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Calderone A, Cardile D, De Luca R, Quartarone A, Corallo F, Calabrò RS. Cognitive, behavioral and psychiatric symptoms in patients with spinal cord injury: a scoping review. Front Psychiatry 2024; 15:1369714. [PMID: 38572000 PMCID: PMC10987747 DOI: 10.3389/fpsyt.2024.1369714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Spinal Cord Injury (SCI) is a condition where the spinal cord is damaged and experiences partial or complete loss of motor and/or sensory function, which is typically less than normal. After SCI, patients may exhibit more severe psychiatric symptoms and experience cognitive impairments, including reduced speed and attention processing capacity, as well as difficulties with executive function and episodic memory retention. Among the behavioral and psychiatric symptoms, depression, anxiety, substance use disorder, and posttraumatic stress disorder are the most common. This review aims to investigate the cognitive, behavioral, or psychiatric symptoms of the patient with SCI and their influence on the rehabilitation process. Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, and Embase databases. Studies published between 2013-2023 were selected. This review has been registered on OSF (n) 3KB2U. We have found that patients with SCI are at high risk of cognitive impairment and experience a wide range of difficulties, including tasks based on processing speed and executive function. This clinical population may experience adjustment disorders with depression and anxiety, as well as other psychiatric symptoms such as fatigue, stress, and suicidal ideation. This review has demonstrated that SCI patients may experience psychiatric symptoms and cognitive impairments that affect their functioning. At the same time, these patients may be more prone to various adjustment and mood disorders. Moreover, these two aspects may interact with each other, causing a range of symptoms, increasing the risk of hospitalization, and delaying the rehabilitation process.
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Affiliation(s)
- Andrea Calderone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Clark JMR, Ozturk ED, Chanfreau-Coffinier C, Merritt VC. Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury. Qual Life Res 2024; 33:229-239. [PMID: 37856045 DOI: 10.1007/s11136-023-03518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To examine clinical outcomes and employment status in Veterans with and without a dual diagnosis of traumatic brain injury (TBI) and spinal cord injury (SCI). METHODS This cross-sectional study examined a national sample of Veterans enrolled in the VA Million Veteran Program who completed the Comprehensive TBI Evaluation (CTBIE) as part of the Veterans Health Administration's TBI Screening and Evaluation Program. Veterans (N = 12,985) were classified into the following TBI/SCI groups using CTBIE data: those with a dual diagnosis of TBI and SCI (TBI+/SCI+); those with a history of TBI but no SCI (TBI+/SCI-); and those with no history of TBI or SCI (TBI-/SCI-; i.e., the control group). CTBIE-derived outcomes included neurobehavioral symptoms, comorbid psychiatric symptoms, pain and pain interference, and employment status. RESULTS Chi-square analyses showed significant associations between TBI/SCI group and all clinical outcomes evaluated (all p's < .001; V = 0.07-0.11). In general, the TBI+/SCI+ and TBI +/SCI- groups endorsed comparable levels of neurobehavioral symptoms, psychiatric symptoms, and pain, but significantly greater rates of symptoms and pain relative to the TBI-/SCI- group. Effect sizes for all pairwise comparisons were small (φ = 0.01-0.11). Finally, there was no significant association between TBI/SCI group and employment status (p = .170; V = 0.02), with all three groups showing relatively comparable rates of unemployment. CONCLUSIONS Regardless of SCI status, Veterans with TBI history endorsed poorer clinical outcomes than Veterans without TBI and SCI. However, rates of unemployment were similarly high across all three groups. Findings suggest that any Veteran completing the CTBIE may be at risk for poor clinical and employment outcomes.
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Affiliation(s)
- Jillian M R Clark
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Erin D Ozturk
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- San Diego Joint Doctoral Program, San Diego State University/University of California, San Diego, CA, USA
| | | | - Victoria C Merritt
- Psychology & Research Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA.
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA.
- VA San Diego Healthcare System (151B), 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
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Hatch MN, Etingen B, Raad J, Siddiqui S, Stroupe KT, Smith BM. Dual utilization of Medicare and VA outpatient care among Veterans with spinal cord injuries and disorders. J Spinal Cord Med 2023; 46:716-724. [PMID: 35108176 PMCID: PMC10446768 DOI: 10.1080/10790268.2022.2027321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Veterans with spinal cord injuries and disorders (SCI/D) utilizing Veterans Affairs healthcare facilities are also Medicare eligible. Use of multiple health care systems potentially duplicates or fragments care in this population; yet little is known about those using multiple systems. This study describes dual use of services paid for by VA and Medicare among Veterans with SCI/D. DESIGN Retrospective, cross-sectional, observational study. PARTICIPANTS Veterans with SCI/D (n = 13,902) who received healthcare services within the VA SCI System of Care and were eligible for or enrolled in Medicare in 2011. INTERVENTIONS N/A. OUTCOME MEASURES Patient characteristics, average number of visits and patient level frequencies of reasons for visits were determined for individuals within healthcare utilization (VA only, Medicare only, or dual VA/Medicare) groups. Multinomial logistic regression analyses were used to investigate associations of patient variables on dual use. RESULTS 65.3% of Veterans with SCI/D were VA only users for outpatient encounters, 4.4% had encounters paid for by Medicare only, and 30.3% were dual users. Veterans were less likely to be VA only users if they were older than 69 and if they had been injured for greater than ten years. African American Veterans with SCI (compared to white) were more likely to be VA only users. CONCLUSION A substantial number (∼30%) of Veterans with SCI/D are dual users. These numbers highlight the importance of improved strategies to coordinate care and increase health information sharing across systems.
