PSYCHOSOCIAL HEALTH—General
Information
Return to Psychosocial Highlights
According
to one report, alcohol and other drug
abuse disorders tend to increase as functional limitation becomes more
severe among women with disabilities.
• There
is considerable information about the relation between alcohol abuse and the
onset of a disability due to accidents and injuries while under the influence.
For example, alcohol consumption is a well-known strong predisposing factor in
traumatic brain injury (TBI), and it has been well documented with high
pre-injury prevalence rates for people with spinal cord injuries (SCI). However, less research has focused on AODA
among people who are already living with disabilities caused by other factors.
• People
who have abused alcohol and other drugs tend to continue to do so after their
injury, and substance abuse among people with TBI and SCI is 3 to 6 times
higher than in the general population.
Moreover, when people are abusing these substances at the time of
injury, they tend to have poorer short-term functional outcomes in
rehabilitation and more severe impairment.
• One
study conducted on a sample of 242 people (20% women) attending a Weekend
Intervention Program (a 3-day intervention for convicted substance impaired
drivers) identified 32.2% of this sample as having a disability, as defined by
the ADA. One third of these individuals
had a traumatic brain injury, followed by mental illness, or back or spinal
cord injury resulting in functional impairment, while a smaller percentage had
learning disabilities and hearing or visual impairments. These findings suggest that persons with
disabilities disproportionately incur arrests for “driving under the
influence.” However, the study did not identify how many of these disabilities
were related to previous substance-related accidents.
• Another
cross-disability study of 900 women with disabilities examined the patterns of
drug use and associated risk factors.
Findings suggested that age, drug use by best friend, and being a victim
of substance abuse-related violence were risk factors for personal drug abuse.
• One
study conducted on 140 people with multiple sclerosis (MS) found severity of
depression, alcohol abuse, and social isolation to predict suicidal intent with
85% accuracy. One third of the participants
reporting suicidal intent had not received psychological help, and two-thirds
of those reporting suicidal intent and major depression had not received
antidepressant medications. Suicidal
intent is a potentially treatable cause of morbidity and mortality in MS.
• It
has been suggested in the literature that people with disabilities may be more
at risk for substance abuse related to the following factors:
o Medical
issues such as overmedication, long-term medication usage, including difficulty
managing medication for chronic pain;
o
Psychosocial issues such as low self-esteem, depression, and anxiety; and
o Sensation-seeking
(rebelliousness) and vicarious experiences.
• Substance
abuse may be more likely to be harmful for a woman’s health if she has a
disability than for a woman who is non-disabled. People with disabilities may
experience more damaging health problems attributed to substance abuse than
people in the general population. Researchers have identified several potential
reasons for this.
o Alcohol
consumption may directly and immediately negatively impact some types of
disabilities, even at light or moderate levels. For example, a woman with
multiple sclerosis may find herself experiencing more rapid vision impairment,
instability, and so forth due to substance use.
o Substance
use has been found to increase vulnerability for secondary conditions among
people with disabilities (i.e., pressure sores and bladder infections).
o People
with disabilities are often prescribed medications that can be harmful when
combined with alcohol or street
drugs. The potential for dangerous
health outcomes when mixing alcohol and prescription drugs is substantial and
particularly hazardous for people with disabilities.
• As
with all women, substance abuse may make women with disabilities more
vulnerable to substance abuse-related violence.
·
Women
with disabilities face many barriers to treatment for AODA. A booklet is available that addresses these
problems and makes suggestions for programs to improve accessibility.
• One
feminist writer observed that most recovery programs emphasize spirituality and
“living one day at a time.” This parallels the positive impact of disability
for people. The 12-step programs are founded on Christian tenets: AA meetings typically end with the Lord’s
Prayer. For many women, accepting
god-talk and the paternalistic perspective is difficult. Nor are the groups
typically disability-sensitive. AA
meetings, for example, are known for excessive cigarette smoke, and this can be
life-threatening for many women with disabilities. Finally, the idea of
powerlessness [over alcohol} may constitute a problem for all women, but more
so for women who experience physical or mental powerlessness in the face of
disability and the world of ableism.
