Anxiety and Depression in Pediatric-Onset Traumatic Spinal Cord Injury: A Systematic Review

Mohammad Mofatteh; Mohammad Sadegh Mashayekhi; Saman Arfaie; Yimin Chen; Armaan K Malhotra; Georgios P Skandalakis; Mohammed Ali Alvi; Fardad T Afshari; Shakila Meshkat; Famu Lin; Ebtesam Abdulla; Ayush Anand; Xuxing Liao; Roger S McIntyre; Carlo Santaguida; Michael H Weber; Michael G Fehlings

doi:10.1016/j.wneu.2023.12.092

Anxiety and Depression in Pediatric-Onset Traumatic Spinal Cord Injury: A Systematic Review

World Neurosurg. 2024 Apr:184:267-282.e5. doi: 10.1016/j.wneu.2023.12.092. Epub 2023 Dec 23.

Authors

Mohammad Mofatteh¹, Mohammad Sadegh Mashayekhi², Saman Arfaie³, Yimin Chen⁴, Armaan K Malhotra⁵, Georgios P Skandalakis⁶, Mohammed Ali Alvi⁷, Fardad T Afshari⁸, Shakila Meshkat⁹, Famu Lin¹⁰, Ebtesam Abdulla¹¹, Ayush Anand¹², Xuxing Liao¹³, Roger S McIntyre¹⁴, Carlo Santaguida¹⁵, Michael H Weber¹⁶, Michael G Fehlings¹⁷

Affiliations

¹ School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK; Neuro International Collaboration (NIC), London, UK. Electronic address: mmofatteh01@qub.ac.uk.
² Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Neuro International Collaboration (NIC), Ottawa, Ontario, Canada.
³ Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada; Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, California, USA; Neuro International Collaboration (NIC), Montreal, Quebec, Canada.
⁴ Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China; Neuro International Collaboration (NIC), Foshan, China.
⁵ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Neuro International Collaboration (NIC), Toronto, Ontario, Canada.
⁶ First Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁷ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Neuro International Collaboration (NIC), Toronto, Ontario, Canada; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁸ Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, UK.
⁹ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.
¹⁰ Department of Neurosurgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China.
¹¹ Department of Neurosurgery, Salmaniya Medical Complex, Manama, Bahrain.
¹² B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
¹³ Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China; Department of Surgery of Cerebrovascular Diseases, Foshan First People's Hospital, Foshan, China.
¹⁴ Neuro International Collaboration (NIC), Toronto, Ontario, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada.
¹⁵ Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
¹⁶ Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, Injury, Repair and Recovery Program, Montreal, Quebec, Canada; Montreal General Hospital, Montreal, Quebec, Canada.
¹⁷ Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery and Spinal Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

PMID: 38143027
DOI: 10.1016/j.wneu.2023.12.092

Abstract

Background: Traumatic spinal cord injury (TSCI) is a debilitating neurological condition with significant long-term consequences on the mental health and well-being of affected individuals. We aimed to investigate anxiety and depression in individuals with pediatric-onset TSCI.

Methods: PubMed, Scopus, and Web of Science databases were searched from inception to December 20th, 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and studies were included according to the eligibility criteria.

Results: A total of 1013 articles were screened, and 18 studies with 4234 individuals were included in the final review. Of these, 1613 individuals (38.1%) had paraplegia, whereas 1658 (39.2%) had tetraplegia. A total of 1831 participants (43.2%) had complete TSCI, whereas 1024 (24.2%) had incomplete TSCI. The most common etiology of TSCI with 1545 people (36.5%) was motor vehicle accidents. The youngest mean age at the time of injury was 5.92 ± 4.92 years, whereas the oldest was 14.6 ± 2.8 years. Patient Health Questionnaire-9 was the most common psychological assessment used in 9 studies (50.0%). Various risk factors, including pain in 4 studies (22.2%), reduced sleep quality, reduced functional independence, illicit drug use, incomplete injury, hospitalization, reduced quality of life, and duration of injury in 2 (11.1%) studies, each, were associated with elevated anxiety and depression.

Conclusions: Different biopsychosocial risk factors contribute to elevated rates of anxiety and depression among individuals with pediatric-onset TSCI. Individuals at risk of developing anxiety and depression should be identified, and targeted support should be provided. Future large-scale studies with long-term follow-up are required to validate and extend these findings.

Keywords: Anxiety; Depression; Pediatric; Spinal cord injury; Spine; Trauma.

Publication types

Systematic Review
Review

MeSH terms

Anxiety / epidemiology
Anxiety / etiology
Child
Child, Preschool
Depression* / epidemiology
Depression* / etiology
Humans
Infant
Paraplegia / etiology
Quality of Life
Spinal Cord Injuries* / complications
Spinal Cord Injuries* / epidemiology