A systematic review of depression and anxiety measures used with individuals with spinal cord injury

Old age alters inflammation and autophagy signaling in the brain, leading to exacerbated neurological outcomes after spinal cord injury in male mice

Older patients with spinal cord injury (SCI) have different features with regard to neurological characteristics after injury. Recent large-scale longitudinal population-based studies showed that individuals with SCI are at a higher risk of developing dementia than non-SCI patients, indicating that SCI is a potential risk factor for dementia. Aging is known to potentiate inflammation and neurodegeneration at the injured site leading to impaired recovery from SCI. However, no research has been aimed at studying the mechanisms of SCI-mediated cognitive impairment in the elderly. The present study examined neurobehavioral and molecular changes in the brain and the underlying mechanisms associated with brain dysfunction in aged C57BL/6 male mice using a contusion SCI model. At 2 months post-injury, aged mice displayed worse performance in locomotor, cognitive and depressive-like behavioral tests compared to young adult animals. Histopathology in injured spinal cord tissue was exacerbated in aged SCI mice. In the brain, transcriptomic analysis with NanoString neuropathology panel identified activated microglia and dysregulated autophagy as the most significantly altered pathways by both age and injury. These findings were further validated by flow cytometry, which demonstrated increased myeloid and lymphocytes infiltration at both the injured site and brain of aged mice. Moreover, SCI in aged mice altered microglial function and dysregulated autophagy in microglia, resulting in worsened neurodegeneration. Taken together, our data indicate that old age exacerbates neuropathological changes in both the injured spinal cord and remote brain regions leading to poorer functional outcomes, at least in part, through altered inflammation and autophagy function.

Correlates of physical activity in ambulatory people with spinal cord injury during the first year after inpatient rehabilitation

STUDY DESIGN

Longitudinal cohort study.

OBJECTIVES

Examine the longitudinal association between mobility and level of physical activity (PA) and explore which other factors are also associated with level of PA in ambulatory people with Spinal Cord Injury (SCI) during the first-year post-inpatient rehabilitation.

SETTING

Three SCI-specialized rehabilitation centers and the Dutch community.

METHODS

Forty-seven adults with recent SCI and ambulatory function were included. All had motor incomplete lesions, 49% had tetraplegia, and the mean age was 55 ± 13 years. Duration of accelerometry-based all-day PA and self-reported level of mobility, exertion of walking, pain, fatigue, depressive mood symptoms, fear of falling, exercise self-efficacy, and attitude toward PA were measured just before discharge from inpatient rehabilitation and 6 and 12 months after discharge. All data were longitudinally analyzed using generalized estimating equations analyses. Models were corrected for age, lesion level, and time since injury.

RESULTS

Mobility was longitudinally associated with level of PA (beta: 4.5, P < 0.001, R2: 41%). In addition, lower levels of exertion of walking (beta: -5.6, P < 0.001), fear of falling (beta: -34.1, P < 0.001), and higher levels of exercise self-efficacy (beta: 2.3, P = 0.038) were associated with higher levels of PA. Exertion of walking and fear of falling were associated with level of PA independent of mobility.

CONCLUSIONS

Mobility, exertion of walking, fear of falling, and exercise self-efficacy seem to be correlates of level of PA in ambulatory people with SCI during the first year after inpatient rehabilitation. Targeting these factors using an interdisciplinary approach may enhance levels of PA in this population.

Role of NLRP3 Inflammasome in Post-Spinal-Cord-Injury Anxiety and Depression: Molecular Mechanisms and Therapeutic Implications

The majority of research on the long-term effects of spinal cord injury (SCI) has primarily focused on neuropathic pain (NP), psychological issues, and sensorimotor impairments. Among SCI patients, mood disorders, such as anxiety and depression, have been extensively studied. It has been found that chronic stress and NP have negative consequences and reduce the quality of life for individuals living with SCI. Our review examined both human and experimental evidence to explore the connection between mood changes following SCI and inflammatory pathways, with a specific focus on NLRP3 inflammasome signaling. We observed increased proinflammatory factors in the blood, as well as in the brain and spinal cord tissues of SCI models. The NLRP3 inflammasome plays a crucial role in various diseases by controlling the release of proinflammatory molecules like interleukin 1β (IL-1β) and IL-18. Dysregulation of the NLRP3 inflammasome in key brain regions associated with pain processing, such as the prefrontal cortex and hippocampus, contributes to the development of mood disorders following SCI. In this review, we summarized recent research on the expression and regulation of components related to NLRP3 inflammasome signaling in mood disorders following SCI. Finally, we discussed potential therapeutic approaches that target the NLRP3 inflammasome and regulate proinflammatory cytokines as a way to treat mood disorders following SCI.

Associations between physical activity, mental health concerns, eating disorder symptoms, and emotional intelligence in adolescent athletes transitioning from COVID-19

BACKGROUND

It is well known that COVID-19 significantly disrupted the routines of school sports for adolescent athletes. In transitioning from this "change event," athletes may need support with resuming their pre-pandemic level of activities, and addressing their ongoing mental health concerns, including exacerbated eating disorder symptoms. Emotional intelligence (the ability to understand emotions, influencing decisions and motivation) is a factor that has not yet been studied during this transition, but may serve as a coping mechanism for altered physical activity, mental health, and eating disorder symptoms.

METHODS

Participants of the study included 315 Iranian adolescent athletes who transitioned back to 1 of 10 sports post quarantine restrictions (January 2022-January 2023). Physical activity and related stages of motivation for behavioral change were assessed by the Physical Activity Stages of Change Questionnaire, mental health concerns were assessed by the General Health Questionnaire-28, eating disorder symptoms were assessed by the Eating Attitudes Test-26, and emotional intelligence was assessed by the Schutte Self-Report Emotional Intelligence Test.

RESULTS

A three-way Multivariate Analysis of Variance (MANOVA) was conducted in order to test the overall differences between the 5 physical activity and behavioral change motivation groups (Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance) on each of the 3 health measures (mental health concerns, eating disorder symptoms, and emotional intelligence); significant main effects were found for each measure. Fischer's Least Significant Difference Post-Hoc Test indicated that there were significant differences between the Pre-Contemplation and Preparation groups, as well as the Preparation and Action groups, on all of the health measure mean variable scores, which contributed to the MANOVA significant main effects.

CONCLUSIONS

Participants in the Pre-Contemplation group (not intending to make behavioral changes within the next 6 months) had less mental health, higher eating pathology, and lower emotional intelligence, compared to participants who were in the Preparation group (intending to make behavioral changes within the next 1 month). Similarly, participants in the Preparation group had less mental health, higher eating pathology, and lower emotional intelligence, compared to participants who were in the Action group (has made specific, overt behavioral changes within the preceding 6 months). Overall, the findings from the current study highlight the need for sports professionals working with adolescent athletes transitioning from COVID-19 to monitor these aspects of mental, eating, and emotional health. Given that those in earlier motivation stages had more health concerns compared to those in later stages, professionals should encourage progression from the Pre-Contemplation to Action/Maintenance stage in order to improve health outcomes.