More (detailed)…
Physical
disability can negatively affect a woman’s body
image, especially in a society that places value on a youthful physical
appearance.
• How
does “body image” develop? In one study,
the authors suggests that in childhood a woman learns what her body can and
cannot do, what her body looks like, and whether she is a boy or a girl. Simultaneously, she develops a value for
herself, her self-esteem, that is, judgments about her own abilities and worth.
She may come to think highly of herself, or she may think of herself as having
few skills or abilities valued by others.
Others’ opinions are part of this process, too.
• It
has been suggested that it is important for a woman with a disability to
appreciate her own value, assert her right to make choices that will improve
her life, feel ownership of her body, restrict the limitations resulting from
her disability to physical functioning only and not impose those limitations on
her sexual self, be accepting, not ashamed of her body, and take action to
enhance her attractiveness.
• One
qualitative study with 31 women with disabilities identified “body image” as a
key theme that impacted participants’ sense of self. When a participant described how she felt
about her body or how others viewed her body, she seemed often to be reflecting
others’ own sense of self. Themes
identified in this study that related to body image were as follows:
o For
some women with disabilities, body image seemed to be part of their definition
of sexuality or their view of themselves as attractive sensual women.
o Body
image was also linked to personal attributes, such as physical characteristics
(bone size, weight) and their impact on the qualitative attributes ascribed to
them (beauty or unattractive beliefs).
o As
expected, body image was linked to social comparison, or how a woman with a
disability compared herself to other people in the community. Women with disabilities
(like all women) are constantly exposed to unrealistic ideals of women
portrayed in the media. Scars and deformity related to disability were
identified as impacting body image and self-esteem. Women with disabilities
living in this society are not exempt from the influence of messages that
attempt to dictate what is desirable and what is not in a woman. These messages
are often internalized, and have an impact on how women with disabilities see
themselves.
o Clothing
and grooming were linked to body image.
Several women with disabilities discussed using clothing as a way to
make themselves feel more attractive.
Some women with disabilities discussed using clothing to hide or mask
their disability.
o One
woman described her body image being related to a lack of physical boundaries
in her life and feeling that her body did not really belong to her.
o Several
women with disabilities had come to a point of being comfortable and accepting
their disability as part of their body image.
These women spoke of acceptance and realizing their inner beauty.
• Early
identification and treatment of body image dissatisfaction may help prevent the
development of depression and other psychosocial impairment in women with
disabilities.
You
lost most of the confidence when you become disabled. Before that I like to wear fashion clothes,
spend more time with myself like what kind of make-up and what kind of
hairstyle I'd like to have today. After
the accident, since I cannot do it myself, then you cannot be so picky when
other people do it for you. It makes it
very difficult at first because I was just not happy with the way that I
looked, at first once I became disabled.
Now I can accept it more, but I just don't think of myself as attractive
as before.
Quote from an Asian woman with
tetraplegia
More (detailed)…
Depression tends to be more
prevalent among women with disabilities than among non-disabled women.
·
Depression
is a common secondary health condition among women with disabilities.
·
Depression
is more common for women with disabilities than for other people.
o
Women
with disabilities face at least a double jeopardy for depression due to being
disabled and female.
o
Depression
is at least twice as common among women as among men.
o
Depression
appears to be possibly three times more common for people with disabilities
than for people in general.
·
A
study of 415 women with disabilities found depression was linked to more pain,
greater stress, lack of social support, and less mobility. Women with
disabilities who experienced abuse in the past year were more likely to be
depressed.
·
One
study of 64 women with spinal cord injury found severe depressive symptoms were
linked to greater stress and social isolation.
·
Depression
is complicated for women with disabilities.
o
Sometimes
the similarities between the symptoms of depression and symptoms of disability
(such as fatigue and sleep disturbance) make it difficult to determine the
cause of a woman’s distress.
o
Depression
among women with disabilities is sometimes caused by medication for the woman’s
underlying health condition.
·
Research
has begun to address the importance of interventions specifically designed to
alleviate depression among women with disabilities. One current study on depression compares two
types of depression interventions among approximately 200 women with
disabilities.
