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Touhami D, Essig S, Scheel-Sailer A, Gemperli A. Why Do Community-Dwelling Persons with Spinal Cord Injury Visit General Practitioners: A Cross-Sectional Study of Reasons for Encounter in Swiss General Practice. J Multidiscip Healthc 2022; 15:2041-2052. [PMID: 36118137 PMCID: PMC9480589 DOI: 10.2147/jmdh.s382087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose In a country of free selection of providers, general practitioners (GPs) remain the most visited health-care professionals by the vast majority of persons with spinal cord injury (SCI) in Switzerland; yet, little is known about these contacts. The study aims to explore reasons for encounters (RFEs) in general practice, and their relationships to first-contact of care (GP or specialist) and GP’s competence in managing SCI-specific problems. Patients and Methods Cross-sectional study from baseline data of non-randomized controlled trial. Persons with SCI in the chronic phase and living in Swiss rural communities were invited. Participants were asked about RFEs (reasons and health problems) of their last visit to a GP. RFEs were coded according to the International Classification of Primary Care (ICPC-2), and analyzed according to first-contact and participants’ ratings of GPs’ competence in managing SCI-specific problems. Results Out of 395, 226 (57%) persons participated, of which 89% have reported 2.1 (SD ±1.4) RFEs and 2.4 (±1.7) health problems per GP visit, on average. Participants visited GPs for medications (49%), urgent medical problems (33%) and follow-up (30%). Most RFEs were related to general/unspecified problems (65%). Persons whose first contact was a specialist were more likely to visit GPs for medications (Specialist = 60% vs GP = 42%). There were no associations between RFEs and the perceived GP’s competence at P < 0.05. Conclusion Irrespective of first contact of care, persons with SCI visit GPs for medication, urgent issues, and follow-up care, and more often for general problems than for secondary health conditions. Strengthening collaboration between GPs in rural communities and specialized centers is recommended; promoting such a connection potentially aids GPs in meeting their information needs for managing secondary health conditions and improving the quality of SCI care for this population.
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Affiliation(s)
- Dima Touhami
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Nottwil, 6207, Switzerland
| | - Stefan Essig
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Center of Primary and Community Care, University of Lucerne, Lucerne, 6002, Switzerland
| | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Center, Nottwil, 6207, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Nottwil, 6207, Switzerland.,Center of Primary and Community Care, University of Lucerne, Lucerne, 6002, Switzerland
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VanDerwerker CJ, Gregory CM, Simpson KN. Using Inferred Mobility Status to Estimate the Time to Major Depressive Disorder Diagnosis Post-Spinal Cord Injury. Arch Phys Med Rehabil 2020; 101:658-666. [PMID: 31891714 PMCID: PMC7441847 DOI: 10.1016/j.apmr.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/25/2019] [Accepted: 11/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors associated with MDD diagnosis; (3) time at which MDD is diagnosed post-spinal cord injury (SCI); and (4) interaction of inferred mobility status (IMS) in a commercially insured population over 3 years. DESIGN Retrospective longitudinal cohort design. SETTING A commercial insurance claims database from January 1, 2010 to December 31, 2013. PARTICIPANTS Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history of MDD ≤30 days pre-SCI (N=1409). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A stratified survival analysis using IMS, based upon durable medical equipment (DME) claims, was also completed. RESULTS Post-SCI, 294 out of 1409 (20.87%) were diagnosed with new-onset MDD. Significant (P<.05) risk factors included: employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, and 2 of 5 IMS comparisons. Median time to MDD was 86 days. Survival analysis demonstrated a significant difference between 6 of 10 IMS comparisons. Regarding new-onset or recurring MDD, 432 out of 1409 (30.66%) were diagnosed post-SCI. Significant risk factors included: female, employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, MDD>30 days pre-SCI, catheter claims, and 2 of 5 IMS comparisons. Median time to MDD was 74 days. Survival analysis demonstrated a significant difference between 4 of 10 IMS comparisons. CONCLUSIONS Prevalence of MDD post-SCI is greater than the general population. Stratification by IMS illustrated that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI.