Understanding the Relationships Between Sleep Quality and Depression and Anxiety in Neurotrauma: A Scoping Review

Sleep problems, depression, and anxiety are highly prevalent after a spinal cord injury (SCI) and traumatic brain injury (TBI) and may worsen functional outcomes and quality of life. This scoping review examined the existing literature to understand the relationships between sleep quality, depression, and anxiety in persons with SCI and TBI, and to identify gaps in the literature. A systematic search of seven databases was conducted. The findings of 30 eligible studies reporting associations between sleep quality and depression and/or anxiety after SCI or TBI were synthesized. The included studies were mostly cross-sectional and employed a range of subjective and objective measures of sleep quality. Poor subjective sleep quality and insomnia tended to be significantly associated with increased levels of depression and/or anxiety, but no such associations were reported when sleep quality was measured objectively. Two longitudinal studies observed worsening depressive symptoms over time were related to insomnia and persistent sleep complaints. Two interventional studies found that treating sleep problems improved symptoms of depression and anxiety. The findings of this review suggest that sleep and psychopathology are related in persons with neurotraumatic injuries. This has important therapeutic implications, because individuals may benefit from therapy targeting both sleep and psychological issues. More longitudinal and interventional studies are warranted to further understand the direction and strength of the relationships and how they impact patient outcomes.

Does the disposition of passive coping mediate the association between illness perception and symptoms of anxiety and depression in patients with spinal cord injury during first inpatient rehabilitation?

PURPOSE

To examine associations between illness perception, also called illness cognitions or appraisals, disposition of passive coping, and symptoms of anxiety and depression, and to test whether passive coping mediates the associations between illness perception and symptoms of anxiety and depression.

MATERIALS AND METHODS

Longitudinal, multicentre study. Participants were inpatients of spinal cord injury (SCI) rehabilitation. Measures included the Brief Illness Perception Questionnaire (B-IPQ), the Utrecht Coping List passive coping subscale (UCL-P), and the Hospital Anxiety and Depression Scale (HADS). Mediation was tested with the PROCESS tool.

RESULTS

The questionnaires were completed by 121 participants at admission and at discharge. Of them, 70% were male, 58% had a paraplegia, and 82% an incomplete lesion. Weak to strong (0.294-0.650) significant associations were found between each pair of study variables. The use of passive coping strategies mediated the associations between illness perception and symptoms of anxiety and depression.

CONCLUSION

Symptoms of anxiety and depression were more frequent in people who have a threatening illness perception combined with a lower use of passive coping strategies. Therefore, it is advised that patients are screened and treated for threatening illness perception and high use of passive coping strategies during rehabilitation after SCI.

The Roles of Stress, Sleep, and Fatigue on Depression in People with Visual Impairments

The study aimed to investigate the mediating effect of fatigue and the moderating effect of sleep quality on stress and depressive symptoms among people with visual impairments. A total of 155 participants completed the online survey. The Perceived Stress Scale, the Fatigue Symptom Inventory, the Centre for Epidemiological Studies-Depression Inventory (CES-D), and the Pittsburgh Sleep Quality Index (PSQI) were used. Descriptive analysis, correlations, and moderated mediation modelling were conducted using R software. From the mediator variable (FSI) model (F = 22.427, R2 = 56.5, p < .001) and the dependent variable (CES-D) model (F = 35.912, R2 = 70.5, p < .001), after controlling for age, sex, employment, and education, sleep quality positively predicted fatigue levels (β = 2.422, p = .009), and fatigue positively predicted depressive symptoms (β = .152, p < .001). Sleep quality is an essential component of psychological well-being in people with visual impairments.

Assessing the Feasibility of a Multimodal Approach to Pain Evaluation in Early Stages after Spinal Cord Injury

This research evaluates the feasibility of a multimodal pain assessment protocol during rehabilitation following spinal cord injury (SCI). The protocol amalgamates clinical workup (CW), quantitative sensory testing (QST), and psychosocial factors (PSF) administered at 4 (T1), 12 (T2), and 24 (T3) weeks post injury and at discharge (T4). Molecular blood biomarkers (BB) were evaluated via gene expression and proteomic assays at T1 and T4. Different pain trajectories and temporal changes were identified using QST, with inflammation and pain-related biomarkers recorded. Higher concentrations of osteopontin and cystatin-C were found in SCI patients compared to healthy controls, indicating their potential as biomarkers. We observed altered inflammatory responses and a slight increase in ICAM-1 and CCL3 were noted, pointing towards changes in cellular adhesion linked with spinal injury and a possible connection with neuropathic pain. Despite a small patient sample hindering the correlation of feasibility data, descriptive statistical analyses were conducted on stress, depression, anxiety, quality of life, and pain interferences. The SCI Pain Instrument (SCIPI) was efficient in distinguishing between nociceptive and neuropathic pain, showing a progressive increase in severity over time. The findings emphasize the need for the careful consideration of recruitment setting and protocol adjustments to enhance the feasibility of multimodal pain evaluation studies post SCI. They also shed light on potential early adaptive mechanisms in SCI pathophysiology, warranting the further exploration of prognostic and preventive strategies for chronic pain in the SCI population.

Computer assisted identification of stress, anxiety, depression (SAD) in students: A state-of-the-art review

Stress, depression, and anxiety are a person's physiological states that emerge from various body features such as speech, body language, eye contact, facial expression, etc. Physiological emotion is a part of human life and is associated with psychological activities. Sad emotion is relatable to negative thoughts and recognized in three stages containing stress, anxiety, and depression. These stages of Physiological emotion show various common and distinguished symptoms. The present study explores stress, depression, and anxiety symptoms in student life. The study reviews the psychological features generated through various body parts to identify psychological activities. Environmental factors, including a daily routine, greatly trigger psychological activities. The psychological disorder may affect mental and physical health adversely. The correct recognition of such disorder is expensive and time-consuming as it requires accurate datasets of symptoms. In the present study, an attempt has been made to investigate the effectiveness of computerized automated techniques that include machine learning algorithms for identifying stress, anxiety, and depression mental disorder. The proposed paper reviews the machine learning-based algorithms applied over datasets containing questionnaires, audio, video, etc., to recognize sad details. During the review process, the proposed study found that artificial intelligence and machine learning techniques are well recommended and widely utilized in most of the existing literature for measuring psychological disorders. The various machine learning-based algorithms are applied over datasets containing questionnaires, audio, video, etc., to recognize sad details. There has been continuous monitoring for the body symptoms established in the various existing literature to identify psychological states. The present review reveals the study of excellence and competence of machine learning techniques in detecting psychological disorders' stress, depression, and anxiety parameters. This paper shows a systematic review of some existing computer vision-based models with their merits and demerits.

Effect of the COVID-19 pandemic on individuals with spinal cord injury: Mental health and use of telehealth

INTRODUCTION

Limited access to health care services and the self-isolation measures due to the coronavirus disease 2019 (COVID-19) pandemic may have had additional unintended negative effects, affecting the health of individuals with spinal cord injury (SCI).

OBJECTIVES

To examine the perceived influence of the COVID-19 pandemic on individuals with SCI. First, this study looked to understand how the pandemic affected the use and perception of telehealth services for these individuals. Second, it investigated the effect of COVID-19 on mental health.

DESIGN

Cross-sectional online survey.

SETTING

Individuals with SCI living in the community in British Columbia, Canada.

PATIENTS

This survey was offered to individuals with SCI and had 71 respondents, with 34% living in a rural setting and 66% in an urban setting.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Telehealth utility, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), Fear of COVID-19 scale (FCV-19S), and Perceived Vulnerability to Disease (PVD).

RESULTS

Telehealth use in the SCI population has increased from 9.9% to 25.4% over the pandemic, with rates of telehealth use in urban centers nearing those of rural participants. Thirty-one percent of respondents had probable depression and 7.0% had probable generalized anxiety disorder as measured by a score of ≥10 on the PHQ-9 and GAD-7, respectively. The mean scores on FCV-19S and PVD were 17.0 (6.6 SD) and 4.29 (1.02 SD), respectively.

CONCLUSION

Telehealth use during COVID-19 has more than doubled. It is generally well regarded by respondents, although only a fourth of the SCI population has reported its use. With this in mind, it is important to understand the barriers to further adoption. In addition, higher rates of probable depression were seen than those estimated by pre-pandemic studies in other countries.

