A longitudinal study of depression in survivors of spinal cord injury

Preliminary investigation into subjective well-being, mental health, resilience, and spinal cord injury

OBJECTIVES

To undertake a pilot investigation into whether individuals whose subjective well-being had returned to the normal homeostatic range after a spinal cord injury (SCI) may be more resilient and therefore, at less risk of emotional distress over time. To consider the relative stability of subjective well-being in individuals with chronic SCI whose subjective well-being had previously returned to the normative homeostatic range.

STUDY DESIGN

Longitudinal study: Time 1 (T1) 2004 and Time 2 (T2) 2009.

SETTING

Victoria, Australia.

PARTICIPANTS

Participants were adults living in the community with chronic SCI, who had no mental ill-health symptoms at T1.

OUTCOME MEASURES

Scales include: Comprehensive Quality of Life Scale - Adult v5 (COMQoL-A5) at T1, Personal Well-being Index (PWI - the successor to the COMQol-A5) at T2, and Depression, Anxiety & Stress Scale - short form (DASS-21) at T1 and T2.

RESULTS

Twenty-one adults participated at T1 and T2. Subjective well-being was stable for 57% of the cohort. However, 19% presented with symptoms of emotional distress by T2. There was no significant difference in age (P = 0.94) or time since injury (P = 0.51) between those reporting significant emotional symptoms and those without; nor was there any systematic change in health status.

CONCLUSION

This study yielded two important findings. First, individuals with chronic SCI may be vulnerable to mental health issues even after they have previously exhibited good resilience. Second, subjective well-being after SCI may not be as stable as suggested by the general quality of life literature that have examined genetic and personality connections to subjective well-being.

Positive and negative affect in individuals with spinal cord injuries

STUDY DESIGN

Participants with spinal cord injuries (SCIs) and healthy controls completed standardized questionnaires assessing depression level, positive and negative affect, and personality traits.

OBJECTIVES

To identify the specific characteristics of emotional experiences affected by spinal cord injury.

SETTING

A Canadian rehabilitation center. Individuals with SCIs were recruited from a list of patients who had volunteered to participate in studies being conducted by the SCI clinic. Healthy controls were recruited from the community, but tested in the SCI clinic.

METHODS

Thirty-six individuals with complete (ASIA A) SCIs and 36 age-, gender- and education-matched controls participated in this study. SCI participants were classified as cervical (C1-C7), upper thoracic (T1-T5) or lower thoracic/upper lumbar (T6-L2). All participants completed the Beck Depression Inventory, the Positive and Negative Affect Schedules, the NEO Neuroticism Questionnaire, and the harm avoidance scale of the Tridimensional Personality Questionnaire. Data were analyzed using independent-samples t-tests (when contrasting SCI and controls) and analysis of variance (when comparing across SCI groups).

RESULTS

Participants with SCIs experienced significantly less positive affect than controls. The two groups did not differ in their experience of negative affect. Participants with SCIs also reported greater levels of depression. Depression scores improved with an increasing number of years post injury.

CONCLUSION

Individuals with SCIs are characterized by specific emotional dysfunction related to the experience of positive emotions, rather than a tendency to ruminate on negative emotions. The results suggest that these individuals would benefit from rehabilitation programs that include training in positive psychology.

Patients with traumatic spinal cord injuries and their satisfaction with their general practitioner

OBJECTIVE

The objective of this study was to examine how satisfied patients with traumatic spinal cord injury (TSCI) are with their general practitioners (GP).

MATERIALS AND METHODS

The study included patients with TSCI, injured in the period 1982-2001 and living in western Norway. We performed a structured telephonic interview of the patients in the period 2004-2007. A total of 105 (59.3%) patients participated.

RESULTS

Patients with TSCI were in general satisfied with their GP. Older patients were most satisfied, and patients with incomplete thoracic SCI were least satisfied. Patients with anxiety and/or depression reported low satisfaction with their GP on several parameters.

CONCLUSIONS

Patients with incomplete SCI were least satisfied probably because their physicians do not acknowledge their complicated medical complaints and do not meet the patient's expectations. Patients with anxiety and/or depression were more likely to report low satisfaction with their GP.