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Affiliation(s)
- Maya N Hatch
- Spinal Cord Injury/Disorder Center, Long Beach Veterans Affairs (VA) Medical Center, Long Beach, California, USA
- Physical Medicine & Rehabilitation Department, UC Irvine School of Medicine, Irvine, California, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of VA Hospital, Chicago, Illinois, USA
| | - Jason Raad
- Econometrica, Inc, Bethesda, Massachusetts, USA
| | - Sameer Siddiqui
- Spinal Cord Injury/Disorder Center, Louis Stokes Cleveland (VA) Medical Center, Cleveland, Ohio, USA
- Department of Physical Medicine & Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of VA Hospital, Chicago, Illinois, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Department of VA Hospital, Chicago, Illinois, USA
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Parker MA, Ichikawa JK, Bombardier CH, Hammond FM. Association Between Anxiety Symptoms, Depression Symptoms, and Life Satisfaction Among Individuals 1 Year After Spinal Cord Injury: Findings From the SCIRehab Project. Arch Rehabil Res Clin Transl 2022; 4:100211. [PMID: 36123974 PMCID: PMC9482038 DOI: 10.1016/j.arrct.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To examine the association between anxiety symptoms, depression symptoms, and life satisfaction 1 year after SCI. Design Cross-sectional analysis of data from the SCIRehab Project. A linear regression model estimated the association between anxiety symptoms and life satisfaction and tested the moderating effect of depression symptoms on the association between anxiety symptoms and depression symptoms with an interaction term. Setting Six rehabilitation facilities across the United States. Participants A total to 940 persons older than 12 years who received inpatient spinal cord injury (SCI) rehabilitation between 2007 and 2009 were followed up 1 year post injury (n=940). Interventions None Main Outcome Measures Life satisfaction 1 year after SCI measured via the Satisfaction With Life Scale. Results Unadjusted analyses showed anxiety symptoms were associated with decreased life satisfaction for individuals with SCI. In adjusted analyses, anxiety symptoms were not associated with life satisfaction. In adding an interaction term, anxiety symptoms were associated with 2 points lower life satisfaction holding the other variables constant (P=.02). There was a moderating effect of depression symptoms on the association between anxiety symptoms and life satisfaction. Persons with anxiety symptoms had lower life satisfaction scores at lower levels of depression symptoms but higher life satisfaction scores at higher levels of depression symptoms than persons with no anxiety. Conclusions In clinical settings, both anxiety and depression symptoms should be monitored, measured, and treated together to optimally improve life satisfaction for persons with SCI. Prioritizing interventions known to have transdiagnostic effects may achieve the best results.
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Affiliation(s)
- Maria A. Parker
- School of Public Health, Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
- Corresponding author Maria A. Parker, PhD, MS, MPH, Indiana University School of Public Health, 809 East 9th St, Bloomington, IN 47405.
| | - Jodi K. Ichikawa
- School of Public Health, Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
| | | | - Flora M. Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN
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Chen Y, Wen H, Baidwan NK, DeVivo MJ. Demographic and Health Profiles of People Living With Traumatic Spinal Cord Injury in the United States During 2015-2019: Findings from the Spinal Cord Injury Model Systems Database. Arch Phys Med Rehabil 2022; 103:622-633. [PMID: 34808122 DOI: 10.1016/j.apmr.2021.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/21/2021] [Accepted: 11/02/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To estimate the population profile of people living with traumatic spinal cord injury (TSCI) to help evaluate health care needs of this aging population. DESIGN Cross-sectional study. SETTING SCI Model Systems (SCIMS) centers in the United States. PARTICIPANTS Individuals (N=20,437) who: (1) incurred a TSCI between 1972 and 2019, (2) were initially treated at one of the SCIMS centers, and (3) were alive during the period from 2015 to 2019. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographics, injury characteristics, health conditions, and social participation, as compared with previous estimates in 2008 and general population statistics in 2017. RESULTS People living with TSCI during the period from 2015-2019 (mean years since injury, 18y; 79.4% male, and 62.5% White) were older (51.6 vs 45.0y) and had a higher percentage of C1-C4 (21.9% vs 17.0%) and American Spinal Injury Association Impairment Scale D injuries (31.5% vs 26.0%) compared with the 2008 TSCI population profile. Although the proportion of people with a bachelor's degree or higher was similar between the TSCI and general US populations (30.7% vs 32.0%), the employment rate was lower in the TSCI population (24.0% vs 59.5%). People are affected by various medical problems over time post TSCI. The prevalence of pain and urinary tract infection remained high over postinjury years, at 86.1% and 52.6%, respectively. Rehospitalization and depression were most common during the first year (34.9% and 22.3%, respectively), and pressure injury was more common among those 20 years or more postinjury (>30.0%). Health conditions declined with advanced age, including self-perceived health, diabetes, and institutional residence. People who survived TSCI for years, however, had relatively good degrees of independence and social participation. CONCLUSION Study findings highlight the need for greater involvement of primary care providers and geriatricians in the continuity of care for SCI to promote healthy aging. Improvement in employment should also be the target in promoting social participation and quality of life.
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Affiliation(s)
- Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL.
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Navneet Kaur Baidwan
- Department of Health Services Administration and UAB-Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
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Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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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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10
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Zleik N, Weaver F, Harmon RL, Le B, Radhakrishnan R, Jirau-Rosaly WD, Craven BC, Raiford M, Hill JN, Etingen B, Guihan M, Heggeness MH, Ray C, Carbone L. Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: A systematic scoping review. J Spinal Cord Med 2019; 42:735-759. [PMID: 29745791 PMCID: PMC6830234 DOI: 10.1080/10790268.2018.1469808] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D.Study Design: Scoping review.Settings/Participants: Human adult subjects with a SCI/D.Outcome measures: Strategies to identify persons with SCI/D at risk for osteoporotic fractures, nonpharmacological and pharmacological therapies for osteoporosis and management of appendicular fractures.Results: 226 articles were included in the scoping review. Risk of osteoporotic fractures in SCI is predicted by a combination of DXA-defined low BMD plus clinical and demographic characteristics. Screening for secondary causes of osteoporosis, in particular hyperparathyroidism, hyperthyroidism, vitamin D insufficiency and hypogonadism, should be considered. Current antiresorptive therapies for treatment of osteoporosis have limited efficacy. Use of surgery to treat fractures has increased and outcomes are good and comparable to conservative treatment in most cases. A common adverse event following fracture was delayed healing.Conclusions: Most of the research in this area is limited by small sample sizes, weak study designs, and significant variation in populations studied. Future research needs to address cohort definition and study design issues.