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Affiliation(s)
- Catherine J VanDerwerker
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina.
| | - Chris M Gregory
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Kit N Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
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Factors influencing depression in individuals with traumatic spinal cord injury and caregivers' perceived burden in a low-income country: a cross-sectional study. Spinal Cord 2020; 58:1112-1118. [PMID: 32203068 DOI: 10.1038/s41393-020-0451-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To investigate factors influencing depressed mood in individuals with traumatic spinal cord injury (TSCI) and caregivers' perceived burden in a low-income country. SETTING Dhulikhel Hospital and Spinal Injury Rehabilitation Center, Nepal. METHODS We recruited 95 couples (one person with spinal cord injury and one caregiver) aged 18-65 years. Participants with various levels and types of TSCI with post-injury duration of or providing care for ≥1 month were eligible for the study. The Nepali Beck Depression Inventory and the Zarit Burden Interview-12 were used to identify depressed mood of those with TSCI and caregivers burden, respectively. Linear regression analyses to explore associations was performed. RESULTS Mean ages of the individuals with TSCI and caregivers were 34.8 (11.0) and 33.6 (12.3) years, respectively. Most of the participants with TSCI were male (67.4%) and (73.7%) had paraplegia. The caregivers were predominantly female (61.1%). Depressed mood was seen in 68% of those with TSCI, and burden was reported by 91.6% of caregivers. Depressed mood was significantly associated with gender, education, lesion type, and duration since the injury. Caregiver burden was associated with occupation, education, level of injury, length of care, and depressed mood level in the person with TSCI. Economic burden was found to be the highest (71.5%) followed by responsibility (22.2%) and time-related (6.3%) burden. CONCLUSIONS The prevalence of depressed mood among individuals with TSCI and the burden of caregiving among caregivers was high. Depressed mood in those with TSCI was associated with caregiver burden. Country-specific contextual factors need to be considered in deriving rehabilitation protocols.
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Abstract
Spinal cord injury results in multiple secondary comorbidities, which vary based on injury severity and other characteristics. Persons with spinal cord injury are at lifelong risk for many complications, most of which are at least partially preventable with proper medical care. The Veterans Health Administration Spinal Cord Injury and Disorders (SCI&D) System of Care offers these evaluations to all persons in their registries. Annual evaluations are performed at any of the 24 SCI&D Veterans Administration Centers nationwide. This allows veterans to receive the care from an interdisciplinary team that specializes in the care of veterans with spinal cord injury.
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Placeres AF, Fiorati RC. Assessment instruments and depression rates in people with spinal cord injury: a systematic review. Rev Esc Enferm USP 2018; 52:e03388. [DOI: 10.1590/s1980-220x2017037303388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/08/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To identify, describe, differentiate and qualify the instruments used to evaluate depression and also identify the percentage and average rates of depression in people with spinal cord injury. Method: This is a systematic review of the literature implementing a qualitative approach. SciELO, LILACS, PubMed and PsycINFO databases were consulted. Original articles were classified according to the variables (Spinal Cord Injury, Depression and Assessment instruments). The studies are presented according to the instruments in recent publications in the past 11 years. Results: Five evaluation instruments were found. PHQ-9, a screening instrument for diagnosing depression was used in most studies, with all being performed in the United States and having a higher impact factor and number of participants. Studies with PHQ-9 presented a total score of people who met the criteria for depression without grading by severity with an average of 17.6% ± 7.3%, while BDI presented 51.6% ± 15.1% and the HADS showed 37.5% ± 31% of people with some degree of depression. Conclusion: This study was important in identifying which instruments can be used to assess depression, the description of each, some of their differences, which ones are used in the best studies and o the depression rates in different parts of the world. It was also important to show how the PHQ-9 is an important instrument, but is limited to being used in the USA.
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Lund EM, Nadorff MR, Thomas KB, Galbraith K. Examining the Contributions of Disability to Suicidality in the Context of Depression Symptoms and Other Sociodemographic Factors. OMEGA-JOURNAL OF DEATH AND DYING 2018; 81:298-318. [PMID: 29665740 DOI: 10.1177/0030222818768609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined the contribution of disability status to suicidality when accounting for depression and sociodemographic risk factors in 438 American adults, 82 (18.7%) of whom identified as having disabilities. Participants with disabilities had significantly higher depression scores and were more likely to be unemployed and unpartnered, all of which were also associated with increased suicidality. However, disability remained a significant predictor of suicidality even when depression and sociodemographic risk factors were accounted for in a linear regression. Other significant predictors of suicidality in this regression were female gender, depression symptoms, and family and friend suicide history; identifying as a member of a religion was a significant protective factor against suicidality. Our findings suggest that the contribution of disability to suicidality goes beyond that which can be explained by increased depression symptoms and sociodemographic vulnerability.