Association between Spinal Cord Injury and Alcohol Dependence: A Population-Based Retrospective Cohort Study

Spinal cord injury (SCI) is a devastating disorder. Alcohol abuse has been recognized as hindering SCI patients from rehabilitation, thus leading to longer length of days and poorer prognosis. This article aimed to investigate the association between spinal cord injury (SCI) and alcohol dependence. Data were derived from the National Health Insurance Research Database (NHIRD). The incidence of alcohol dependence between SCI and non-SCI groups was compared. Other possible risk factors were also analyzed. Patients (N = 5670) with SCI from 2000 to 2009 were initially assessed for eligibility. After propensity score matching, 5639 first-time SCI survivors were included. The Cox proportional hazard regression model was used to assess differences in the incidence of alcohol dependence syndrome. Based on the adjusted hazard ratios (HR), the SCI group had a higher hazard for alcohol dependence syndrome compared to the non-SCI group (adjusted HR: 1.39, 95% CI: 1.03~1.86, p = 0.0305). The injury level did not have an impact on the incidence of alcohol dependence syndrome. A higher incidence of alcohol dependence syndrome was related to male patients, lower insurance levels, higher Deyo’s CCI, and psychiatric OPD times. A lower incidence of alcohol dependence syndrome was related to elder age. The incidence of alcohol dependence increased after the occurrence of SCI and was also related to age, sex, monthly income, comorbidities, and psychiatric problems. The injury level did not affect the incidence of alcohol dependence after SCI.

Prevalência de sintomas de depressão e ansiedade em trabalhadores durante a pandemia da Covid-19

Resumo O estudo avaliou a prevalência de sintomas de depressão e ansiedade em uma amostra de trabalhadores brasileiros de diversos segmentos, durante a pandemia da Covid-19. Foi também verificada a correlação entre as escalas de ansiedade e depressão dos instrumentos de rastreio. Foram coletados dados on-line por meio de três instrumentos: questionário sociodemográfico e ocupacional, a Depression, Anxiety and Stress Scale - Short Form e o Inventário de Saúde Mental Ocupacional. Participaram 503 profissionais, destes 78,5% do sexo feminino, com idade média de 41,38 anos, das quais 92% cursaram o ensino superior e residiam na região Sul do Brasil. Ambas as escalas detectaram maior prevalência de sintomas de ansiedade em mulheres (54,3% e 59,9%) e em pessoas solteiras (68,8% e 68,1%). Houve associação significativa entre desfechos de sintomas de ansiedade e depressão e prevalência de duas variáveis independentes: o contato com pessoas diagnosticadas com Covid-19 e sentir-se preocupado com a pandemia. O Inventário de Saúde Mental Ocupacional mostrou maior sensibilidade para aferir sintomas de ansiedade e discriminar os trabalhadores que apresentam sintomas daqueles que indicam ter saúde mental, quando comparado ao outro instrumento. Sugerem-se estudos longitudinais para capturar os efeitos de longo termo dos desfechos avaliados, a fim de aperfeiçoar a análise dos preditores dos valores críticos e não críticos dos sintomas de agravos à saúde mental.

Potential usefulness of complete blood count parameters and inflammatory ratios as simple biomarkers of depression and suicide risk in drug-naive, adolescents with major depressive disorder

We determined whether an elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were associated with depression in major depressive disorder (MDD), or suicide risk in MDD patients. A total of 137 adolescents with MDD who were antidepressant-naïve and 56 healthy controls (HC) were included. Recent suicidal behaviors were assessed. The NLR, PLR, and MLR were calculated from parameters obtained from a routine complete blood cell count parameters and compared between the MDD subgroups and HC. Cohen's d was calculated as a measure of effect size. The linear relationship between biomarkers with depression severity or suicidality severity was also analysed. Changes in CBC parameters and inflammatory ratios appeared to be more closely related to the suicidality severity than depressive severity. As compared with HC, the WBC count, neutrophil percentage, platelet count, NLR, and PLR were higher in MDD, whereas the lymphocyte percentage was lower. As compared to non-suicidal ideation (non-SI) MDD and HC, the lymphocyte percentage was decreased in MDD with suicidal attempts (SA), whereas monocyte count and MLR were increased. Suicidal attempts in MDD patients were associated with the lower lymphocytes percentage, as well as the elevated monocyte count and MLR.

Augmented feedback for manual wheelchair propulsion technique training in a virtual reality simulator

BACKGROUND

Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback (AF) may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing AF with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion.

METHODS

Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency AF group received AF in the form of knowledge of performance throughout all propulsion training; the faded AF group received this AF in a faded schedule (high relative frequency of AF early in practice, with relative frequency of AF provision diminishing throughout practice); and the control group underwent training with no AF. Propulsion assessments were performed at baseline and 48 h after practice in both virtual and real environments to measure retention and transfer, respectively.

RESULTS

Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant between-group differences were also found between the high-frequency and faded feedback groups.

CONCLUSION

Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes AF regarding propulsion biomechanics.

Depression or anxiety symptoms associated with occupational role transitions in Brazilian adults with a traumatic spinal cord injury: A multivariate analysis

BACKGROUND

Psychological morbidity is commonly experienced by people with a spinal cord injury (SCI), but whether it is associated with occupational role transitions in is unknown.

OBJECTIVE

To analyze whether anxiety or depression symptoms are independently associated to increased likelihoods of role transitions in adults with SCI.

METHODS

Cross-sectional study; multivariate analysis using a heteroscedastic Dirichlet regression.

PARTICIPANTS

Thirty persons with traumatic SCI.

MEASURES

Role Checklist (e.g. role transitions: dependent variables) and Beck's Depression Inventory and State-Trait Anxiety Inventory (independent variables), adjusted for socio-demographic, functional, and injury-level confounders.

RESULTS

Greater depression symptoms independently increased the likelihood of occupational role transitions, either for roles loss [adjusted Odds Ratio (AOR): 1.04; 95% confidence interval (CI):1.009-1.080] or roles gain [AOR: 1.07; 95% CI:1.02-1.13], as opposed to continued occupational roles. Higher anxiety as a trait, in turn, independently reduced the likelihood of occupational roles gain [AOR: 0.93; 95% CI: 0.869-0.992]. The "worker" role was the one lost more frequently (83%).

CONCLUSION

Psychological morbidity is associated to occupational role transitions, as opposed to continued roles. Further research (e.g. with larger samples, longitudinal design, using structural equation modelling) should elucidate on the intricate relationships between mental health status and occupational role transitions in people experiencing SCI.

Trajectories of Self-Efficacy, Depressed Mood, and Anxiety From Admission to Spinal Cord Injury Rehabilitation to 1 Year After Discharge

OBJECTIVE

Self-efficacy (SE) is an important determinant for the psychological adjustment of people with spinal cord injury (SCI). However, little is known about the course of SE during inpatient rehabilitation up to 1 year after discharge. The aim of this study was to determine latent trajectory classes of SE, depressive mood, and anxiety in people with SCI, as well as the interrelationships between these trajectories.

DESIGN

Longitudinal inception cohort study.

SETTING

Eight specialized SCI rehabilitation centers.

PARTICIPANTS

The participants (N=268) were mainly men 183 of 268 (68.3%) with a mean age of 55.6 years. Almost half had a traumatic SCI 135 of 268 (50.4%) and tetraplegia (53.7%), and the minority had a motor complete SCI (32.2%).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

SE was measured using the University of Washington Self-Efficacy Scale. In addition, the Hospital Anxiety and Depression Scale was used to asses distress and perform dual trajectory modeling analyses.