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Affiliation(s)
- Nour Zleik
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Robert L. Harmon
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
| | - Brian Le
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | | | - Wanda D. Jirau-Rosaly
- Department of Medicine, Division of Geriatrics, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - B. Catharine Craven
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Mattie Raiford
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jennifer N. Hill
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Marylou Guihan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Michael H. Heggeness
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Laura Carbone
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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McDonald SD, Mickens MN, Goldberg-Looney LD, Mutchler BJ, Ellwood MS, Castillo TA. Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries. J Spinal Cord Med 2018; 41:691-702. [PMID: 28287932 PMCID: PMC6217469 DOI: 10.1080/10790268.2017.1293868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. DESIGN Cross-sectional. SETTING A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. PARTICIPANTS/METHODS Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. RESULTS Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. CONCLUSIONS Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.
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Affiliation(s)
- Scott D. McDonald
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melody N. Mickens
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Brian J. Mutchler
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael S. Ellwood
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Teodoro A. Castillo
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Kang MG, Kim CH, Park E, Huh JW, Yang WJ, Nam TW, Min YS, Jung TD. Effect of Family Caregiving on Depression in the First 3 Months After Spinal Cord Injury. Ann Rehabil Med 2018; 42:130-136. [PMID: 29560333 PMCID: PMC5852216 DOI: 10.5535/arm.2018.42.1.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the effect of family caregiving on depression in the first 3 months after spinal cord injury (SCI). Methods A retrospective study was carried out on 76 patients diagnosed with an SCI from January 2013 to December 2016 at the Department of Physical Medicine and Rehabilitation of Kyungpook National University Hospital, Korea. Clinical characteristics including age, gender, level of injury, completeness of the injury, time since injury, caregiver information, etiology, and functional data were collected through a retrospective review of medical records. Depression was assessed using the Beck Depression Inventory (BDI). Patients with 14 or more points were classified as depressed and those with scores of 13 or less as non-depressed group. Results Of the 76 patients, 33 were in the depressed group with an average BDI of 21.27±6.17 and 43 patients included in the non-depressed group with an average BDI of 4.56±4.20. The BDI score of patients cared by unlicensed assistive personnel (UAP) was significantly higher than that of patients cared by their families (p=0.020). Univariate regression analysis showed that motor complete injury (p=0.027), UAP caregiving (p=0.022), and Ambulatory Motor Index (p=0.019) were associated with depression after SCI. Multivariate binary logistic regression analysis showed that motor completeness (p=0.002) and UAP caregiving (p=0.002) were independent risk factors. Conclusion Compared with UAP, family caregivers lowered the prevalence of depression in the first 3 months after SCI.
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Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chul-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eunhee Park
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jae-Won Huh
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Won-Jong Yang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Tae-Woo Nam
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea
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Gruener H, Zeilig G, Laufer Y, Blumen N, Defrin R. Increased psychological distress among individuals with spinal cord injury is associated with central neuropathic pain rather than the injury characteristics. Spinal Cord 2017; 56:176-184. [PMID: 29238095 DOI: 10.1038/s41393-017-0014-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/14/2017] [Accepted: 08/19/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Central neuropathic pain (CNP) is common after spinal cord injury (SCI). The psychological impact of CNP is not clear. Previous studies reported depression and pain catastrophizing among patients with SCI and CNP; however, the lack of control groups prevented discerning whether these were attributed to CNP or to the SCI itself. The aim was to examine the psychological distress among individuals with SCI with and without CNP and controls to evaluate its impact and possible source. SETTING Outpatient clinic of a large rehabilitation center. METHODS Individuals with SCI and CNP (n = 27) and without CNP (n = 23), and able-bodied controls (n = 20) participated. Data collection included sociodemographics, SCI characteristics, and level of post-traumatic stress disorder (PTSD), anxiety, stress, depression, and pain catastrophizing. The sensory, affective, and cognitive dimensions of CNP were analyzed. RESULTS Individuals with SCI and CNP exhibited elevated levels of PTSD, anxiety, stress, depression, and pain catastrophizing compared to the two control groups, which presented similar levels. The psychological variables among the CNP group correlated positively only with the affective dimension of CNP. Neither CNP nor the psychological variables correlated with SCI characteristics. CONCLUSIONS Irrespective of CNP intensity, the affective dimension (suffering) is associated with increased psychological distress. Perhaps individual differences in the response to SCI and/or individual traits rather than the mere exposure to SCI may have a role in the emergence of CNP and psychological distress/mood dysfunction. Rehabilitation programs should prioritize stress management and prevention among individuals with SCI and CNP.
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Affiliation(s)
- Hila Gruener
- Department of Physical Therapy at Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yocheved Laufer
- Physical Therapy Department, University of Haifa, Haifa, Israel
| | - Nava Blumen
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Department of Rehabilitation Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Defrin
- Department of Physical Therapy at Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Etingen B, Locatelli SM, Miskevics S, LaVela SL. Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders. Disabil Rehabil 2017; 40:2637-2643. [PMID: 28743195 DOI: 10.1080/09638288.2017.1355938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder. METHODS A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder. RESULTS Veterans with (vs. without) post-traumatic stress disorder (n = 896) reported lower social participation (40.2 vs. 43.9, p < 0.0001). Multivariate analyses showed that longer duration of injury (OR = 0.98, 95% CI: 0.97-1.00, p = 0.04) and white race (OR = 0.62, 95% CI: 0.38-1.01, p = 0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR = 1.43, 95% CI: 1.25-1.64, p < 0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR = 0.94, 95% CI: 0.90-0.98, p = 0.003). CONCLUSIONS Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation. Implications for Rehabilitation Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences. Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder. Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.