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Affiliation(s)
- Emily M Lund
- St. Cloud State University, MN, USA.,Utah State University, Logan, UT, USA
| | - Michael R Nadorff
- Mississippi State University, Starkville, MS, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Katie B Thomas
- Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Kate Galbraith
- Utah State Office of Rehabilitation, Salt Lake City, UT, USA
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Depressive mood in individuals with spinal cord injury (SCI) living in Greece. Spinal Cord 2018; 56:883-889. [PMID: 29581518 DOI: 10.1038/s41393-018-0093-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To provide data on depressive symptoms rates in the Greek SCI population and to investigate their association with demographic and clinical variables. SETTING Greek territory. METHODS One hundred and sixty-four individuals with SCI living in the community for at least 1 year after the completion of the primary inpatient rehabilitation program were included in the study. Our group of participants were enrolled from multiple rehabilitation centers throughout Greece and were evaluated for probable depression according to the Patient Health Questionnaire (PHQ-9). Univariable and multiple linear regression analyses were performed to assess the possible association of risk factors with the occurrence of depression. We had also examined the correlation between PHQ-9 and scales measuring social reintegration (Craig Handicap Assessment and Reporting Technique (CHART)), quality of life (World Health Organization Quality of Life BREF (WHOQOL-BREF)), and independence (Spinal Cord Independence Measure (SCIM)). RESULTS It was found that 18.2% of the sample had probable depression. The mean (SD) PHQ-9 score was 5.7 (4.9). The multiple linear regression analysis showed that high pain scores (P = 0.001) and suffering from both nociceptive and neuropathic pain (P = 0.005) were associated with depressive mood, while pressure ulcers had a significant effect (P = 0.049) only in the univariable analysis. Participant's PHQ-9 scores had also a negative correlation with almost all CHART, WHOQOL-BREF, and SCIM subscales' scores. CONCLUSIONS This study documents relatively low rates of probable depression among individuals with SCI in Greece. Severe pain and pressure ulcers were the main identified predictors of depressive mood.
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Cao Y, Li C, Gregory A, Charlifue S, Krause JS. Depressive symptomatology after spinal cord injury: A multi-center investigation of multiple racial-ethnic groups. J Spinal Cord Med 2017; 40:85-92. [PMID: 27844565 PMCID: PMC5376138 DOI: 10.1080/10790268.2016.1244314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To identify (1) racial-ethnic differences in depressive symptomatology after spinal cord injury (SCI) and (2) the relationship of multiple additional factors to depressive symptoms, including health behaviors, employment, fatigue, and pain interference. DESIGN Cross-sectional Setting: Data were collected at 3 specialty hospitals in different regions of the USA (Southeastern, Mountain, Western). PARTICIPANTS Participants (N = 1,063) were identified from outpatient records of the 3 hospitals with oversampling of racial-ethnic minority groups. INTERVENTIONS N/A Main Outcome Measure(s): The outcome, depressive symptomatology, was measured by the Older Adult Health and Mood Questionnaire (OAHMQ). Participant demographic and injury characteristics were measured as statistical controls, as well as other variables including health behavior factors, depression/stress relief medication usage, fatigue, and pain interference. The multivariate analyses were developed using OLS regression models and logistic regression models. RESULTS Employment was protective for depressive symptomatology, whereas fatigue, pain interference, and binge drinking were risk factors for higher OAHMQ scores. Although there were no bivariate racial-ethnic differences in depressive symptoms, fatigue and pain interference had suppression effects on the relationship between race-ethnicity and depressive symptomatology. After controlling for fatigue and pain interference, Hispanic participants had significantly lower OAHMQ scores and lower odds of probable major depression (PMD) than non-Hispanic Whites and Blacks. CONCLUSIONS Fatigue and pain interference are associated with both race-ethnicity and depressive symptomatology. Assuming the same level of fatigue and pain interference, Hispanics will have a lower risk of depressive symptoms than non-Hispanic Whites and Blacks.
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Affiliation(s)
- Yue Cao
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Chao Li
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Anne Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | | | - James S. Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Coleman JA, Harper LA, Perrin PB, Olivera SL, Perdomo JL, Arango JA, Arango-Lasprilla JC. The relationship between physical and mental health variables in individuals with spinal cord injury from Latin America. PM R 2014; 7:9-16. [PMID: 25091569 DOI: 10.1016/j.pmrj.2014.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous research has examined the health-related quality of life (HRQOL) and mental health of persons with spinal cord injury (SCI), but the majority of the research has taken place in the United States, Western Europe, and other developed countries. Limited research has been conducted with persons with SCI in Latin America. OBJECTIVE To examine the relationship between HRQOL and mental health in persons with SCI from Neiva, Colombia. DESIGN Cross-sectional. SETTING Participants were recruited from the Foundation for the Integral Development of People with Disabilities, a nonprofit community organization for persons with disabilities. PARTICIPANTS Forty persons with SCI from Neiva, Colombia. METHODS Caregivers completed the Spanish versions of questionnaires. MAIN OUTCOME MEASURES Participants completed self-report measures of HRQOL (SF-36 Health Questionnaire) and mental health (Satisfaction with Life Scale, Patient Health Questionnaire-9, and State Trait Anxiety Inventory). RESULTS The hypothesis that higher HRQOL would be related to better mental health found robust support, as the canonical correlation between these 2 sets of variables uncovered that 50.4% of the variance was shared, such that persons with lower HRQOL had reduced mental health. Within this canonical correlation, anxiety, fatigue, and general health loaded most highly, suggesting that persons with SCI who experienced lower energy and reduced general health tended to have high anxiety. Additionally, 9 out of the 18 bivariate correlations between these 2 variable sets were statistically significant. CONCLUSIONS In Latin America, SCI rehabilitation services are extremely sparse and rarely include interventions that target postinjury mental health. The current study suggests that mental health issues in patients with reduced HRQOL warrant attention in SCI rehabilitation services, especially in this region.
