have a disability because we assume that the person must be unhappy or depressed because of their limitations. We have got this all wrong. The “disability paradox” suggests that many individuals with disabilities report that they experience an excellent quality of life when, to most people, they seem to live an undesirable daily existence (Albrecht & Devilieger, 1999). Studies report that individuals with disabilities do, at times, report lower quality of life as compared their peers though the degree of impairment does not seem to be associated with quality of life. For example, in a recent study we published with in Archives of Physical Medicine and Rehabilitation, exploring factors that influence quality of life and depression in individuals with spinal cord injury, we saw that quality of life was not affected by the degree of functional impairment (Hartoonian et al. 2014). In other words, satisfaction with life is possible even when the person is completely physically dependent on others.

Aren’t you wondering by now how someone with tetraplegia (also knows as quadriplegia) can report the same or even better quality of life as a full able-bodied individual? If we think of this as a trajectory, this is how it may typically look. Immediately after the injury many people report symptoms of depression and may even think that they would be better off dead. Yet, after a period of time, the same individual who contemplated suicide adapts to their condition. Though there are many factors (i.e., demographic characteristics, medical complications, social interactions, pre-disability mental health status) that influence quality of life in individuals with SCI, one theory that may explain this relative stability of emotions despite the changes that took place in one’s life is “hedonic adaptation” or dynamic equilibrium theory. This theory refers to the idea that one’s quality of life tends to return to homeostatic levels. That is, we maintain a relatively stable level of happiness despite the positive or negative changes that take place in our lives. Other psychological processes that take place after an injury are adaptation and accommodation which have also shown to influence quality of life.

Other factors evidenced to be associated with symptoms of depression and lower quality of life experiencing greater physical pain, and secondary medical complications (Dijkers et al., 2005; Post et al., 2005; Hoffman et al., 2011).  In addition, factors related to participation, such as being a spouse or parent, working, or social interactions, have been shown to positively influence QOL (Dijkers, 1997)

What all of this tells us is that, though there are factors that influence quality of life, we human beings have the ability to adapt to any situation. So the reality is we tend to wrongly assume that those individuals with functional impairments tend to face more misery. Similar as reported in other studies (Dijkers, 1997; Dijkers 1999), our APMR study showed that participation (social, occupational or physical activity), but not disability or level of injury, was significantly associated with quality of life. Participating in social, occupational or physical activities appears to exert positive effect on depression and quality of life. So the lesson learned is it is not what we can or can’t do but what we do with what we have that makes the difference (adapted from Vince Lombardi).

DSC_0146Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and biological psychology.


Hartoonian, N., Hoffman, J. M., Kalpakjian, C. Z., Taylor, H. B., Krause, J. K., Bombardier, C. H. (2013) Evaluating a SCI-specific model of depression and quality of life. Archives of Physical Rehabilitation and Medicine. DOI: 10.1016/j.apmr.2013.10.029

Dijkers M. Quality of life after spinal cord injury: a meta analysis of the effects of disablement components. Spinal Cord 1997;35:829-40

Dijkers MP. Correlates of life satisfaction among persons with spinal cord injury. Archives of Physical Medicine Rehabilitation 1999;80:867-76.

Dijkers MP. Quality of life of individuals with spinal cord injury: a review of conceptualization, measurement, and research findings. J Rehabil Res Dev 2005;42:87-110.

Post M, Noreau L. Quality of life after spinal cord injury. J Neurol Phys Ther 2005;29:139-46.

Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil 2011;92:411-8.