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Affiliation(s)
- Bella Etingen
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sara M Locatelli
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Scott Miskevics
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sherri L LaVela
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA.,b Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
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15
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Abderhalden L, Weaver FM, Bethel M, Demirtas H, Burns S, Svircev J, Hoenig H, Lyles K, Miskevics S, Carbone LD. Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders. Osteoporos Int 2017; 28:925-934. [PMID: 27924381 DOI: 10.1007/s00198-016-3841-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/11/2016] [Indexed: 01/09/2023]
Abstract
UNLABELLED Low T-scores at the hip predict incident fractures in persons with a SCI. INTRODUCTION Persons with a spinal cord injury (SCI) have substantial morbidity and mortality following osteoporotic fractures. The objective of this study was to determine whether dual-energy X-ray absorptiometry (DXA) measurements predict osteoporotic fractures in this population. METHODS A retrospective historical analysis that includes patients (n = 552) with a SCI of at least 2 years duration who had a DXA performed and were in the VA Spinal Cord Disorders Registry from fiscal year (FY) 2002-2012 was performed. RESULTS The majority of persons (n = 455, 82%) had a diagnosis of osteoporosis or osteopenia, with almost half having osteoporosis. BMD and T-scores at the lumbar spine were not significantly associated with osteoporotic fractures (p > 0.48) for both. In multivariable analyses, osteopenia (OR = 4.75 95% CI 1.23-17.64) or osteoporosis (OR = 4.31, 95% CI 1.15-16.23) compared with normal BMD was significantly associated with fractures and higher T-scores at the hip were inversely associated with fractures (OR 0.73 (95% CI 0.57-0.92)). There was no significant association of T-scores or World Health Organization (WHO) classification with incident fractures in those with complete SCI (p > 0.15 for both). CONCLUSION The majority (over 80%) of individuals with a SCI have osteopenia or osteoporosis. DXA-derived measurements at the hip, but not the lumbar spine, predict fracture risk in persons with a SCI. WHO-derived bone density categories may be useful in classifying fracture risk in persons with a SCI.
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Affiliation(s)
- L Abderhalden
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - F M Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - M Bethel
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - H Demirtas
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - S Burns
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - J Svircev
- VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - H Hoenig
- Durham VA Medical Center, 508 Fulton St, Durham, NC, USA
| | - K Lyles
- Duke University and VA Medical Centers, Durham, NC, USA
- The Carolinas Center for Medical Excellence, Cary, NC, USA
| | - S Miskevics
- Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - L D Carbone
- Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA.
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Guihan M, Murphy D, Rogers TJ, Parachuri R, SAE Richardson M, Lee KK, Bates-Jensen BM. Documentation of preventive care for pressure ulcers initiated during annual evaluations in SCI. J Spinal Cord Med 2016; 39:290-300. [PMID: 26763668 PMCID: PMC5073760 DOI: 10.1080/10790268.2015.1114225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Community-acquired pressure ulcers (PrUs) are a frequent cause of hospitalization of Veterans with spinal cord injury (SCI). The Veterans Health Administration (VHA) recommends that SCI annual evaluations include assessment of PrU risk factors, a thorough skin inspection and sharing of recommendations for PrU prevention strategies. We characterized consistency of preventive skin care during annual evaluations for Veterans with SCI as a first step in identifying strategies to more actively promote PrU prevention care in other healthcare encounters. DESIGN/SETTING/PARTICIPANTS Retrospective cross-sectional observational design, including review of electronic medical records for 206 Veterans with SCI admitted to 2 VA SCI centers from January-December, 2011. OUTCOME MEASURES Proportion of applicable skin health elements documented (number of applicable elements/skin health elements documented). RESULTS Our sample was primarily white (78%) male (96.1%), and mean age = 61 years. 40% of participants' were hospitalized for PrU treatment, with a mean of 294 days (median = 345 days) from annual evaluation to the index admission. On average, Veterans received an average of 75.5% (IQR 68-86%) of applicable skin health elements. Documentation of applicable skin health elements was significantly higher during inpatient vs. outpatient annual evaluations (mean elements received = 80.3% and 64.3%, respectively, P > 0.001). No significant differences were observed in documentation of skin health elements by Veterans at high vs. low PrU risk. CONCLUSION Additional PrU preventive care in the VHA outpatient setting may increase identification and detection of PrU risk factors and early PrU damage for Veterans with SCI in the community, allowing for earlier intervention.
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Affiliation(s)
- Marylou Guihan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA,Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Correspondence to: Marylou Guihan, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines, Jr. VA Hospital (151-H), 5000 S. 5th Avenue, Hines, IL 60141–3030, USA.
| | - Deidre Murphy
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Thea J. Rogers
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Ramadevi Parachuri
- Spinal Cord Injury Service, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | | | - Kenneth K. Lee
- Clement J. Zablocki VA Medical Center, Spinal Cord Injury Center, Milwaukee, WI, USA
| | - Barbara M. Bates-Jensen
- Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA,UCLA School of Nursing & David Geffen School of Medicine, Los Angeles, CA, USA
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Lan CW, Fiellin DA, Barry DT, Bryant KJ, Gordon AJ, Edelman EJ, Gaither JR, Maisto SA, Marshall BDL. The epidemiology of substance use disorders in US Veterans: A systematic review and analysis of assessment methods. Am J Addict 2016; 25:7-24. [PMID: 26693830 PMCID: PMC5123305 DOI: 10.1111/ajad.12319] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/09/2015] [Accepted: 12/02/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs), which encompass alcohol and drug use disorders (AUDs, DUDs), constitute a major public health challenge among US veterans. SUDs are among the most common and costly of all health conditions among veterans. OBJECTIVES This study sought to examine the epidemiology of SUDs among US veterans, compare the prevalence of SUDs in studies using diagnostic and administrative criteria assessment methods, and summarize trends in the prevalence of SUDs reported in studies sampling US veterans over time. METHODS Comprehensive electronic database searches were conducted. A total of 3,490 studies were identified. We analyzed studies sampling US veterans and reporting prevalence, distribution, and examining AUDs and DUDs. RESULTS Of the studies identified, 72 met inclusion criteria. The studies were published between 1995 and 2013. Studies using diagnostic criteria reported higher prevalence of AUDs (32% vs. 10%) and DUDs (20% vs. 5%) than administrative criteria, respectively. Regardless of assessment method, both the lifetime and past year prevalence of AUDs in studies sampling US veterans has declined gradually over time. CONCLUSION The prevalence of SUDs reported in studies sampling US veterans are affected by assessment method. Given the significant public health problems of SUDs among US veterans, improved guidelines for clinical screening using validated diagnostic criteria to assess AUDs and DUDs in US veteran populations are needed. SCIENTIFIC SIGNIFICANCE These findings may inform VA and other healthcare systems in prevention, diagnosis, and intervention for SUDs among US veterans.