RESULTS

Three trajectories of SE, indicating low, middle, and high SE, could be distinguished. Furthermore, a 2-class trajectory solution for depressive mood and a 4-class solution for anxiety were found to be most suitable. All trajectories were stable over time. Developmental connections between SE and depressive mood and between SE and anxiety were revealed. In particular, participants who adjusted well, reporting low scores on depressive mood and anxiety, could be identified by their high SE scores. However, the group of participants with high depressive mood scores and anxiety scores could not always be identified based on their SE trajectory.

CONCLUSIONS

In accordance with our hypotheses, distinct trajectories of SE, depressive mood, and anxiety were identified and high probabilities that SE trajectories were interrelated to the trajectories from depressive mood and anxiety were confirmed. Concurrent screening for SE and distress might best detect people at risk for adjustment problems.

Comparison of DASS-21, PHQ-8, and GAD-7 in a virtual behavioral health care setting

Background

Validated depression and anxiety symptom screeners are commonly used in clinical settings. How results from different brief depression and anxiety symptom assessment tools compare to each other is not well established, especially in real world healthcare settings. This study aimed to compare the Depression Anxiety Stress Scales 21 Depression scale (DASS-Depression) and Anxiety (DASS-Anxiety) scale to the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7 (GAD-7) respectively, in a real-world virtual behavioral healthcare setting.

Methods

This was a retrospective comparison study of clinical data from a population of adults who completed a consultation via telephone or secure video with a licensed therapist as part of a standardized, evidence-based, virtual behavioral therapy program for individuals with comorbid medical and behavioral health conditions. The joint distributions and correlations between scores yielded by each depression and anxiety scale were assessed using descriptive and Spearman correlation statistics.

Results

The DASS-Depression and PHQ-8 were highly correlated (r = .71; p=<.001); the DASS-Anxiety and GAD-7 correlation was also high (r = .61; p=<.001). The PHQ-8 categorized more individuals as having above-threshold depression scores versus the DASS-Depression (71.5% vs. 43.5%; p < .001). The GAD-7 categorized more individuals as having above-threshold anxiety scores versus the DASS-Anxiety (59.0% vs. 45.0%; p < .001).

Limitations

This study compared results yielded by validated screeners, precluding conclusions related to the validity of screener results.

Conclusions

The DASS-Depression and PHQ-8 and the DASS-Anxiety and GAD-7 similarly ranked symptom severity. The PHQ-8 and GAD-7 were more likely than the DASS-21 Depression or Anxiety scales to classify individuals as having above-threshold symptom severity.

Prevalence of depression among women with obstetric fistula in low-income African countries: a systematic review and meta-analysis

Depression is one of mental health consequences that present in women with obstetric fistula. It is estimated that over 264 million people of all ages suffer from depression globally. The objective of this systematic review and meta-analysis was to synthesize the epidemiologic evidence from previous studies on the prevalence of depression among women with obstetric fistula in low-income African countries. We followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines to conduct this meta-analysis. The common databases (PubMed, SCOPUS, EMBASE, Psych INFO, Google Scholar, African Index Medicus, and African Journals Online (AJOL)) were searched for the relevant literature. We used a random-effect meta-analysis model to estimate the overall prevalence of depression and the Q -and I² -statistics were used to assess the heterogeneity between the studies included in the meta-analysis. Egger's test and visual inspection of the symmetry in funnel plots were used to check for the presence of publication bias. The pooled estimated prevalence of depression among women with obstetric fistula in low-income African countries was 56.2% (95% CI 43.1-68.4). The prevalence of depression among women with obstetric fistula was 74.4% in Ethiopia, 72.9% in Kenya, 46.0% in Malawi, 41.0% in Sudan, 34.8% in Nigeria, and 27.7% in Tanzania. Furthermore, the prevalence of depression was higher (97.0%) when it was measured by using Beck's Depression Inventory (BDI) when compared with Patient Health Questionnaire (PHQ9) (62.7%), General Health Questionnaire (GHQ-28) (36.7%), Hamilton Depression Rating Scale (HDRS) (41.0%), and Center for Epidemiologic Studies Depression Scale (CES-D) (27.7%). Moreover, the pooled estimated prevalence of depression among women with obstetric fistula was ranged from 48.1 to 57.7% in a leave-one-out sensitivity analysis. The prevalence of depression among women with obstetric fistula in low-income African countries was high. Screening and appropriate management of depression among women with obstetric fistula are warranted.

Post-traumatic stress disorder symptoms and pain intensity in persons with spinal cord injury

STUDY DESIGN

Cross-sectional.

OBJECTIVES

To examine the association between post-traumatic stress disorder (PTSD) symptoms and pain intensity, taking symptoms of anxiety and depression into account within persons with spinal cord injury (SCI).

SETTING

Persons with SCI, who visited a Dutch rehabilitation centre between 2005 and 2010, were invited to complete a survey.

METHODS

PTSD symptoms were measured with the Trauma Screening Questionnaire (TSQ), pain intensity with an 11-point Numerical Rating Scale (NRS), and symptoms of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). To determine associations between PTSD symptoms and pain intensity, linear regression analyses were performed. Confounding variables representing anxiety and depression were added to the final model.

RESULTS

In total, 175 participants (55.8% traumatic, 29.1% complete) were included (response rate of 31.7%). Of them, 11.4% had clinically relevant symptoms of probable PTSD (TSQ score ≥ 6) 69.8% experienced moderate to severe pain levels (NRS ≥ 4), 14.9% had symptoms of anxiety and 20.8% symptoms of depression (HADS scores ≥ 11). Levels of PTSD symptoms were strongly associated with symptoms of anxiety (0.54) and depression (0.49). Bivariate analyses showed a moderate significant association (0.30) between PTSD symptoms and pain intensity. This association became small (0.10) when anxiety and depression comorbidity were factored into the final regression model.

CONCLUSIONS

No independent association between PTSD symptoms and pain intensity was shown when adjusted for anxiety and depression. Results of this study suggest the usefulness of screening for PTSD in persons with SCI (regardless of injury cause or type/level) who score high on symptoms of anxiety/depression.

Clinical and sociodemographic profiles of persons with spinal cord injury

AIM

To collect and correlate the sociodemographic and clinical details of persons with spinal cord injury who were admitted to the Department of Neurological Rehabilitation.

OBJECTIVES

To assess the sociodemographic characteristics and collect the clinical profiles of persons with spinal cord injury and to correlate their sociodemographic and clinical details.

MATERIALS AND METHODS

A retrospective file review was done over a period of 2 years from January 2017 to December 2018 to study patients with spinal cord injury who were admitted to the Neurological Rehabilitation ward of NIMHANS, Bengaluru, Karnataka, India.

RESULTS

A total of 60 patients were admitted with spinal cord injury. The mean age was 32.39 years and majority of the patients were young married males. Most of them belong to the low socioeconomic status and are housewives and daily wage laborers. Falls and road traffic accidents are the causes for the injury. Anxiety and depression are high among traumatic spinal cord injury patients.

CONCLUSION

This information may contribute to prevent SCI and to improve the quality of life of patients with SCI. It has implications for the primary care physicians who are at first contact to identify and refer them for specialized super speciality district hospitals for further treatment as they pose a great threat to public health and their proportions are increasing. It is imperative that trauma care is included in graduate medical training as well to facilitate early intervention after initial screening.

Identifying unique profiles of perceived dyspnea burden in heart failure

BACKGROUND

Dyspnea is a common symptom of heart failure (HF) but dyspnea burden is highly variable.

OBJECTIVES

Identify distinct profiles of dyspnea burden and identify predictors of dyspnea symptom profile.