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Affiliation(s)
- Jennifer A Coleman
- Department of Psychology, Virginia Commonwealth University, Richmond, VA(∗)
| | - Leia A Harper
- Department of Psychology, Virginia Commonwealth University, Richmond, VA(†)
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA(‡)
| | | | - Jose Libardo Perdomo
- Department of Psychology, Universidad Cooperativa de Colombia, Neiva, Colombia(¶)
| | - Jose Anselmo Arango
- Department of Psychology, Universidad Cooperativa de Colombia, Neiva, Colombia(#)
| | - Juan Carlos Arango-Lasprilla
- Department of Psychology, University of Deusto, IKERBASQUE, Basque Foundation for Science, Bilbao 48007, Spain(∗∗).
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Alcedo Rodríguez MÁ, García Carenas L, Fontanil Gómez Y, Arias-Martínez B, Aguado Díaz AL. Adaptation Process in Women with Spinal Cord Injury: The Relationship between Psychological and Sociodemographic Variables. AQUICHAN 2014. [DOI: 10.5294/aqui.2014.14.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: conocer el funcionamiento psicológico de 44 mujeres con LM en el proceso de adaptación a la lesión; en concreto, las estrategias de afrontamiento, la motivación y ansiedad de ejecución, el neuroticismo-extraversión, la depresión y su posible relación con variables sociodemográficas. Método: se trata de un estudio con estrategia correlacional y diseño de evaluación transversal. El proceso de selección ha sido realizado a través de centros sanitarios y de asociaciones de personas con discapacidad. Participaron un total de 44 mujeres con LM, residentes en su mayoría en el Principado de Asturias (54,5 %) y en Euskadi (40,9 %), aunque también contamos con una pequeña representación de mujeres procedentes de Valladolid (4,5 %). Resultados: las diferencias significativas halladas nos muestran puntuaciones más elevadas en la escala de depresión en mujeres casadas y con menor nivel educativo. Los datos de este estudio reflejan la existencia de procesos individualizados de adaptación con un funcionamiento bastante aleatorio respecto a las variables sociodemográficas y, por tanto, apoyan los postulados del modelo de diferencias individuales en el proceso de adaptación a la LM. Conclusión: se sugiere que los procesos terapéuticos deben ser sensibles a la aparición de sentimientos de desesperanza y depresión en las mujeres con LM.
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Luedtke K, Bouchard SM, Woller SA, Funk MK, Aceves M, Hook MA. Assessment of depression in a rodent model of spinal cord injury. J Neurotrauma 2014; 31:1107-21. [PMID: 24564232 DOI: 10.1089/neu.2013.3204] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Despite an increased incidence of depression in patients after spinal cord injury (SCI), there is no animal model of depression after SCI. To address this, we used a battery of established tests to assess depression after a rodent contusion injury. Subjects were acclimated to the tasks, and baseline scores were collected before SCI. Testing was conducted on days 9-10 (acute) and 19-20 (chronic) postinjury. To categorize depression, subjects' scores on each behavioral measure were averaged across the acute and chronic stages of injury and subjected to a principal component analysis. This analysis revealed a two-component structure, which explained 72.2% of between-subjects variance. The data were then analyzed with a hierarchical cluster analysis, identifying two clusters that differed significantly on the sucrose preference, open field, social exploration, and burrowing tasks. One cluster (9 of 26 subjects) displayed characteristics of depression. Using these data, a discriminant function analysis was conducted to derive an equation that could classify subjects as "depressed" on days 9-10. The discriminant function was used in a second experiment examining whether the depression-like symptoms could be reversed with the antidepressant, fluoxetine. Fluoxetine significantly decreased immobility in the forced swim test (FST) in depressed subjects identified with the equation. Subjects that were depressed and treated with saline displayed significantly increased immobility on the FST, relative to not depressed, saline-treated controls. These initial experiments validate our tests of depression, generating a powerful model system for further understanding the relationships between molecular changes induced by SCI and the development of depression.
