Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury

Ashley Craig; Kathryn Nicholson Perry; Rebecca Guest; Yvonne Tran; Annalisa Dezarnaulds; Alison Hales; Catherine Ephraums; James Middleton

doi:10.1016/j.apmr.2015.02.027

Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury

Arch Phys Med Rehabil. 2015 Aug;96(8):1426-34. doi: 10.1016/j.apmr.2015.02.027. Epub 2015 Mar 14.

Authors

Ashley Craig¹, Kathryn Nicholson Perry², Rebecca Guest³, Yvonne Tran⁴, Annalisa Dezarnaulds⁵, Alison Hales⁶, Catherine Ephraums⁶, James Middleton³

Affiliations

¹ John Walsh Center for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: a.craig@sydney.edu.au.
² Australian College of Applied Psychology, Sydney, New South Wales, Australia; School of Social Sciences and Psychology, The University of Western Sydney, Sydney, New South Wales, Australia.
³ John Walsh Center for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney, Sydney, New South Wales, Australia.
⁴ John Walsh Center for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney, Sydney, New South Wales, Australia; Key University Center for Health Technologies, University of Technology, Sydney, Sydney, New South Wales, Australia.
⁵ Spinal Cord Injury Unit, Prince of Wales Hospital, Randwick, New South Wales, Australia.
⁶ Spinal Cord Injury Unit, Royal Rehabilitation Center, Sydney, Ryde, New South Wales, Australia.

PMID: 25778773
DOI: 10.1016/j.apmr.2015.02.027

Abstract

Objective: To conduct a prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury (SCI), determine psychotropic medication usage, and establish predictors of psychological disorders after transition to the community.

Design: Longitudinal design with multiple measures.

Setting: Assessment occurred in SCI units and the community.

Participants: Adults with SCI (N=88) admitted over a period of 32 months into 3 SCI units.

Interventions: Participants completed inpatient rehabilitation for an acute SCI. Longitudinal assessment occurred up to 6 months postdischarge.

Main outcome measures: Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI. The Mini International Neuropsychiatric Interview, a structured diagnostic psychiatric interview, was conducted to determine the presence of psychological disorders. Medical measures included severity of secondary conditions or complications. Psychological measures included measures of anxiety and depressive mood, resilience, pain catastrophization, self-efficacy, and cognitive capacity.

Results: Rates of psychological disorders of 17% to 25% were substantially higher than rates found in the Australian community. The occurrence of psychological disorder comorbidities was also very high. Anxiety was significantly elevated in those with a psychological disorder. Psychotropic medications were prescribed to more than 36% of the sample, with most being antidepressants. Factors predictive of psychological disorders included years of education, premorbid psychiatric/psychological treatment, cognitive impairment, secondary complications, resilience, and anxiety.

Conclusions: SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge. Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community. Additional resources should be invested in improving the mental health of adults with SCI.

Keywords: Anxiety; Chronic pain; Depression; Mental disorders; Rehabilitation; Spinal cord injuries.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Australia
Cognition
Female
Humans
Inpatients
Longitudinal Studies
Male
Mental Disorders / complications*
Mental Health
Middle Aged
Pain / complications
Prospective Studies
Quality of Life
Resilience, Psychological
Self Efficacy
Severity of Illness Index
Socioeconomic Factors
Spinal Cord Injuries / complications*
Spinal Cord Injuries / rehabilitation*
Stress, Psychological / complications
Young Adult