METHODS

A secondary analysis of data from five studies completed at Oregon Health and Science University was conducted. The Heart Failure Somatic Perception Scale was used to measure dyspnea burden. Latent class mixture modeling identified distinct profiles of dyspnea burden in a sample of HF patients (n = 449). Backwards stepwise multinomial logistic regression identified predictors of latent profile membership.

RESULTS

Four profiles of dyspnea burden were identified: no dyspnea/not bothered by dyspnea, mild dyspnea, moderate exertional dyspnea, and moderate exertional dyspnea with orthopnea and PND. Higher age was associated with greater likelihood of not being bothered by dyspnea than having moderate exertional dyspnea with orthopnea and PND. Higher NYHA class, anxiety, and depression were associated with greater likelihood of greater dyspnea burden.

CONCLUSIONS

Burden of dyspnea is highly variable among HF patients. Clinicians should account for the nuances of dyspnea and the activities that induce dyspnea when assessing HF patients.

Investigating the Relationship between Religious Beliefs with Care Burden, Stress, Anxiety, and Depression in Caregivers of Patients with Spinal Cord Injuries

Spinal cord injury (SCI) is one of the most severe diseases associated with the central nervous system of the individuals, which can lead to disability in the patient. The aim of the present study was to determine the relationship between religious beliefs with CG, depression, anxiety and stress (DAS) in caregivers of patients with SCI in the city of Ilam, Iran. This is a descriptive-analytic article, and the study population were caregivers of patients with SCI. A sample size of 150 patients was selected according to previous studies. The questionnaires used for data collection included Religious Coping Questionnaire (RC), Caregiver Questionnaire (CG), and Depression, Anxiety and Stress Scale-21 (DASS-21) Items. In this study, caregivers of patients with SCI were included in the study using convenience sampling method in Ilam city. The researchers identified patient caregivers who met the inclusion criteria. The research objectives were described for caregivers, and the questioners were initiated if caregivers were willing to participate in the study. Literate caregivers completed questionnaires through interviews, and trained questioners completed for illiterate caregivers in the same way (interviewing). Data were analyzed using spss 16 statistical software, and descriptive and analytical methods were used for statistical analysis. According to the findings, the mean (SD) of RC is 18.41 (2.73), negative RC is 7.05 (2.06), positive RC is 11.36 (1.89), stress is 10.78 (6.27), anxiety is 10.12 (5.58), depression is 10.50 (3.08), and CG is 78.16 (27.09). There is a significant relationship between RC levels with stress (P = 0.000, F = 40.565), anxiety (P = 0.000, F = 45.300), and CG (P = 0.000, F = 37.332), but there was no relationship between the RC level with depression status (P = 0.42, F = 0.634). Considering that religion can affect the level of CG, stress, and anxiety of the caregivers of the patients, it is suggested to provide necessary conditions to improve the health status of caregivers of patients with SCI by improving the religion status in patients and performing appropriate interventions in this regard.

Web-Based Health Coaching for Spinal Cord Injury: Results From a Mixed Methods Feasibility Evaluation

Background

Individuals with spinal cord injury (SCI) are at high risk of experiencing secondary conditions like pressure injuries. Self-management programs may reduce the risk of complications, but traditional programs have proven to be insufficiently tailored to the needs of people with SCI. To overcome barriers to self-management support, a web-based, self-management program was developed for Canadians with SCI called SCI & U.

Objective

This study aims to evaluate the feasibility and potential impact of the SCI & U program in the context of a mixed methods pilot study.

Methods

The study followed an explanatory, sequential mixed methods design. Participants (N=11) were Canadians with SCI who had been living in the community for more than 1 year. Each took part in a self-paced, six-session self-management program guided by a trained peer health coach. During sessions, participants could discuss a health topic with their coach from a predefined list (eg, skin or bowel management). Quantitative data were gathered before and after program participation to assess program feasibility and impact. Feasibility measures included attrition rates, frequency of topics selected, and recorded goals, whereas impact measures included measures of self-efficacy (University of Washington Self-Efficacy Scale [UW-SES]), mood (Personal Health Questionnaire Depression Scale [PHQ-8]), secondary conditions (Spinal Cord Injury Secondary Conditions Scale [SCI-SCS]), and resilience (Spinal Cord Injury Quality of Life Resilience Scale [SCI-QOL-R]). Qualitative measures were based on postintervention interviews; these were designed to confirm and expand on quantitative

Results

Of the 11 participants, 10 completed pre- and postassessments, and 6 coaching sessions. Sessions lasted between 31 and 81 min (average 55, SD 13), and the duration of the program ranged from 35 to 88 days (average 56, SD 23). Diet and exercise were selected as topics 40% (20/50 sessions with topics) of the time, whereas topics such as mental health, bladder management, pain, and bowel management were chosen less frequently. Results gathered before and after the pilot study demonstrated improvements with moderate effect sizes on the UW-SES and the electronic health literacy scale (ie, Hedges g>0.5). Effect sizes for measures of resilience (SCI-QOL-R), depression (PHQ-8), and secondary conditions (SCI-SCS) were small (ie, Hedges g>0.3). Qualitative results confirmed a common focus on diet and exercise, and defined coaches as sources of accountability, information, reassurance and affirmation, and emotional and technical support.

Conclusions

Results demonstrated that a web-based self-management program is feasible and acceptable by Canadians with SCI. Results also indicated a web-based, peer-led self-management program may impact resilience, self-efficacy, mood, and secondary complications. Finally, results illuminated the role of the coach in facilitating behavior change. Future work seeks to validate results in the context of a randomized controlled trial.

Effect of a mindfulness intervention on patients admitted after multisystem trauma

Background

The incidence of depression, anxiety, and post-traumatic stress disorders is reported to be as high as 50% in trauma patients. The perpetual negative emotions and state of mind in these disorders predisposes patients to negative mental health outcomes. Mindfulness, on the other hand, helps people to process their experience and emotions in a non-judgmental manner, and recently, there has been increased utilization of mindfulness-based therapies for the treatment of mental health conditions. This proof-of-concept study evaluates the use of a mindfulness-based online application in patients admitted to the trauma service at a Level 1 Trauma Centre.

Methods

Trauma patients who were English speaking, over the age of 18, and without brain injury or pre-existing neurocognitive disorder were included. Participants completed the Depression Anxiety Stress Scale (DASS)-21 to assess level of depression, anxiety, and stress, and the Connor-Davidson Resilience Scale (CD-RISC) to assess level of resiliency. Then, after 28 consecutive days of practicing mindfulness using the app ‘Stop, Breathe, and Think,’ the questionnaires were repeated and an exit survey conducted.

Results

For this study, 13 participants were enrolled, 2 withdrew, and 5 were lost to follow-up. The mean DASS-21 score at time enrollment was 16.4 and was 11.2 at follow-up ( p = 0.10). There were no differences between the level of depression and stress from enrollment to follow-up, but there was significant decrease in anxiety symptoms from 7.2 to 3.0 (<0.05). CD-RISC scores at enrollment and follow-up were 77.8 and 81 ( p = 0.23), respectively. At the time of exit interview, 67% of patients continued to use the application three to four times a week and 67% responded they plan to continue using the application. In addition, 83% of patients always or often felt better after practicing mindfulness and stated they would recommend the application to others.

Conclusions

Mindfulness shows promising potential to decrease psychological distress in trauma patients.