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Affiliation(s)
- Chiao-Wen Lan
- Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California
| | - David A Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Declan T Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Pain Treatment Services, APT Foundation, Inc., New Haven, Connecticut
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Julie R Gaither
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University, School of Public Health, Providence, Rhode Island
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Bombardier CH, Adams LM, Fann JR, Hoffman JM. Depression Trajectories During the First Year After Spinal Cord Injury. Arch Phys Med Rehabil 2015; 97:196-203. [PMID: 26525525 DOI: 10.1016/j.apmr.2015.10.083] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/15/2015] [Accepted: 10/05/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the number and type of longitudinal depression trajectories during the first year after spinal cord injury (SCI) and to identify baseline predictors of these trajectories. DESIGN Cohort study. SETTING Rehabilitation and postacute community settings. PARTICIPANTS Of 168 consecutive admissions to inpatient rehabilitation for acute SCI, 141 (115 men, 26 women) patients were enrolled in a randomized controlled trial telephone follow-up intervention, which showed no outcome differences, and completed assessments on at least 2 of the 4 follow-up occasions (3, 6, 9, and 12 months after SCI). Participants were on average 41 years old, most were non-Hispanic (96%) and white (86%), and 61.7% had tetraplegia. INTERVENTIONS Data were drawn from the ineffective randomized controlled trial. MAIN OUTCOME MEASURE Patient Health Questionnaire-9 (PHQ-9). RESULTS Unconditional linear latent class growth analysis models of PHQ-9 total scores revealed an optimal 3-class solution: stable low depression (63.8%), mild to moderate depression (29.1%), and persistent moderate to severe depression (7.1%). Preinjury mental health history and baseline pain, quality of life, and grief predicted class membership. CONCLUSIONS The modal response to SCI was stable low depression, whereas persistent moderate to severe depression primarily represented a continuation or relapse of preinjury depression. This line of research has the potential to improve identification of subgroups destined for poor outcomes and to inform early intervention studies.
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Affiliation(s)
- Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
| | | | - Jesse R Fann
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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Craig A, Nicholson Perry K, Guest R, Tran Y, Dezarnaulds A, Hales A, Ephraums C, Middleton J. Prospective Study of the Occurrence of Psychological Disorders and Comorbidities After Spinal Cord Injury. Arch Phys Med Rehabil 2015; 96:1426-34. [DOI: 10.1016/j.apmr.2015.02.027] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/24/2015] [Indexed: 11/25/2022]
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Finlay AK, Binswanger IA, Smelson D, Sawh L, McGuire J, Rosenthal J, Blue-Howells J, Timko C, Blodgett JC, Harris AHS, Asch SM, Frayne S. Sex differences in mental health and substance use disorders and treatment entry among justice-involved Veterans in the Veterans Health Administration. Med Care 2015; 53:S105-11. [PMID: 25767963 PMCID: PMC5764085 DOI: 10.1097/mlr.0000000000000271] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over half of veterans in the criminal justice system have mental health or substance use disorders. However, there is a critical lack of information about female veterans in the criminal justice system and how diagnosis prevalence and treatment entry differ by sex. OBJECTIVES To document prevalence of mental health and substance use disorder diagnoses and treatment entry rates among female veterans compared with male veterans in the justice system. RESEARCH DESIGN Retrospective cohort study using national Veterans Health Administration clinical/administrative data from veterans seen by Veterans Justice Outreach Specialists in fiscal years 2010-2012. SUBJECTS A total of 1535 females and 30,478 male veterans were included. MEASURES Demographic characteristics (eg, sex, age, residence, homeless status), mental health disorders (eg, depression, post-traumatic stress disorder), substance use disorders (eg, alcohol and opioid use disorders), and treatment entry (eg, outpatient, residential, pharmacotherapy). RESULTS Among female veterans, prevalence of mental health and substance use disorders was 88% and 58%, respectively, compared with 76% and 72% among male veterans. Women had higher odds of being diagnosed with a mental health disorder [adjusted odds ratio (AOR)=1.98; 95% confidence interval (CI), 1.68-2.34] and lower odds of being diagnosed with a substance use disorder (AOR=0.50; 95% CI, 0.45-0.56) compared with men. Women had lower odds of entering mental health residential treatment (AOR=0.69; 95% CI, 0.57-0.83). CONCLUSIONS Female veterans involved in the justice system have a high burden of mental health disorders (88%) and more than half have substance use disorders (58%). Entry to mental health residential treatment for women is an important quality improvement target.