More (detailed)…
Women
with disabilities have lower rates of post-secondary (college) education than non-disabled women.
• Education
constitutes one of many barriers faced by women with disabilities when striving
to perform important social roles.
• One
analysis found that, compared to non-disabled women, women with 3 or more
functional limitations were more likely to have a high school education or less
(78% versus 54%).
• Another
analysis identified that women with higher levels of education are less likely to
have a disability. Nearly half of those with less than a high school education
were found to have disabilities.
• A
national study of women with physical disabilities revealed that younger, more
educated, and less disabled women were much more likely to be employed. More
highly educated respondents reported engaging in more health promoting
behaviors.
• Education
has been associated with abuse. One interview study of 14 women with
disabilities found that the women who were involved in the severest abusive
relationships were the least educated.
o Lack
of education inhibited the ability of participants to find good jobs that could
lead them out of abusive relationships.
Without jobs, they were unable to support themselves or pursue good
medical care, better neighborhoods, or other things that would improve their
quality of life.
o One
woman, who said she had been beaten all of her life, had only completed the 6th
grade, and had a stroke at age 36. She blamed her lack of education as one of
the reasons she had trouble finding and keeping a job.
o In
that same interview study, another woman with a disability dropped out of
school and married at age 15. She shared
“I educated myself …I went [to school] as much as I could. I couldn’t afford to support four children
and go to school, you know, and yeah, I would have loved to continue, but I
couldn’t.”
• On
the other hand, another study found that, among 415 women with disabilities,
those who had more education were more likely to have experienced abusive experiences
within the previous year.
• Additional
research is needed on the relation between educational levels and abuse.
More (detailed)…
Compared
to all other adults in the
·
Women
in general face discrimination in employment. This discrimination appears to be
greater for women with disabilities.
·
A
huge employment disparity exists in the
·
The
employment rate for women with severe disabilities was about half of that for
other women with disabilities in that 1993 report. The situation has not changed. An analysis of
more recent data indicates that women with more functional limitations are
significantly less likely to be employed and more likely not to be in the labor
force than are women with fewer functional limitations.
·
Only
1 out of every 4 women with severe disabilities had a job or business during
the mid-1990s compared to 3 out of 4 of non-disabled women.
·
Rates
of employment are greater for younger, versus older, women with disabilities, who
may not be able to continue working due to increased and major functional
limitation and/or illness.
·
Women
with disabilities who participated in an interview study indicated that
salaried employment was an important factor for staying psychologically healthy
by having a structured day, staying mentally active, and keeping busy. As
expected by population estimates, only a few women in the study had this
employment opportunity.
·
According
to census reports, more than 1 of 5
·
The
economic situation is much worse for women living with severe disabilities
whose costs could be exceedingly high due to factors such as days lost from
productive activity related to illness; need for assistance with essential
tasks of daily living; and need for household assistance. A year-long study is
currently underway to examine the costs of secondary health conditions, such as
depression, in women with disabilities.
·
A
national study on women with physical disabilities found that younger, more
educated, and less disabled women with disabilities were significantly more
likely to be employed.
More (detailed)…
Women
with disabilities have significantly lower income
compared to non-disabled women. Women
with disabilities have been called “the poorest of the poor.”
• Women
with disabilities are more likely than non-disabled women to live in households
below the poverty level. This is especially true for women with three or more
functional limitations.
• Although
many women with disabilities receive government income, more than half of all
women with three or more functional limitations receive no disability or
government income.
• In
a study of 415 women with disabilities, the average education level was 13
years. Nearly half of the women in the
study had some college education or its equivalent. However, approximately 4
out of every 5 of the women were unemployed.
• In
1999, the authors of the Chartbook on
Women and Disability in the United States summarized national data on women
with work-related disabilities:
o Working
age women (21-64 years) earn less than working age men regardless of
disability. Working women with disabilities earn less then working men and
women without disabilities.
o Women
are more likely to be living in poverty than men. People with disabilities are more likely to
be living in poverty than people without disabilities. Women with disabilities are more likely to be
living in poverty than men with disabilities.