Urban Heat Island Monitoring and Impacts on Citizen’s General Health Status in Isfahan Metropolis: A Remote Sensing and Field Survey Approach

Urban heat islands (UHIs) are one of the urban management challenges, especially in metropolises, which can affect citizens’ health and well-being. This study used a combination of remote sensing techniques with field survey to investigate systematically the effects of UHI on citizens’ health in Isfahan metropolis, Iran. For this purpose, the land surface temperature (LST) over a three-year period was monitored by Landsat-8 satellite imagery based on the split window algorithm. Then, the areas where UHI and urban cold island (UCI) phenomena occurred were identified and a general health questionnaire-28 (GHQ-28) was applied to evaluate the health status of 800 citizens in terms of physical health, anxiety and sleep, social function, and depression in UHI and UCI treatments. The average LST during the study period was 45.5 ± 2.3 °C and results showed that the Zayandeh-Rood river and the surrounding greenery had an important role in regulating the ambient temperature and promoting the citizens’ health. Citizens living in the suburban areas were more exposed to the UHIs phenomena, and statistical analysis of the GHQ-28 results indicated that they showed severe significant (P < 0.05) responses in terms of non-physical health sub-scales (i.e., anxiety and sleep, social functioning, and depression). Therefore, it can be concluded that not all citizens in the Isfahan metropolis are in the same environmental conditions and city managers and planners should pay more attention to the citizens living in the UHIs. The most important proceedings in this area would be the creation and development of parks and green belts, as well as the allocation of health-medical facilities and citizen education.

The Relationship Between Psychological and Physical Secondary Conditions and Family Caregiver Burden in Spinal Cord Injury: A Correlational Study

Background: Caregiver burden (CB) is a consequence of providing care to people with spinal cord injury (SCI). However, there is a lack of clarity about the influence of secondary conditions of care recipients on family caregivers. Secondary conditions refer to the physical and psychological complications that can occur after SCI and lead to increased hospitalization and reduced functionality, quality of life, and social participation. Objective: To assess the impact of physical and psychological secondary conditions of people with SCI on the perceived burden of family caregivers. Methods: A multicenter, cross-sectional study of 56 dyads of family caregivers and individuals with SCI in two urban spinal units in Italy and Ireland. Care recipients completed a toolset consisting of demographic information and assessments of functional, physical, and psychological health. Caregivers completed a multidimensional measure of CB. Bivariate data analysis was used. Results: No significant differences between centers were identified. CB was found to be related to physical secondary conditions and functional independence but not to mental health of care recipients. Bladder dysfunction and urinary tract infections influenced all dimensions of CB, whereas pressure injuries influenced only the time-dependent dimension. Level and completeness of injury and duration of caregiving increased CB. Conclusion: Findings indicate the value of a reduction in secondary conditions not just for individuals with SCI but also for their family caregivers. To reduce the individual and family burden of secondary conditions, a two-pronged, multidimensional approach, focusing on self-management for care recipients and psychoeducational support for caregivers, is required.

Factors influencing depression in individuals with traumatic spinal cord injury and caregivers' perceived burden in a low-income country: a cross-sectional study

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.

Safety and Feasibility of Various Functional Electrical Stimulation Cycling Protocols in Individuals With Multiple Sclerosis Who Are Nonambulatory

Objective

To examine the safety, feasibility, and response to functional electrical stimulation (FES) cycling protocols requiring differing levels of effort in people with multiple sclerosis (MS) who are nonambulatory.

Design

Pilot study with pre-post intervention testing.

Setting

Outpatient clinic setting of a long-term acute care hospital.

Participants

Individuals (N=10) with MS (6 men; mean age 58.6±9.86y) who use a wheelchair for community mobility. Participants’ Expanded Disability Status Scale score ranged from 6.5 to 8.5 (median 7.5).

Intervention

Participants performed 3 or 4 FES cycling protocols requiring different levels of volitional effort during 6-8 testing sessions.

Main Outcome Measures

The primary outcome was safety, measured by adverse events and increase in MS symptoms, all assessed throughout, immediately post- and 1 day postsession. FES cycling performance for each protocol was also recorded. Exploratory outcome measures collected before and after all testing sessions included functional assessment of MS, MS Impact Scale, Exercise Self Efficacy Scale, Patient Health Questionnaire-9 item, and the Zarit Caregiver Burden Scale.

Results

All participants (4 women, 6 men) completed all testing sessions. There were no serious adverse events or differences in vitals or symptoms between protocols. Two participants had an isolated episode of mild hypotension. Changes in pain, spasticity, and fatigue were minimal. Five participants were able to cycle for 30 minutes and completed interval training protocols requiring increasing difficulty. The remainder cycled for <3 minutes and completed a rest interval protocol. There was modest improvement on the exploratory outcome measures.

Conclusions

People with MS who use a wheelchair for community mobility can safely perform FES cycling requiring more effort than previously reported research. Therefore, the individuals may experience greater benefits than previously reported. Further study is required to better understand the potential benefits for optimizing function and improving health in people with MS.

•

People with multiple sclerosis who are nonambulatory can safely perform functional electrical stimulation (FES) cycling using parameters requiring more effort.

•

FES cycling may offer an opportunity for increased exercise stimulus or neuromuscular training if individuals are adequately challenged using an appropriate cycling protocol.

Comparison of psychiatric comorbidity in treatment-seeking, opioid-dependent patients with versus without chronic pain

AIM

To compare psychiatric morbidity in treatment-seeking, opioid-dependent patients with versus without chronic pain.

DESIGN

A retrospective comparative cohort design was used involving record linkage from routinely collected, nationally held data sets. Data were managed within a Scottish Government-certified Safe Haven.

SETTING AND PARTICIPANTS

Participants comprised all patients of an NHS Substance Misuse Service in the East of Scotland (n = 467) who were in treatment during 2005 and had been in treatment for varying lengths of time. Their mean age at study inception was 35.0 years in the chronic pain group and 32.1 years; 68% of the chronic pain group and 74% of the no pain group were male.

MEASUREMENTS

The outcomes were (a) psychiatric comorbidity assessed at study inception using the 28-item General Health Questionnaire and the Clinical Outcomes in Routine Evaluation-Outcome Measure and (b) receipt of at least one prescription for a psychiatric condition during a 5-year period following study inception. The independent variable was chronic pain measured at study inception using the Brief Pain Inventory-Short Form.

FINDINGS

A total of 246 (52.7%) reported chronic pain and 221 (47.3%) did not. A higher proportion of patients with chronic pain had at least one psychiatric morbidity (62.4 versus 46.3%, P < 0.001). At the study inception, a higher proportion of patients with chronic pain were prescribed anxiolytics (49.0 versus 39.1%, P = 0.015) and antimanic drugs (9.9 compared with 4.9%, P = 0.015).

CONCLUSIONS

Patients of opioid treatment services in Scotland who report chronic pain may have a higher prevalence of psychiatric comorbidity than those who do not.

Promoting psychological health in women with SCI: Development of an online self-esteem intervention

BACKGROUND

There are no known interventions addressing self-esteem in women following spinal cord injury (SCI).

OBJECTIVES

To test the feasibility of an online self-esteem intervention for women with disabilities, as modified for women with SCI.

METHOD

We conducted a randomized, controlled feasibility test of a self-esteem intervention (N = 21). Participants were randomly assigned to the intervention or control group that received intervention materials at the end of the study. Intervention participants met as avatars for 7 weekly real-time group sessions in Second Life (SL), a free online virtual world. Feasibility indicators were study engagement, acceptability of SL and the intervention, and improvements on measures of psychological health promoting behaviors, social support, self-efficacy, self-esteem, and depression.

RESULTS

Intervention participants (n = 10) were highly engaged, and most described the SL program as more enjoyable and more convenient than in-person programs. All rated the intervention as "good" (n = 4) or "very good" (n = 6), and all 10 rated themselves has having made positive life changes as a result of the program. Intervention participants experienced significantly greater change than controls on two measures of health-promoting behavior (Health Promoting Lifestyle Profile-II Spiritual Growth/Self-actualization; Interpersonal Relations). Examining change in the intervention group using regression analyses, we found medium-to-large effects of the intervention on these behaviors and measures of depression (CESD-10, PHQ-9). The intervention had small effects on remaining measures.