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Affiliation(s)
- Andrea K. Finlay
- Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA
| | - Ingrid A. Binswanger
- Division of General Internal Medicine University of Colorado School of Medicine, Community Health Services, Denver Health Medical Center, Denver, CO
| | - David Smelson
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Leon Sawh
- National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
- School of Criminology and Justice Studies, University of Massachusetts, Lowell, Bedford, MA
| | - Jim McGuire
- Department of Veterans Affairs, Veterans Justice Programs
| | - Joel Rosenthal
- Department of Veterans Affairs, Veterans Justice Programs
| | | | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
- Department of Psychiatry and Behavioral Sciences
| | - Janet C. Blodgett
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
| | - Alex H. S. Harris
- Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA
| | - Steven M. Asch
- Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA
| | - Susan Frayne
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA
- Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA
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21
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El-Gabalawy R, Thompson JM, Sweet J, Erickson J, Mackenzie CS, Pietrzak RH, VanTil L, Sareen J. Comorbidity and functional correlates of anxiety and physical conditions in Canadian Veterans. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2015. [DOI: 10.3138/jmvfh.2014-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Little is known about the relationship between anxiety disorders and physical conditions in Canadian Veterans. The purpose of this investigation was to examine the comorbidity of anxiety and physical conditions and their relation to physical and mental health–related quality of life and activity limitations in a nationally representative sample of Canadian Veterans. Methods: Participants were selected from the cross-sectional 2010 Survey on Transition to Civilian Life ( N = 3,154, response rate = 71.0%). The sample consisted of former Canadian Armed Forces Regular Force personnel who were released from 1998 to 2007. Multivariate logistic and linear regression models evaluated associations between several commonly occurring chronic physical conditions and any anxiety disorder and correlates (i.e., quality of life and activity limitations) of comorbidity. Results: Any anxiety disorder was associated with significantly elevated rates of cardiovascular, gastrointestinal, respiratory, and musculoskeletal conditions; diabetes; and chronic pain after controlling for sociodemographics, military characteristics, any mood disorder, and heavy drinking. However, when additionally controlling for number of physical conditions, any anxiety disorder remained significantly associated with gastrointestinal conditions (adjusted odds ratio [AOR] = 1.63, 99% confidence interval [CI] = 1.07–2.50) and chronic pain (AOR = 1.79, 99% CI = 1.15–2.78). Co-occurring anxiety disorders and musculoskeletal conditions were associated with poorer physical health–related quality of life and activity limitations than musculoskeletal conditions alone. Conclusion: Anxiety disorders and physical health problems co-occur at high rates among Canadian Veterans, and this comorbidity is linked to poorer physical health–related quality of life and activity limitations. These findings have implications for supporting at-risk personnel with the transition to civilian life and for informing health promotion and prevention efforts.
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Affiliation(s)
- Renée El-Gabalawy
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M. Thompson
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Jill Sweet
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Julie Erickson
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey S. Mackenzie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert H. Pietrzak
- Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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Williams R, Murray A. Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil 2014; 96:133-40. [PMID: 25220943 DOI: 10.1016/j.apmr.2014.08.016] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/17/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To use meta-analysis to synthesize point prevalence estimates of depressive disorder diagnoses for persons who have sustained a spinal cord injury (SCI). DATA SOURCES We searched PsycINFO, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Dissertation Abstracts International (DAI) for studies examining depression after SCI through 2013. We also conducted a manual search of the reference sections of included studies. STUDY SELECTION Included studies contained persons with SCI; used a diagnostic measure of depression (ie, an unstructured, semi-structured, or structured clinical interview, and/or a clinician diagnosis); and provided a diagnosis of major or minor depressive episodes for the subjects in the study. Diagnostic criteria were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (including Research Diagnostic Criteria) criteria. DATA EXTRACTION The 2 authors of this study screened the titles and abstracts of 1053 unique studies for inclusion in this meta-analysis. Nineteen studies, containing 35,676 subjects and 21 effect size estimates, were included. DATA SYNTHESIS The mean prevalence estimate of depression diagnosis after SCI was 22.2%, with a lower-bound estimate of 18.7% and an upper bound estimate of 26.3%. Random effects and mixed effects models were used in this work. A small number of study moderators were explored, including sample sex composition, Diagnostic and Statistical Manual of Mental Disorders version used, data collection method (primary vs secondary), sample traumatic etiology composition, sample injury level and completeness composition, and sample diagnostic composition. Data collection method, Diagnostic and Statistical Manual of Mental Disorders version, and diagnostic composition significantly predicted variation in observed effect size estimates, with primary data collection studies having lower estimates compared with secondary data analysis studies, studies using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria having higher estimates compared with studies using Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria, and samples comprising individuals diagnosed only with major depression having lower prevalence estimates. CONCLUSIONS The existing data on depression after SCI indicate that the prevalence of depression after SCI is substantially greater than that in the general medical population. These results underscore the importance of continued research on measuring depression in persons with SCI and on treatments for depression after SCI.
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Affiliation(s)
| | - Adrian Murray
- Department of Counseling, Educational Psychology, and Research, College of Education, Health and Human Sciences, University of Memphis, Memphis, TN
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Ullrich PM, Smith BM, Blow FC, Valenstein M, Weaver FM. Depression, healthcare utilization, and comorbid psychiatric disorders after spinal cord injury. J Spinal Cord Med 2014; 37:40-5. [PMID: 24090156 PMCID: PMC4066550 DOI: 10.1179/2045772313y.0000000137] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Depression is often comorbid with other psychiatric conditions in the general population, with resultant impact on severity of conditions and healthcare utilization. It is unclear to what degree this is also true among persons with spinal cord injury (SCI). OBJECTIVE This study examined rates at which psychiatric conditions were comorbid with depression after SCI, and the association between a depression diagnosis and healthcare and pharmaceutical drug use. METHODS Retrospective analysis of data (N = 41 213) abstracted from Veterans Health Administration administrative databases between fiscal years (FYs) 1997 and 2007 to examine overall rates of depression. Administrative data from FY 2007 was used to examine rates of psychiatric disorders comorbid with depression, and to compare veterans with SCI and depression to veterans with SCI but no depression on healthcare and pharmaceutical use. RESULTS Twenty-eight percent (n = 11 506) of 41 213 veterans who received SCI care between FY 1997 and FY 2007 were diagnosed with depressive disorders. Among the veterans with SCI and depression diagnoses in 2007 (n = 2615), 70% were also diagnosed with another psychiatric illness, with posttraumatic stress disorder and other anxiety disorders being the most common. Veterans with SCI and depression had more healthcare visits and received more pharmaceutical prescriptions than their counterparts without depression. CONCLUSIONS Persons with SCI and depression are likely to experience comorbid psychiatric illnesses, with associated increased healthcare visits and medication use. Research and theory on depression after SCI should develop toward describing and addressing psychiatric and medical co-morbidities that are normative in this population.
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Affiliation(s)
- Philip M. Ullrich
- Correspondence to: Phil Ullrich, VA Spinal Cord Injury and Disorders Services, 128 NAT, Puget Sound VA Medical Center, 1660 Columbian Way, Seattle, WA 98108, USA.