Women with severe disabilities have the highest poverty rates of all
people. Women with disabilities have been called the “poorest of the poor.”
o Women
with disabilities receive social security at lower rates then do men with
disabilities; however, more women with disabilities than men with disabilities
receive need-based benefits such as Medicaid, public housing, and subsidized
housing.
o In
1996, fewer women than men received vocational rehabilitation services.
o Men
receive higher disabled workers’ benefits than women.
o Medical
expenses are four times greater for people with disabilities than for the
non-disabled population, accounting for almost half of the
• One
of the most serious problems among women with physical disabilities is low
economic status, which is associated with the lack of medical insurance and, consequently,
the loss of access to medical care and health services
More (detailed)…
Women
with disabilities often talk about establishing intimate relationships, but they receive strong messages that they
are not suitable intimate partners.
• The
quality of interpersonal and marital relationships is consistently associated
with health and well-being.
·
Women
with disabilities often talk about establishing intimate relationships but
receive strong messages that they are not suitable intimate partners.
• In
one study, women with disabilities, when compared to women without
disabilities, were less likely to be involved in romantic relationships.
o The
women with disabilities were also less satisfied with how often they dated and
perceived they had more problems in attracting dating partners.
o Friendships
of women with disabilities were less likely to evolve into romantic
relationships.
• Negative
aspects of relationships are associated with decreased well-being in women with
disabilities. Strained relationships can
be a problem.
• One
7-session health promotion program for women with disabilities resulted in
improvements in positive social interaction.
This finding suggests that participants tended to have greater
availability of other persons for sharing and relaxation after completing the
program than before they began it.
• The
unpredictable nature of disability can make it difficult to make plans for
social activities and maintaining relationships.
• Intimate
partners of women with disabilities may have difficulty accepting a woman’s
disability.
o A
woman in one article stated: “I had a
real blow when a man I cared deeply told me he could not be in a relationship
with me because of my illness [multiple sclerosis]. I know now that was his issue … but felt it
just confirmed my initial fears—I was ill and no one would want to be with me.”
• Although
not confirmed by research studies, some writers have suggested that romantic
disadvantages of women with disabilities involve:
o Society’s
value on physical attractiveness, which may result in women with disabilities
being judged as “flawed” or “defective” as sexual partners if they are not
beautiful and “sexy” in the traditional female stereotype.
o Another
explanation involves function. It has
been said that women with disabilities may be perceived as useless in that
people consider them unable to care for children and partners, coordinate
households, and perform other traditional female roles.
More (detailed)…
Women with severe disabilities are less likely to be married than other women.
Are women with disabilities as likely as
other women to be married? For the most part, the answer is a flat-out
“no”. What reasons are given for this
difference? Findings on marital status and women with disabilities indicate the
following:
• Women
with disabilities tend to have lower rates of being married than men or women
without disabilities and men with disabilities. For example, in 1992, 50% of
women with activity limitations were married compared to 64% of the women
without activity limitations. Most notably, only 44% of women with severe
limitations were married at the time of the study. Women with activity
limitations are less often currently married and more often widowed, compared
to other groups. It is unknown whether this difference is related to women’s
greater longevity.
• Another
analysis, however, found that all women regardless of age or limitation were
more likely to be married than to be in any other marital status category
(i.e., widowed, divorced or separated, and never married), except women 65 or
older with functional limitations, who were more likely to be widowed. However, women with three or more functional
limitations were significantly less likely than women with two or less
functional limitations to be married.
• One
study found that, 3-5 years after leaving secondary school, young women with
disabilities tended to have the same marriage rates as those without
disabilities, but a closer look revealed that marriage depended on the types of
disabilities they had. It seems that young
women with physical disabilities were less likely to be married than those
women with learning, speech, and emotional disabilities. The women with
physical disabilities were also not as likely to be living with a partner. The
author writing about this study suggested this difference might be related to
cultural norms of attractiveness.
• According
to study of nearly 1000 women with and without disabilities, more than half
(58%) of the women with disabilities were single compared to 45% of the women
without disabilities – 42% of the women with disabilities said they were not
married (or in a serious relationship) because no one asked them compared to
27% of women without disabilities.
