Depression in Individuals With Traumatic and Nontraumatic Spinal Cord Injury Living in the Community

Abstract

Objective: To assess depression in a sample of individuals with spinal cord injury (SCI) living in the community, and to determine the prevalence of probable major depressive disorder (PMDD) among those with traumatic spinal cord injury (T-SCI) and those with nontraumatic spinal cord injury (NT-SCI).

Design: Cross-sectional.

Setting: Data were collected on individuals with SCI now living in the community, who completed a comprehensive follow-up assessment at the hospital.

Participants: Individuals with T-SCI or NT-SCI (N=831) completed the Patient Health Questionnaire-9 (PHQ-9) and were included.

Interventions: Not applicable.

Main outcome measure: The PHQ-9 was used to detect the presence of PMDD and to measure the severity of the depression.

Results: The most frequent etiology of SCI was T-SCI (66.9%). Overall, 16.2% of participants met the criteria for PMDD; however, a higher prevalence was noted for individuals with NT-SCI (21.1%) than for individuals with T-SCI (13.8%). Risk factors between T-SCI and NT-SCI did not differ greatly. Female sex, chronic pain, and lower levels of/difficulties in participation were associated with the presence of PMDD.

Conclusions: PMDD appears to occur at a higher rate in individuals with NT-SCI, with greater symptom severity. The finding that problems with participation are directly associated with depression raises the need for specific treatment goals, with the aim of empowering individuals with SCI to reintegrate into the community. Potential stress factors (eg, environmental barriers, limited participation options) should be addressed accordingly.

Keywords: Depression; Rehabilitation; Spinal cord injuries.