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Affiliation(s)
- Kelsey Luedtke
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center , Bryan, Texas
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12
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Robinson-Whelen S, Taylor HB, Hughes RB, Wenzel L, Nosek MA. Depression and depression treatment in women with spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:23-31. [PMID: 24574819 PMCID: PMC3919691 DOI: 10.1310/sci2001-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Research has documented high rates of depression in people with spinal cord injury (SCI); however, most SCI research is conducted with predominantly male study participants. Additional research is needed on depression and depression treatment among women with SCI. OBJECTIVE Study objectives were to examine depression, correlates of depression, and depression treatment in a sample of women with SCI. METHODS The sample included 51 ethnically and racially diverse women with SCI who participated in a larger study on secondary conditions of women with diverse physical disabilities. Recruited through health clinics and community organizations in a large metropolitan area, participants completed structured interviews that included demographic and disability characteristics and measures of health and health care utilization. RESULTS Scores on the Beck Depression Inventory-II (BDI-II) indicated that 41% of the women had depressive symptomatology in the mild to severe range. BDI-II scores were significantly related to more severe secondary conditions, greater pain, and poorer health perceptions but not to demographic or disability variables. Nearly a third (n = 16) of the women had scores exceeding the standard cutoff for significant clinical depressive symptomatology, yet only 5 of those had received any treatment for depression in the past 3 months and only 1 had received counseling or psychotherapy. Lifelong depression treatment showed a similar pattern of predominantly pharmacologic treatment. CONCLUSION Depression is a common problem for women with SCI, and many do not receive treatment, particularly psychological treatment. Disability-sensitive and affordable depression treatment must be made available to women with SCI.
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Affiliation(s)
- Susan Robinson-Whelen
- Spinal Cord Injury and Disability Research Center, Houston, Texas
- The Institute of Rehabilitation and Research Memorial Hermann, Houston, Texas
- Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, Texas
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Heather B. Taylor
- Spinal Cord Injury and Disability Research Center, Houston, Texas
- The Institute of Rehabilitation and Research Memorial Hermann, Houston, Texas
- Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rosemary B. Hughes
- The Rural Institute on Disabilities, University of Montana, Missoula, Montana
| | - Lisa Wenzel
- The Institute of Rehabilitation and Research Memorial Hermann, Houston, Texas
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Margaret A. Nosek
- Center for Research on Women with Disabilities, Baylor College of Medicine, Houston, Texas
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
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13
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Hartoonian N, Hoffman JM, Kalpakjian CZ, Taylor HB, Krause JK, Bombardier CH. Evaluating a spinal cord injury-specific model of depression and quality of life. Arch Phys Med Rehabil 2013; 95:455-65. [PMID: 24269994 DOI: 10.1016/j.apmr.2013.10.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine whether demographic, injury, health, and functional factors similarly have the same predictive relation with both somatic and nonsomatic symptoms of depression, as well as whether somatic and nonsomatic symptoms of depression have the same association with quality of life (QOL). DESIGN Secondary analysis of cross-sectional survey data. SETTING Community PARTICIPANTS Patients with traumatic spinal cord injury (N=4976) who completed an interview at 1 year postinjury between 2006 and 2011. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Somatic and nonsomatic symptoms of depression from the Patient Health Questionnaire-9 and QOL measured by the Satisfaction With Life Scale. RESULTS Structural equation modeling showed that the hypothesized model provided a good fit to the data, but modification of the model led to a significant improvement in model fit: Δχ(2)(1)=226.21, P<.001; comparative fit index=.976; χ(2)(199)=585.39, P<.001; root mean square error of approximation=.027 (90% confidence interval, .025-.030). The health-related factors including pain severity, pain interference, and health status were similarly associated with both somatic and nonsomatic symptoms of depression. QOL was negatively associated with nonsomatic symptoms of depression but was unrelated to somatic symptoms of depression. CONCLUSIONS Assessment of depression after spinal cord injury should include a careful assessment of health concerns given the relation between health-related factors and both somatic and nonsomatic symptoms of depression. Treatments of depressive symptoms may be improved by targeting health concerns, such as pain, along with a specific focus on nonsomatic symptoms to improve the QOL.
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Affiliation(s)
- Narineh Hartoonian
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Heather B Taylor
- TIRR Memorial Hermann and University of Texas Health Science Center, Houston, TX
| | - James K Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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14
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Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord 2013; 51:882-92. [PMID: 24126851 DOI: 10.1038/sc.2013.112] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/21/2013] [Accepted: 08/01/2013] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Scoping review. OBJECTIVES To gain a better understanding of the prevalence, course and association with age of secondary health conditions in individuals with spinal cord injury (SCI). SETTING Seattle, Washington, USA. METHODS We performed searches of electronic databases for studies published from 1986-2011 that provided information regarding the prevalence, course or associations with age and duration of secondary health conditions in individuals with SCI. RESULTS Ninety-two studies were included. The findings indicate that: (1) individuals with SCI experience a number of secondary health conditions, many of which occur at a higher rate in those with SCI than the normative population; (2) the most common conditions or symptoms are pain, bowel and bladder regulation problems, muscle spasms, fatigue, esophageal symptom and osteoporosis; (3) a number of conditions, including cardiovascular disease, diabetes, bone mineral density loss, fatigue and respiratory complications or infections, occur with higher frequency in older individuals or those with longer SCI duration, relative to younger individuals or those with shorter SCI duration; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in individuals aging with SCI. CONCLUSIONS The findings support the conclusion that individuals with SCI show signs of 'premature aging' in different organ systems. Longitudinal research is needed to understand when problems are most likely to emerge, and to develop and test the efficacy of interventions to prevent these health conditions and their negative impact.