More (detailed)…
Self-efficacy has
been associated with health outcomes for women with disabilities.
Self-efficacy involves our confidence
in our ability to achieve desired goals.
In other words, we tend to choose to do things that we believe we can
do. If we believe we can stop smoking, chances are pretty good that we will
succeed when compared to our chances if we do not possess such confidence. High self-efficacy can be important for our
health and well-being.
• Positive
changes in self-efficacy have resulted in improvements in self-reported health,
including pain and disability, in samples of mostly women with disabilities.
• In
studies of mostly women with disabilities, those who were more confident in
their ability to exercise actually participated in more exercise than those
with lower self-efficacy. However, at
least one study found that self-efficacy was not enough for those with severe
limitations and pain (i.e., rheumatoid arthritis and osteoarthritis). They were
not as likely to exercise as others with less severe limitation and pain.
• Several
group intervention studies on the health of women with disabilities include
structured exercises to raise self-efficacy and competence in achieving
goals. Groups of women participating in
the interventions showed improvements in self-efficacy compared to groups who
did not participate in the interventions.
o One
pilot study resulted in improvements in self-efficacy for healthy dietary
behaviors.
o Another
program for women with rheumatoid arthritis showed improvements in
self-efficacy for managing pain and other disease-related symptoms. Greater efficacy for coping was related to
less psychological distress.
• A
year-long study of mostly women with rheumatoid arthritis found that the
participants who believed they had the ability to personally accomplish things
they wanted to do tended to have greater life satisfaction and less depression.
• Various
instruments have been developed to measure self-efficacy for managing specific
disabling conditions, such as arthritis and multiple sclerosis. Appropriate
measures of self-efficacy regarding the self-management of the effects of
disability specific to a cross-disability sample of women have not been
developed. The Generalized Self-Efficacy Scale, which measures one’s confidence
in coping with a range of demanding situations, has been widely used in studies
comprised of women, or mostly women, with disabilities. This scale has been used successfully to
measure changes in participants’ confidence in their coping abilities over
time.
• For
women with disabilities, relational efficacy may be as relevant, or even more
relevant, than self-efficacy. The feminist perspective offers relational
efficacy as a move away from the linear, control and mastery, sense of self to
a more mutually connected type of efficacy.
To date, no research has been conducted on this question.
More (detailed)…
Self-esteem plays
an important role in the health and wellness of women with disabilities.
·
Self-esteem
involves one’s sense of worthiness, adequacy, and self-respect.
·
According
to the feminist perspective, women’s self-esteem may be based on participating
in mutual relationships, caring for others, a sense that they can influence and
be influenced by others, and the perception that they are really visible to
others.
·
It
is not disability per se but rather the contextual, social, physical, and
emotional dimensions of the impact of disability that may influence the
self-esteem of women with disabilities.
o
However,
one study suggested that older women with less disability have higher
self-esteem compared to younger women with more severe disability.
o
Some
studies suggest that certain factors have been found to diminish self-esteem,
including experiences with pain, fatigue, dependency on others, the development
of secondary conditions, or losses, such as employment and health insurance.
o
Other
studies fail to show consistent associations of self-esteem with either
severity or duration of disability.
o
A
qualitative study of women with physical disabilities suggested that negative
messages such as being a burden to the family or positive expectations
regarding a woman’s potential can profoundly influenced the women’s
self-esteem.
·
"If
you truly believe you are a woman of value, you gain tremendous strength to
forge your way through the most stubborn of barriers," responded Margaret
A. Nosek, Founder and Executive Director of the Center for Research on Women
with Disabilities (CROWD), when asked for the main lesson learned from their
national study on women with physical disabilities. Findings from that study
suggest that:
o
Compared
to women without disabilities, women with disabilities tend to experience
problems related to low self-esteem such as depression, social isolation, and
abuse.
o
Although
many women with disabilities have positive self-esteem, overall, their
self-esteem, still tends to be lower than that of non-disabled women.
o
Older
respondents with less disability, a more positive school environment, less
over-protection, and more affection in the home tended to have better
self-esteem.
o
Level
of education was not significantly related to self-esteem in the women with
disabilities.