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Ji W, Hu S, Zhou J, Wang G, Wang K, Zhang Y. Tissue engineering is a promising method for the repair of spinal cord injuries (Review). Exp Ther Med 2013; 7:523-528. [PMID: 24520240 PMCID: PMC3919911 DOI: 10.3892/etm.2013.1454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/10/2013] [Indexed: 12/23/2022] Open
Abstract
Spinal cord injury (SCI) may lead to a devastating and permanent loss of neurological function, which may place a great economic burden on the family of the patient and society. Methods for reducing the death of neuronal cells, inhibiting immune and inflammatory reactions, and promoting the growth of axons in order to build up synapses with the target cells are the focus of current research. Target cells are located in the damaged spinal cord which create a connect with the scaffold. As tissue engineering technology is developed for use in a variety of different areas, particularly the biomedical field, a clear understanding of the mechanisms of tissue engineering is important. This review establishes how this technology may be used in basic experiments with regard to SCI and considers its potential future clinical use.
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Affiliation(s)
- Wenchen Ji
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China ; Department of Physiology, College of Medicine, University of Sydney, Sydney 2006, Australia
| | - Shouye Hu
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jiao Zhou
- Department of Surgery, The Third Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Gang Wang
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Kunzheng Wang
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Yuelin Zhang
- Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Lusilla-Palacios P, Castellano-Tejedor C, Lucrecia-Ramírez-Garcerán, Navarro-Sanchís JA, Rodríguez-Urrutia A, Parramon-Puig G, Valero-Ventura S, Cuxart-Fina A. Training professionals’ communication and motivation skills to improve spinal cord injury patients’ satisfaction and clinical outcomes: Study protocol of the ESPELMA trial. J Health Psychol 2013; 20:1357-68. [DOI: 10.1177/1359105313512351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acute spinal cord injury leaves patients severely impaired and generates high levels of psychological distress among them and their families, which can cause a less active role in rehabilitation, worse functional recovery, and less perceived satisfaction with the results. Additionally, rehabilitation professionals who deal with this psychological distress could ultimately experience higher stress and more risk of burnout. This article presents the study protocol of the ESPELMA project, aimed to train rehabilitation professionals in the clinical management of acute spinal cord injury–associated psychological distress, and to measure the impact of this training on the patients’ perceived satisfaction with treatment.
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Affiliation(s)
- Pilar Lusilla-Palacios
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Carmina Castellano-Tejedor
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
- Institut de Recerca Vall d’Hebron de Barcelona, Spain
| | - Lucrecia-Ramírez-Garcerán
- Universitat Autònoma de Barcelona, Spain
- Department of Rehabilitation and Traumatology, Hospital Universitari Vall d’Hebron, Spain
| | - José A Navarro-Sanchís
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Amanda Rodríguez-Urrutia
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Gemma Parramon-Puig
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Sergi Valero-Ventura
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Spain
- Universitat Autònoma de Barcelona, Spain
- Institut de Recerca Vall d’Hebron de Barcelona, Spain
| | - Ampar Cuxart-Fina
- Universitat Autònoma de Barcelona, Spain
- Department of Rehabilitation and Traumatology, Hospital Universitari Vall d’Hebron, Spain
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26
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Trapp SK, Lumpkin JM, Ellwood M. Neuropsychological Assessment and Treatment Following a Spinal Cord Injury and Alcohol Withdrawal. Clin Case Stud 2013. [DOI: 10.1177/1534650113504293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mr. Wellington, a 61-year-old veteran, was referred for a neuropsychological assessment and mental health treatment by his attending physician and psychologist following a spinal cord injury (SCI) and alcohol withdrawal. According to the referral, Mr. Wellington had been experiencing anxiety and depressive symptoms, as well as diminished cognitive functioning. These symptoms were considered to be interfering with his participation in SCI rehabilitation. Prior to the assessment, Mr. Wellington had sustained a tetraplegic injury due to a syrinx and partial L5 injury caused by an uncontrolled chronic bone infection and was receiving treatment at a Veteran’s Administration medical center. Results of the assessment, the related challenges in identifying the etiology of the patient’s diminished neurocognitive functioning, and mental health treatment are discussed.
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Affiliation(s)
| | - Jennifer M. Lumpkin
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
| | - Michael Ellwood
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
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Ullrich PM, Smith BM, Poggensee L, Evans CT, Stroupe KT, Weaver FM, Burns SP. Pain and post-traumatic stress disorder symptoms during inpatient rehabilitation among operation enduring freedom/operation iraqi freedom veterans with spinal cord injury. Arch Phys Med Rehabil 2012; 94:80-5. [PMID: 22864017 DOI: 10.1016/j.apmr.2012.07.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the frequency of post-traumatic stress disorder (PTSD) symptoms and pain, and how PTSD symptoms were associated with pain severity ratings and the longitudinal course of pain during inpatient rehabilitation for spinal cord injury (SCI) among veterans of the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) conflicts. DESIGN Longitudinal analysis of data gathered from electronic medical records. SETTING SCI specialty care centers within the Department of Veterans Affairs. PARTICIPANTS Veterans of the OEF/OIF conflicts (N=87) who received inpatient rehabilitation for SCI and disorders at Department of Veterans Affairs SCI centers between May 2003 and October 2009. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) PTSD screening at start of rehabilitation and pain numeric rating scale measurements completed throughout rehabilitation. Cut-scores were used to categorize participants into 1 of 4 groups on the basis of scores at the start of rehabilitation: Pain and PTSD, Pain Alone, PTSD Alone, Neither Condition. RESULTS Comorbid pain and PTSD symptoms were more common than either condition alone, and nearly as common as not having either condition. Participants with pain at the start of rehabilitation (Pain and PTSD, Pain-Alone groups) showed declines in pain ratings over the course of rehabilitation. In contrast, participants in the PTSD-Alone group showed increasing pain over the course of rehabilitation. CONCLUSIONS Pain and PTSD symptoms may be more likely to manifest as comorbidities than as isolated conditions during inpatient rehabilitation. Assessment routines and care plans should be prepared with comorbidities as a foremost concern. It is advisable to screen for pain and PTSD at multiple time points during inpatient rehabilitation to detect new or emerging concerns.