CONCLUSION

We found preliminary support for the feasibility of this modified self-esteem intervention offered in SL. Such programming may help circumvent barriers to community-based psychological services and may improve psychological health.

Diagnostic accuracy and feasibility of depression screening in spinal cord injury: A systematic review

Context: Individuals with spinal cord injury or disease (SCI/D) are at increased risk of depression, which is associated with poor short- and long-term outcomes. Accurate diagnosis is complicated by overlapping symptoms of both conditions, and a lack of consensus-derived guidelines specifying an appropriate depression screening tool. Objective: To conduct a systematic review to: (1) identify the diagnostic accuracy of established depression screening tools compared to clinical assessment; and, (2) to summarize factors that influence feasibility of clinical implementation among adults with SCI/D. Methods: A systematic search using MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane databases using the terms spinal cord injury, depression or mood disorder, and screening or diagnosis identified 1254 initial results. Following duplicate screening, five articles assessing eight screening tools met the final inclusion and exclusion criteria. Measures of diagnostic accuracy and feasibility of implementation were extracted. The Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2) was used to assess study quality. Results: The Patient Health Questionnaire-9 (PHQ-9) had the highest sensitivity (100%), and specificity (84%). The 2-item version, the PHQ-2, comprised the fewest questions, and six of the eight tools were available without cost. Utilizing the QUADAS-2 tool, risk of bias was rated as low or unclear risk for all studies; applicability of the results was rated as low concern. Conclusion: The PHQ-9 is an accurate and feasible tool for depression screening in the adult SCI/D population. Future studies should evaluate the implementation of screening tools and the impact of screening on access to mental health interventions.

Development of Emotional Well-Being indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context: Emotional Well-Being (EWB) post-spinal cord injury or disease (SCI/D) is a critical aspect of adjustment to disability. Advancing care and assuring equity in care delivery within this rehabilitation care domain is essential. Herein, we describe the selection of EWB structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods: A pan-Canadian Working Group completed the following tasks: (1) defined the EWB construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with EWB; and, (4) prepared a process map. Facilitated meetings allowed selection and review of feedback following rapid-cycle evaluations of proposed structure, process and outcome indicators. Results: The structure indicator is the proportion of staff with appropriate education and training in EWB and access to experts and resources. The process indicator is the proportion of SCI/D patients who were screened for depression and anxiety symptoms at rehabilitation admission and rehabilitation discharge. The intermediary outcome is the proportion of SCI/D patients at risk for depression or anxiety at rehabilitation discharge based on screening symptom scores. The final outcomes are: (a) proportion of individuals at risk for depression or anxiety based on screening symptom scores; and (b) proportion of individuals who received referral for EWB services or intervention. Conclusion: The proposed indicators have a low administrative burden and will ensure feasibility of screening for depression and anxiety at important transition points for individuals with SCI/D. We anticipate that the current structures have inadequate resources for at-risk individuals identified during the screening process.

The comparison of general health in athlete and non-athlete women

The aim of the present study was to compare the general health in athlete and non-athlete women. The statistical population of the present study included all athlete and non-athlete women in Shiraz, Iran. The sample consisted of 764 subjects (382 athletes, 382 non- athletes) that the athletes sample selected by Gerjesy and Morgan’ sample size table and non-athletes sample selected by purposeful sampling method. The General Health Questionnaire (Goldberg, 1978) was used for measuring the general health. Independent t-test and multivariate analysis of variance (MANOVA) tests were used for data analysis. The results showed a significant difference between athlete and non-athlete women in the general health and its subscales (p<0.05). According to this finding, general health in athletes is better than non-athlete women. Regarding the findings of this study, it can be argued that sport activities are effective in improving general health of women.

Measuring resilience with the Connor-Davidson Resilience Scale (CD-RISC): which version to choose?

STUDY DESIGN

Cross-sectional psychometric study.

OBJECTIVES

To compare psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) with 25, 10, and 2 items, and to assess the agreement between these versions in individuals with spinal cord injury (SCI).

SETTING

Standard psychological screening at a Dutch rehabilitation centre during the first 2 weeks of inpatient rehabilitation.

METHODS

Anonymous data from the psychological screening were analysed. CD-RISC outcomes were checked for floor and ceiling effects. Internal consistency was assessed by calculating Cronbach's α. Convergent validity was assessed by Spearman's correlation between resilience and anxiety, depression, passive coping, and life satisfaction. Agreement between CD-RISC versions was examined by calculating intraclass correlation coefficients (ICCs), corresponding 95% confidence intervals (CIs), and Bland-Altman plots.

RESULTS

Total CD-RISC scores were only skewed on the CD-RISC 2 (-1.12). There were no floor and ceiling effects. Internal consistency of the 25-, 10-, and 2-item scales was good to moderate (0.90, 0.86, and 0.66, respectively). Good convergent validity was shown only for the CD-RISC 10. Agreement was highest between the CD-RISC 25 and CD-RISC 10 with an ICC of 0.90 with 95% CI from 0.85 to 0.94.

CONCLUSIONS

Out of the three CD-RISC versions, the CD-RISC 10 showed the best combination of reliability, validity, and practicality. Therefore, this version is advised as measure of resilience in individuals with SCI in a rehabilitation setting. Measurement of resilience could be part of a psychological screening to identify individuals at risk to develop psychological problems after SCI.

The 21-Item and 12-Item Versions of the Depression Anxiety Stress Scales: Psychometric Evaluation in a Korean Population

PURPOSE

This study aimed to evaluate the psychometric properties of the Depression Anxiety Stress Scales 21 and 12 in a Korean population.

METHODS

The Depression Anxiety Stress Scales were translated into Korean using a translation and back-translation technique, and the content validity was assessed by an expert panel. Participants were recruited from six community health centers (n = 431) and two community mental health centers (n = 50). A field test of the psychometric properties of the instruments was conducted using confirmatory factor analysis with bootstrap maximum likelihood estimation involving 1,000 samples, Pearson's analysis, t test, and Cronbach's α coefficient.

RESULTS

Confirmatory factor analysis of the Depression Anxiety Stress Scales 21 and 12 supported both three-factor and second-order three-factor models. The Scales 21 and 12 satisfied convergent validity with the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Perceived Stress Scale-10 and discriminant validity with the Rosenberg Self-Esteem Scale. The scores for the Depression Anxiety Stress Scales 21 and 12 were higher for the psychiatric group than for the nonpsychiatric group, confirming the presence of known-groups validity. The Depression Anxiety Stress Scales 21 and 12 exhibited moderate-to-strong correlations with the Negative Affect. Cronbach's α coefficients for the Depression Anxiety Stress Scales 21 and 12 were .93 and .90, respectively.

CONCLUSION

The Depression Anxiety Stress Scales 21 and 12 appear to be acceptable, reliable, and valid instruments. However, the shorter Depression Anxiety Stress Scales 12 may be more feasible to use in a busy practice and also be less burdensome to respondents.

Cognitive function after spinal cord injury: A systematic review

OBJECTIVE

To systematically examine the incidence of cognitive impairment in individuals with spinal cord injury (SCI), as well as identify potential contributing and confounding factors.