·
Several
measures of self-esteem have been used in research studies. One that has been
used frequently is the Rosenberg Self-Esteem Scale.
·
Some
programs have been developed to enhance the self-esteem of women with
disabilities. One study involving 102 women with disabilities from centers for
independent living suggested that a 6-session weekly self-esteem program may
increase self-esteem and self-efficacy, and reduce depression for the women who
participate.
Social connectedness, social
support, and social integration are associated with positive health outcomes
for women with disabilities.
• In
general, social connectedness is an important aspect of social support, and it has
been found to help reduce psychological and physical problems.
• Social
isolation is a common secondary condition associated with any primary
disability in women. In other words, the
woman’s primary disability may lead to less contact and connectedness with
other people.
• Social
isolation has been found to leave both women and men with disabilities
vulnerable for psychological and other health problems, including thoughts
about taking their own lives or suicide itself.
• Findings
from a national study comparing women with and without physical disabilities
suggest that:
o Compared
to women without disabilities, women with disabilities have significantly
greater levels of social isolation.
o Women
with disabilities with positive school environments, less over-protection, and
more affection in the home tend to experience less social isolation.
o Age,
education, and disability severity do not tend to be related to social
isolation in women with disabilities.
• Social
connectedness may help one to cope with stress. Women with disabilities may be
more vulnerable to stress if they lack social support.
• In
one article, women with chronic health conditions and physical disabilities
reported that they benefit in many ways from mutual connectedness and relationships
that offer safety, positive support, nurturing, and help in making meaning of
lives that are continually changing as a result of health problems.
• Each
of the four types of isolation (geographical, economical, political, and
social) is compounded by having a disability, thus elevating vulnerability for
violence.
• Social
isolation may increase the vulnerability of women with disabilities for
violence and abuse. One study found that women with disabilities who reported
that they were isolated from other people had experienced sexual, physical, or
disability-related abuse within the past year.
• Women
with disabilities have reported benefit from health promotion programs that
include opportunities for building connectedness, specifically, meeting together
with a group of women with similar experiences related to disability.
• Clinical
observations and feedback from women with disabilities participating in health
promotion programs have indicated that women with disabilities yearn for and
benefit from opportunities to develop and nurture mutual and caring
relationships with one another, to heal multiple losses related to disability,
and to attain optimal levels of wellness through connections with other women
with disabilities.
• Group
intervention programs for women with disabilities may help participants to
break disability-related isolation, build connections among women with
disabilities, share important information about resources, and confront
internalized multiple oppressions.
• Qualitative
findings from a study conducted by CROWD suggested that women with disabilities
perceived positive relationships as being essential for well-being. Ways for
maintaining psychological well-being were identified, including interacting
with people, avoiding toxic people, and being with loved ones and friends. Social interactions included talking to
disabled friends, venting to attendants, and visiting or staying with family
members.
More (detailed)…
Spirituality
may support women with disabilities in attaining optimal health
and well-being.
Spirituality is a quality that goes
beyond involvement in a religious organization. It is a more basic construct.
The highest level of our development is affected by our ability to appreciate
the sacred in life and to find a sense of meaning and purpose. Spirituality
invites women with disabilities to live fully and in the present.
·
Research
suggests that people, and in particular persons with disability, depend on
spirituality and religion as an important, if not primary, method of coping
with physical health problems and life stress. Most research, however, has
addressed one’s involvement in religion rather than spirituality.
·
Although
research about spirituality in the context of disability is sparse, many
thoughtful writers have considered religion and spirituality to be crucial
factors in adjustment to disability. They write that acceptance of limitations
by relying only on the belief that “this is God’s will” or that one has been
abandoned by God may limit one’s ability to fully benefit from rehabilitation.
They advocate against using disability as an opportunity to preach, saying that
it could do more harm than good.
Instead, they advocate for the ministry of presence.
·
Being
affiliated with a specific religion can sometimes help women with disabilities
find comfort in times of isolation and despair.
·
One
interview study of women with physical disabilities who were in recovery from
past experiences with violence revealed that spirituality helped them in their
recovery process.