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Hess MJ, Hough S. Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med 2012; 35:211-8. [PMID: 22925747 PMCID: PMC3425877 DOI: 10.1179/2045772312y.0000000025] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study focuses on the impact a spinal cord injury may have on achieving physical and emotional intimacy, and potential to maximize sexual ability and quality of life. Spinal cord injury is a traumatic, life-altering event that is usually associated with loss of motor and sensory function, as well as sexual impairment. At the time of injury, the individual is faced with devastating loss and an abundance of new information in a setting of extreme stress and challenge. In the acute rehabilitation setting, there is often a considerable void in providing education and resources regarding sexual concerns and needs. There is a positive relationship between sexual education and sexual activity. The impact of inadequate sexual counseling and education as a part of rehabilitation can be deleterious.
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Affiliation(s)
- Marika J. Hess
- Spinal Cord Injury Service, VA Boston Healthcare System, West Roxbury, MA, USA; Physical Medicine and Rehabilitation, Tufts School of Medicine, Boston, MA, USA; and Harvard Medical School, Boston, MA, USA,Correspondence to: Marika J. Hess, Spinal Cord Injury Service (SCI #128), VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA.
| | - Sigmund Hough
- Spinal Cord Injury Service, VA Boston Healthcare System, West Roxbury, MA, USA; Harvard Medical School, Boston, MA, USA; and Boston University School of Medicine, Boston, MA, USA
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Abstract
STUDY DESIGN Review. OBJECTIVES To review literature on subjective well-being (SWB; mental health and life satisfaction) and on psychological and social support factors associated with these outcomes in people with spinal cord injury (SCI), in order to identify gaps in scientific knowledge and recommend research priorities. SETTING Non applicable. METHODS Narrative review of the SCI literature on life satisfaction and mental health (depression, anxiety, post-traumatic stress syndrome) outcomes in people with SCI. Further, reviews were performed of the SCI literature on psychological and social support variables associated with SWB and on psychosocial interventions aimed to improve SWB. RESULTS People with SCI experience, on average, higher levels of distress and lower levels of life satisfaction compared with the general population. Individual differences, however, are large, and most people with SCI adapt well to their condition. A set of psychological and social support factors is strongly related to SWB. Intervention studies on cognitive behavioural therapy or coping effectiveness training to improve SWB show promising results, but suffer from methodological weaknesses (for example, lack of randomization and small sample size). CONCLUSION There is a need for cohort studies with sufficient sample size, which include people early after onset of SCI in order to enhance our understanding of the course of mental health and well-being after SCI. Cohort studies could also identify which people are at risk for long-term impairment of SWB. Finally, intervention studies on psychosocial interventions are needed to identify which interventions may improve SWB of people with SCI.
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Arango-Lasprilla JC, Ketchum JM, Starkweather A, Nicholls E, Wilk AR. Factors predicting depression among persons with spinal cord injury 1 to 5 years post injury. NeuroRehabilitation 2012; 29:9-21. [PMID: 21876291 DOI: 10.3233/nre-2011-0672] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Estimate changes in prevalence of Major Depressive Disorder (MDD) 1 to 5 years post spinal cord injury (SCI); Identify demographic, injury, and discharge factors associated with MDD at 1 and 5 years post-injury; Identify modifiers of changes in MDD. DESIGN Retrospective. SETTING Model Spinal Cord Injury System. PARTICIPANTS 2,256 adult participants enrolled in the National Spinal Cord Injury Statistical Center between 1999 and 2004. MAIN OUTCOME MEASURE MDD as determined by the Patient Health Questionnaire-9 (PHQ-9). RESULTS Prevalence of MDD was 11.9% at 1 year and 9.7% at 5 years post SCI. Odds of MDD decreased significantly 1 to 5 years post-injury (odds ratio=1.26, 95% confidence interval=1.02, 1.56). At 1 year post-injury, the odds of MDD was greater for persons 35-55 years old at injury, unemployed, having an indwelling catheter or voiding bladder management at discharge, and higher scores on ASIA motor index. At 5 years post-injury, the odds of MDD were greater for females, persons 35-55 years old at injury, those with a high school education or less, those having an indwelling catheter, voiding, and no bladder management at discharge, and higher scores on ASIA motor index. Sex was the only significant modifier. CONCLUSIONS MDD occurs commonly 1 to 5 years post SCI. Sociodemographic, injury, and discharge factors are associated with the development and changes in depression. Future research should expand upon current findings in order to identify, prevent, and reduce the prevalence of MDD after SCI.