METHODS

Studies quantitatively reporting cognitive ability after spinal cord injury were searched electronically via Medline, CINAHL, Embase, and PsycINFO. Manual screening for references within articles was also performed. A total of 2,481 studies were screened and a total of 70 were included in this review, 21 reporting cognitive function after SCI compared to an able-bodied control group and 49 with no able-bodied controls. Studies were analyzed for the incidence of impairment and the interactions with concomitant traumatic brain injury, psychological or somatic complaints, decentralized cardiovascular control, sleep apnea, neurologic level of injury, and age.

RESULTS

There is a high volume of evidence reporting substantial cognitive impairment in individuals with SCI. Potential co-contributors include concomitant brain injury, psychological or somatic comorbidities, decentralized cardiovascular control, and sleep apnea. Cognitive functioning was negatively correlated with age. No clear agreement was found for the incidence of cognitive impairment or its association with level of injury.

CONCLUSION

Current evidence suggests that individuals with SCI should be examined and addressed for cognitive impairment. Future studies aimed at identifying potential secondary causative factors should employ stringent controls for co-occurring brain trauma since it appears to be a major contributor and confounder to impaired cognition.

Coping Flexibility as Predictor of Distress in Persons With Spinal Cord Injury

OBJECTIVES

Examine whether coping flexibility at admission to first spinal cord injury (SCI) rehabilitation was predictive of distress 1 year after discharge.

DESIGN

Longitudinal inception cohort study.

SETTING

Rehabilitation center.

PARTICIPANTS

Of the 210 people admitted to their first inpatient SCI rehabilitation program, 188 met the inclusion criteria. n=150 (80%) agreed to participate; the data of participants (N=113) with a complete dataset were used in the statistical analysis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Coping flexibility was operationalized by (1) flexible goal adjustment (FGA) to given situational forces and constraints and (2) tenacious goal pursuit (TGP) as a way of actively adjusting circumstances to personal preference. The Assimilative-Accommodative Coping Scale was used to measure FGA and TGP. The Hospital Anxiety and Depression Scale was used to assess distress.

RESULTS

Scores on FGA and TGP measured at admission were negatively associated with the scales depression (r= -.33 and -.41, respectively) and anxiety (r= -.23 and -.30, respectively) 1 year after discharge. All demographic and injury-related variables at admission together explained a small percentage of the variance of depression and anxiety. FGA, TGP, and the interaction term together explained a significant additional 16% of the variance of depression and 10% of anxiety.

CONCLUSIONS

The tendency to pursue goals early postonset of the injury seems to have a protecting effect against distress 1 year after discharge. People with low TGP may experience protection against distress from high FGA.

Prevalence and Correlates of Psychological Distress among Retired Elite Athletes: A Systematic Review

This article presents results of a systematic review of the literature (2000-2017) examining the prevalence and correlates of psychological distress among retired elite athletes. Forty articles were selected and included. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. However, subgroups reporting medical comorbidities, significant pain, a greater number of concussions, less social support, and adverse psychosocial factors were at greater risk for psychological distress. Additionally, athletes experiencing psychological distress in retirement often do not seek treatment for their distress. Based on the existing literature, there is a need for greater standardization and use of reliable measures, as well as use of diagnostic interviews in order to assess the most accurate prevalence of psychological distress among these athletes. Longitudinal designs, matched control groups, more heterogeneous samples, and use of multivariate analyses would also help to more accurately determine the prevalence and risk factors of psychological distress in this population. This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes.

Depressive mood in individuals with spinal cord injury (SCI) living in Greece

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.

Catechol O-methyltransferase (COMT) functional haplotype is associated with recurrence of affective symptoms: A prospective birth cohort study

BACKGROUND

Catechol-O-methyltransferase (COMT) polymorphisms play an essential role in dopamine availability in the brain. However, there has been no study investigating whether a functional four-SNP (rs6269-rs4633-rs4818-rs4680) haplotype is associated with affective symptoms over the life course.

METHODS

We tested this using 2093 members of the Medical Research Council National Survey of Health and Development (MRC NSHD), who had been followed up since birth in 1946, and had data for COMT genotypes, adolescent emotional problems (age 13-15) and at least one measure of adult affective symptoms at ages 36, 43, 53, or 60-64 years. First, differences in the levels of affective symptoms by the functional haplotype using SNPs rs6269, rs4818, and rs4680 were tested in a structural equation model framework. Second, interactions between affective symptoms by COMT haplotype were tested under an additive model. Finally, a quadratic regressor (haplotype2) was used in a curvilinear model, to test for a possible inverted-U trend in affective symptoms according to COMT-related dopamine availability.

RESULTS

Women had a significant interaction between COMT haplotypes and adolescent emotional problem on affective symptoms at age 53. Post hoc analysis showed a significant positive association between adolescent emotional problems and affective symptoms at age 53 years in the middle dopamine availability group (valA/valB or met/met; β = .11, p = .007). For men, no significant interactions were observed.

CONCLUSIONS

Combination of the COMT functional haplotype model and inverted-U model may shed light on the effect of dopaminergic regulation on the trajectory of affective symptoms over the life course.

Reliability and validity of the Persian version of the spinal cord injury lifestyle scale and the health behavior questionnaire in persons with spinal cord injury

STUDY DESIGN

Cross-sectional psychometric study.

OBJECTIVE

To evaluate the reliability and validity of a spinal cord injury lifestyle scale (SCILS) and Health Behavior Questionnaire (HBQ) in the Persian language for persons with spinal cord injury (SCI).

SETTING

Participants were selected among those referred to health centers and the Brain and Spinal Cord Injury Research Center.

METHOD

In accordance with standard procedure for translation, two questionnaires, the SCILS and HBQ, were translated using a forward and backward translation approach by professional translators. Face validity of the questionnaires was assessed by ten persons with SCI and content validity was agreed upon by 12 professors from health care teaching universities. To test the final versions of both questionnaires, 97 persons with SCI were included using a consecutive sampling method. Other questionnaires were used to assess concurrent validity (secondary impairment checklist, as well as SCILS and HBQ) and convergent validity (impact of event scale revised, brief symptom inventory, beck depression inventory, and functional independence measure).

RESULTS

Internal consistency of SCILS and HBQ, assessed by Cronbach's alpha, was 0.75 for SCILS and 0.85 for HBQ. Test-retest reliability intraclass correlations were 0.86 and 0.92 for SCILS and HBQ, respectively. The number of current secondary impairments had a significant and negative correlation with SCILS (r = -0.22, P < 0.001), but it was not correlated with HBQ. SCILS had a significant and strong correlation with HBQ (r = 0.65, P < 0.001).

CONCLUSION

SCILS and HBQ can be used for measuring the health behavior of persons with SCI in Iran.

Psychometric properties and correlates of the PHQ-2 and PHQ-9 after traumatic brain injury

PRIMARY OBJECTIVE

To determine the predictive accuracy of the Patient Health Questionnaire (PHQ)-2 in predicting PHQ-9 findings and to examine demographic, historical, and injury correlates of PHQ-9 ratings.

RESEARCH DESIGN

Retrospective analysis of data collected as part of routine clinical outpatient care over a period of 30 months on 168 persons with mild to severe traumatic brain injury, who were referred for neuropsychological evaluation within 1-12 months after injury.

MAIN OUTCOMES AND RESULTS

PHQ-2 scores ≥2 had a sensitivity of 0.90 in predicting PHQ-9 scores ≥10, and a sensitivity of 0.95 in predicting endorsement of any passive or active suicidal thoughts on the PHQ-9. Premorbid history of having experienced personal abuse was the strongest predictor of post-injury PHQ-9 ratings.

CONCLUSIONS

The PHQ-2 has adequate sensitivity in predicting PHQ-9 findings and can be used as a screener in clinical practice in persons with traumatic brain injury, as long as formal psychometric assessment is supplemented with a comprehensive review of premorbid history.