·
While
little research has been conducted on the influence of organized religion in
the context of disability, studies on the general population have been positive.
o
For
example, a 28-year follow-up of thousands of people aged 18-65 years found that
the individuals who attended at least weekly religious services had lower rates
of depression, smoking, and alcohol use; they also tended to have greater
social support. Frequent attendees were more likely to have engaged in other
healthy behaviors, including physical exercise. The effect on survival was good
after other factors were taken into consideration – their risk of death was
reduced by 34%.
o
Religion
is often used for help with coping with difficult life circumstances, such as
declining physical health resources.
·
The
spirituality of women with disabilities has been discussed by a woman with a
disability who is a priest and writes:
o
Unlike
men with disabilities, women with disabilities experience double and triple
oppression by negative attitudes and stereotypes. Moreover, they are economically
disadvantaged.
o
She
asks how women with disabilities can be “normal” and understand wholeness and
healing when people who claim to be religious talk about the importance of
having more faith in order to be healed (i.e., without disability).
o
When
disability is integrated as another dimension of living, spiritual growth can
take place. Integrating experiences of disability allows a woman with a
disability to recognize that suffering and hurtful experiences are universal
conditions.
o
Spirituality
is a way for women with disabilities to fulfill their potential and discover
the possibilities while learning to live with and integrate their
disability-related limitations and yet expand their boundaries to experience
the fullness of life.
o
The
spiritual journey invites women with disabilities to new growth and change, and
finally to inner healing.
o
Women
with disabilities need to tell their stories, having them heard and received.
o
Avoiding
the past pain and suffering may leave women with disabilities lost in a
spiritual desert.
·
Another
autobiographical article by another woman with a disability about spirituality
and disability offers the following:
o
If
self-surrender is imposed on people at a time of traumatic change (onset of
disability), it may result in a sense of helplessness rather than spiritual
enrichment.
o
“It
distresses me that the field of rehabilitation has so completely ignored the
most essential aspect of my being—my spirituality…while I chose to regard my
disability as characterizing me rather than defining me, I must admit that it
has caused me numerous emotional and spiritual crises.”
o
A
spiritual foundation may help equip women with disabilities to handle
challenges introduced by disability.
o
The
spiritual side of us can be a motivating force in the physical, vocational,
psychological and social domains of rehabilitation.
·
Another
article summarizing findings on spirituality from several studies concluded:
o
Spirituality
is an important tool used by women with disabilities to counteract overwhelming
negative odds imposed by societal stereotypes and barriers against achieving
lives of fulfillment.
o
Self
in connection to others is an integral part of sense of self for all women, yet
women with disabilities face extraordinary barriers to establishing positive,
long-lasting relationships. How the
societal and environmental factors that discourage connection to others impact
the disabled woman's concept of self and her place in the world has been the
subject of very little research. How
women with disabilities see connection to others as a source of spiritual
fulfillment has also not been the subject of investigation and merits
attention.
o
Women
with disabilities draw power from both the self on the mundane plane and the
Self on the spiritual plane to create lives of active participation and
fulfillment.
·
A
variety of spirituality assessment instruments have been developed to measure
spiritual health, wellness, and maturity.
Most of these instruments are based on Judeo-Christian beliefs in God or
a Higher Power, and they may not include Eastern religions and many other
perspectives. A review of the literature
did not reveal that spirituality instruments had been used among women with
disabilities.
·
Barriers
related to architecture, communication, and attitudes that limit participation
in worship activities are being addressed nationwide by the Religion and
Disability Program of the National Organization on Disability.
o
“Each
of us has abilities; each seeks fulfillment and wholeness. Each of us has disabilities; each knows
isolation and despair … Let the House of God be open to all.”
More (detailed)…
Stress constitutes more of a
problem for women with disabilities than for non-disabled women.
·
Many
women with disabilities report problems with stress. One study suggested that elevated stress
levels were related to architectural barriers in the home and employment
environments, problems with personal assistance, and problems with
transportation services.
·
According
to one analysis, the more functional limitations a woman had the more likely she
reported having difficulties with stress. This difficulty with stress seemed to
be more of a problem for working age women than for women over 65 years of age.