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Affiliation(s)
- Juan Carlos Arango-Lasprilla
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Rehabilitation Psychology and Neuropsychology, School of Medicine, MCV Campus, West Hospital, 3rd Floor Room 3-102, 730 E. Broad Street, 4th Floor, Room4320a, Richmond, VA 23298-0542, USA.
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Mehta S, Orenczuk S, Hansen KT, Aubut JAL, Hitzig SL, Legassic M, Teasell RW. An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabil Psychol 2011; 56:15-25. [PMID: 21401282 PMCID: PMC3206089 DOI: 10.1037/a0022743] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). METHOD Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. RESULTS Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. CONCLUSIONS CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI.
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Affiliation(s)
- Swati Mehta
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | | | - Jo-Anne L. Aubut
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | - Matthew Legassic
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | - Robert W. Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London ON
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Kalpakjian CZ, Houlihan B, Meade MA, Karana-Zebari D, Heinemann AW, Dijkers MP, Wierbicky J, Charlifue S. Marital status, marital transitions, well-being, and spinal cord injury: an examination of the effects of sex and time. Arch Phys Med Rehabil 2011; 92:433-40. [PMID: 21276959 DOI: 10.1016/j.apmr.2010.07.239] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/18/2010] [Accepted: 07/06/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the applicability of marital resource (marriage has substantial benefits for well-being over not being married) or marital crisis (marital dissolution leads to poorer well-being) models to the spinal cord injury (SCI) population by studying the effects of sex, marital status, and marital transitions on well-being. DESIGN Prospective cohort study from the SCI Model Systems National Database. SETTING Community. PARTICIPANTS Men (n=4864) and women (n=1277) who sustained traumatic SCI and completed a minimum of 1 follow-up interview beginning at 1 year through 15 years postinjury. INTERVENTIONS None. MAIN OUTCOMES MEASURES Life satisfaction, depressive symptoms, and self-perceived health status by using linear mixed models for longitudinal data. RESULTS In general, well-being improved over time since injury. Hypothesis testing supported the marital crisis model, as marital loss through being or becoming separated or divorced and being or becoming widowed, had the most consistent and negative impact across well-being outcomes, whereas being or becoming married had an advantage for only lower depression symptoms over time. However, marital dissolution or loss did not have a uniformly adverse impact on well-being outcomes, and this effect often was moderated by sex, such that widows had higher depressive symptoms and poorer self-perceived health than widowers, but separated or divorced women had higher life satisfaction and self-perceived health than men. Irrespective of sex, being separated or divorced versus being single was associated with higher depressive symptoms over time. CONCLUSIONS Results support the marital crisis model and that women and men can experience marital dissolution differently. All marital loss does not result in compromised well-being and all marriage does not enhance well-being, highlighting complex dynamics worthy of further investigation in this population.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
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Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury. Arch Phys Med Rehabil 2010; 91:562-9. [PMID: 20382288 DOI: 10.1016/j.apmr.2009.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/25/2009] [Accepted: 12/02/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI). DESIGN Prospective cohort (4 data collection periods across 4 years). SETTING Community. PARTICIPANTS Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed. INTERVENTIONS None. MAIN OUTCOME MEASURES Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms). RESULTS The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness. CONCLUSIONS Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108-5744, USA.
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Krause JS, Saunders LL, Reed KS, Coker J, Zhai Y, Johnson E. Comparison of the Patient Health Questionnaire and the Older Adult Health and Mood Questionnaire for self-reported depressive symptoms after spinal cord injury. Rehabil Psychol 2010; 54:440-8. [PMID: 19929126 DOI: 10.1037/a0017402] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To directly compare estimates of potential depressive disorders and clinically significant depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) and Older Adult Health and Mood Questionnaire (OAHMQ) among participants with spinal cord injury (SCI). RESEARCH DESIGN 727 participants from a hospital in the Southeastern United States were administered the PHQ-9 and OAHMQ during a follow-up survey. We compared the rates of depressive disorders using cutoff scores and diagnostic criteria for each instrument. No independent psychiatric diagnostic interviews were conducted. RESULTS The PHQ-9 and OAHMQ were significantly correlated (r = .78), and both were correlated with satisfaction with life (r = -.48, -.54). Using recommended diagnostic scoring procedures, 10.7% of participants met the diagnostic criteria for major depressive disorder with the PHQ-9; 9.3% met the criteria for major depression based on PHQ-9 > or = 10; and 19.7% based on PHQ-9 > or = 15. Using the OAHMQ, 19.7% reported probable major depression and 44.5% clinically significant symptomatology. CONCLUSIONS The measures were highly correlated overall. However, the estimated prevalence of depressive disorders varied substantially between the 2 instruments. These estimates were comparable to those previously reported for each instrument (i.e., higher rates with the OAHMQ). Therefore, differing estimates of depressive disorders reported in the literature using these instruments were largely attributable to the instruments themselves.