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Affiliation(s)
- Philip M Ullrich
- Department of Veterans Affairs, Spinal Cord Injury and Disorders Services, VA Puget Sound Healthcare System, Seattle, WA, USA.
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Soo J, Webber MP, Gustave J, Lee R, Hall CB, Cohen HW, Kelly KJ, Prezant DJ. Trends in probable PTSD in firefighters exposed to the World Trade Center disaster, 2001-2010. Disaster Med Public Health Prep 2011; 5 Suppl 2:S197-203. [PMID: 21900417 DOI: 10.1001/dmp.2011.48] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We present the longest follow-up, to date, of probable posttraumatic stress disorder (PTSD) after the 2001 terrorist attacks on the World Trade Center (WTC) in New York City firefighters who participated in the rescue/recovery effort. METHODS We examined data from 11,006 WTC-exposed firefighters who completed 40,672 questionnaires and reported estimates of probable PTSD by year from serial cross-sectional analyses. In longitudinal analyses, we used separate Cox models with data beginning from October 2, 2001, to identify variables associated with recovery from or delayed onset of probable PTSD. RESULTS The prevalence of probable PTSD was 7.4% by September 11, 2010, and continued to be associated with early arrival at the WTC towers during every year of analysis. An increasing number of aerodigestive symptoms (hazard ratio [HR] 0.89 per symptom, 95% confidence interval [CI] 0.86-.93) and reporting a decrease in exercise, whether the result of health (HR 0.56 vs no change in exercise, 95% CI 0.41-.78) or other reasons (HR 0.76 vs no change in exercise, 95% CI 0.63-.92), were associated with a lower likelihood of recovery from probable PTSD. Arriving early at the WTC (HR 1.38 vs later WTC arrival, 95% CI 1.12-1.70), an increasing number of aerodigestive symptoms (HR 1.45 per symptom, 95% CI 1.40-1.51), and reporting an increase in alcohol intake since September 11, 2001 (HR 3.43 vs no increase in alcohol intake, 95% CI 2.67-4.43) were associated with delayed onset of probable PTSD. CONCLUSIONS Probable PTSD continues to be associated with early WTC arrival even 9 years after the terrorist attacks. Concurrent conditions and behaviors, such as respiratory symptoms, exercise, and alcohol use also play important roles in contributing to PTSD symptoms.
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Affiliation(s)
- Jackie Soo
- Department of Medicine, Montefiore Medical Center, USA
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30
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Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil 2011; 92:411-8. [PMID: 21353823 DOI: 10.1016/j.apmr.2010.10.036] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 10/27/2010] [Accepted: 10/28/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe rates of probable major depression and the development and improvement of depression and to test predictors of depression in a cohort of participants with spinal cord injury (SCI) assessed at 1 and 5 years after injury. DESIGN Longitudinal cohort study. SETTING SCI Model System. PARTICIPANTS Participants (N=1035) who completed 1- and 5-year postinjury follow-up interviews from 2000 to 2009. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Probable major depression, defined as Physician Health Questionnaire-9 score of 10 or higher. RESULTS Probable major depression was found in 21% of participants at year 1 and 18% at year 5. Similar numbers of participants had improvement (25%) or worsening (20%) of symptoms over time, with 8.7% depressed at both 1 and 5 years. Increased pain (odds ratio [OR], 1.10), worsening health status (OR, 1.39), and decreasing unsafe use of alcohol (vs no unsafe use of alcohol; OR, 2.95) are risk factors for the development of depression at 5 years. No predictors of improvement in depression were found. CONCLUSION In this sample, probable major depression was found in 18% to 21% of participants 1 to 5 years after injury. To address this high prevalence, clinicians should use these risk factors and ongoing systematic screening to identify those at risk for depression. Worsening health problems and lack of effective depression treatment in participants with SCI may contribute to high rates of chronic or recurrent depression in this population.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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Stroud MW, Bombardier CH, Dyer JR, Rimmele CT, Esselman PC. Preinjury alcohol and drug use among persons with spinal cord injury: implications for rehabilitation. J Spinal Cord Med 2011; 34:461-72. [PMID: 22118253 PMCID: PMC3184483 DOI: 10.1179/2045772311y.0000000033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent spinal cord injury (SCI). DESIGN Survey. SETTING Acute inpatient rehabilitation program. PARTICIPANTS Participants were 118 (84.8%) of 139 consecutive admissions who met inclusion criteria and were screened for preinjury alcohol and drug use. INTERVENTIONS None. OUTCOME MEASURES Alcohol and drug use, toxicology results, alcohol problems, readiness to change, and treatment preferences. RESULTS Participants were on average 37 years old, 84% were men, and 85% were white. Fifty-one percent of the sample was considered 'at-risk' drinkers. Significant lifetime alcohol-related problems were reported by 38% of the total sample. Thirty-three percent reported recent illicit drug use and 44% of the 82 cases with toxicology results were positive for illicit drugs. Seventy-one percent of at-risk drinkers reported either considering changes in alcohol use or already taking action. Forty-one percent reported interest in trying substance abuse treatment or Alcoholics Anonymous (AA). Motivation to change alcohol use was significantly and positively associated with self-reported indicators of alcohol problem severity. CONCLUSION Preinjury alcohol and drug abuse are common among persons with recent SCI. Substance abuse screening is feasible and detects not only salient clinical problems but also significant motivation to change and interest in AA or treatment, all of which represent an important window of opportunity for appropriate brief interventions and referrals. In contrast with the idea that alcoholism is a 'disease of denial', the majority of at-risk drinkers with new onset SCI indicate they are considering making changes.
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Affiliation(s)
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Joshua R. Dyer
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Carl T. Rimmele
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and VA Puget Sound Health Care System, Seattle, WA, USA
| | - Peter C. Esselman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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