·
Women
with disabilities who report a combination of social isolation, lack of social
support, pain, and experiencing abuse in the past year are more likely to
report high levels of stress. In addition, high levels of stress are linked
with high levels of depression.
·
Like
all women, women with disabilities are more likely than men to experience life
stress related to poverty, violence and other forms of victimization, and
chronic health problems.
·
Women
with disabilities are faced with stressors, such as the uncertainty of their
underlying health condition, barriers to health care, unemployment, and lower
wages. Other disability-related stressors include increased time and effort to
accomplish basic activities.
·
Women
with disabilities are vulnerable to developing secondary conditions associated
with stress, such as fatigue, depression, and cardiovascular problems,
including hypertension and problems with overweight.
·
Although
a few stress reduction interventions have been developed for people with
disabilities, until recently, little research has been conducted on the
techniques for self-management of stress specific for women with disabilities.
o
One
current study involves a stress self-management program for women with physical
disabilities. This program emphasizes
goal setting, problem-solving, and relaxation training.
Women
with disabilities experience similar, if not greater, rates of emotional,
physical, and sexual violence
compared to non-disabled women; and they are more vulnerable to
disability-related violence.
The reaction of the general public,
medical professionals, and disability-related service providers to information
about violence against women with disabilities is often one of shock and
disbelief, as if they believe that disability is somehow a protective factor
against this epidemic social problem.
Advocates and researchers in the field of disability, on the other hand,
are bringing to light case studies and statistics that point to disability as a
risk factor for intimate partner violence and sexual assault.
• Violence
against women with disabilities (including women with physical, sensory,
developmental, and other types of disabilities) occurs universally and
relentlessly.
• Violence
is a very serious problem for women with disabilities. They have even fewer options for escaping or
resolving the abuse than non-disabled women.
• According
to one study of nearly 1,000 women, the same percentage (62%) of women with and
without disabilities had experienced emotional, physical, or sexual abuse over
their lifetime.
o In
the same study of 1,000 women, women with disabilities experienced violence for
longer periods of time and were victimized by a wider variety of perpetrators
(i.e., attendants, adult child caregivers, spouses, etc.) than women without
disabilities. Of the women with disabilities, 13% described experiencing
physical or sexual abuse in the previous year.
o In
addition to the types of abuse experienced by all women, women with
disabilities in this study were abused by the withholding of needed equipment
(wheelchairs, braces), medications, transportation, or essential assistance
with personal tasks, such as dressing or getting out of bed.
o Women
with disabilities face serious barriers to accessing existing programs to help
women remove violence from their lives.
• Women
with disabilities who experience abuse may be more vulnerable to greater levels
of stress and depression than those who have not experienced abuse.
• Two
brief abuse screening measures for women with disabilities have been developed and
may prove to be helpful for identifying women with disabilities who are in
abusive situations.
• Violence
has been associated with alcohol abuse in the general population. In an interview study, one woman with a
disability shared that she and her husband both drank and slapped each other
around. She said she did not realize
that she was experiencing abuse until she became involved in Alcoholics
Anonymous, and her sponsor made her aware that her marriage was abusive. She and her husband attended AA, and, within
a short time, the abuse stopped. She was
sober for 17 years at the time of the interview, and her husband had been sober
for 15 years.
• It
is important that health professionals, rehabilitation counselors, and other
service providers ask their clients about abuse and offer them resources for
getting help.
• Three
directories on violence against women with disabilities have been published
including one on disability-related services of battered women’s programs, the
second a guide for domestic abuse programs for intervention with women with
disabilities, and the third an abuse guide for centers for independent
living.
• Safety
planning intervention programs are being developed for preventing and reducing
violence against women with disabilities.
SafePlace in Austin, Texas, provides this kind of program
(www.austin-safeplace.org).
• CROWD
has evaluated a pilot test of a one-hour safety planning program with 50 women
with disabilities. Results were
promising, but additional research on this program is recommended.
• CDC
has identified social isolation as a key factor that must be addressed when
delivering violence-prevention interventions to women with disabilities.
More (detailed)…
Return to Psychosocial Highlights