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Affiliation(s)
- James S Krause
- Department of Health Sciences and Research, Medical University of South Carolina, South Carolina, USA.
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van Loo MA, Post MWM, Bloemen JHA, van Asbeck FWA. Care needs of persons with long-term spinal cord injury living at home in the Netherlands. Spinal Cord 2009; 48:423-8. [DOI: 10.1038/sc.2009.142] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kalpakjian CZ, Bombardier CH, Schomer K, Brown PA, Johnson KL. Measuring depression in persons with spinal cord injury: a systematic review. J Spinal Cord Med 2009; 32:6-24. [PMID: 19264045 PMCID: PMC2647502 DOI: 10.1080/10790268.2009.11760748] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Depression has been studied extensively among people with spinal cord injury (SCI). However, basic questions persist regarding the reliability and validity of depression measurement in the context of SCI. The objective of this study was to evaluate the state of knowledge of depression measurement in persons with SCI. METHODS English-language peer-reviewed citations from MEDLINE, CINAHL, PsycINFO, ProQuest, Google Scholar, and Web of Science from 1980 to present. Two reviewers screened 377 abstracts on SCI and depression topics to identify 144 containing classifiable psychometric data. All 144 were reviewed by 6 reviewers. Twenty-four studies reporting psychometric data on 7 depression measures in SCI samples were identified, including 7 validity studies. RESULTS Reliability data were limited to internal consistency and were consistently good to excellent across 19 studies. Validity data were limited to concurrent validity, construct validity, and/or clinical utility in 10 studies. Measures were comparable with respect to internal consistency, factor structure, and clinical utility. Results are limited to peer-reviewed, English literature, and studies were not judged for quality. CONCLUSIONS Greater attention should be paid to the psychometric evaluation of established measures. Although existing evidence may not justify universal screening, we recommend depression screening in clinical practice when patients may be seen by nonpsychology personnel. There is insufficient evidence to recommend one screening measure over another. Therefore, selection of measures will depend on clinician preferences. Psychometric studies are needed to show test-retest reliability, criterion validity, and sensitivity to change to improve depression recognition and treatment.
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Affiliation(s)
- Claire Z Kalpakjian
- Model SCI System, University of Michigan, Department of Physical Medicine and Rehabilitation, 300 N. Ingalls, Room NI 2A09, Ann Arbor, MI 48109, USA.
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Kalpakjian CZ, Toussaint LL, Albright KJ, Bombardier CH, Krause JK, Tate DG. Patient health Questionnaire-9 in spinal cord injury: an examination of factor structure as related to gender. J Spinal Cord Med 2009; 32:147-56. [PMID: 19569462 PMCID: PMC2678286 DOI: 10.1080/10790268.2009.11760766] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 07/30/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Despite the attention depression after spinal cord injury (SCI) has received, research and clinical practice have been hampered by inadequate emphasis on reliable and valid measurement. Assessment of symptoms in persons with SCI is challenged by the presence of "trans-diagnostic" symptoms and unexamined effects of gender. The objective of this study was to examine the factor structure of the Patient Health Questionnaire-9 (PHQ-9; the 9-item depression scale of the Patient Health Questionnaire) and determine whether the structure replicates across gender. METHODS A total of 1,168 women and men were matched on level/completeness of SCI, follow-up year, and age to create 584 pairs. Exploratory factor analysis examined 1- and 2-factor models and congruence in 2 randomly split half samples to establish congruence of the factor solution and replication across gender. RESULTS The 1- and 2-factor solutions fit the structure of the items accounting for 41% to 51% of original item variance. Congruence between random samples was uniformly high for the 1-factor solution (r = 0.791-0.948) but variable for the 2-factor solution. Although congruence was high for the combined sample and men (r = 0.90-0.97 and 0.71-0.94, respectively), it was variable for women (r = 0.29-0.85). CONCLUSIONS Although there was support for the 1-factor structure of the PHQ within and between sexes, the low congruence between sexes and within women for the 2-factor structure indicates potentially important differences about how certain symptoms may be experienced or interpreted differently, by men and women with SCI. Future research should focus on where sexes diverge in cognitive, affective, and somatic dimensions of depressive symptoms and whether sex-specific or sex-neutral measures are warranted.
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Affiliation(s)
- Claire Z Kalpakjian
- Model SCI System, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor 48109, USA.
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