Prognosis of C4 dislocation with spinal cord injury following psychological intervention

Analysis of Influencing Factors of Major Depression After Spinal Cord Injury

Objective

To analyze the risk factors of major depressive disorder (MDD) after spinal cord injury (SCI).

Methods

Patients with SCI in our hospital from February 2020 to February 2023 were selected as the study objects. According to the Hamilton Depression Scale (HAMD) score, patients with 36~75 points were included in the major depression group, and 0~35 points were included in the non-major depression group. The general sociological characteristics (age, gender, educational level, place of residence, family economic status, payment method of medical expenses, marital status) and disease-related characteristics (course of disease, cause of injury, neurological level of injury, type of injury, degree of pain) of all patients were collected, and the items with differences were selected for logistic regression analysis to analyze the risk factors for major depression in patients with spinal cord injury.

Results

Totally 216 patients were enrolled in our study, including 45 patients (18.98%) had moderate-to-severe depression and 175 patients (81.02%) had non-severe depression. Univariate analysis showed that gender (χ2 = 11.865, P < .001), course of disease (χ2 = 12.967, P < .001), family economic status (χ2 = 8.610, P = .003), educational level (χ2 =15.287, P < .001), neurological level of injury (χ2 = 9.013, P = .003) and pain level (χ2 = 16.673, P < .001) were statistically significant differences between the 2 groups. Multivariate logistic regression analysis showed that gender [odds ratio (OR) (95 % CI) = 3.986 (1.743~9.116), P = .001], course of disease [OR (95 % CI) = 4.033 (1.818~8.947), P = .001], family economic status [OR (95 % CI) = 3.136 (1.449~6.785), P = .004], educational level [OR (95 % CI) = 4.332 (1.998~9.388), P = .000], neurological level of injury [OR (95 % CI) = 2.848 (1.414~5.734), P = .003], and pain level [OR (95 % CI) = 5.767 (2.309~14.404), P < .001] were risk factors for major depressive disorder in SCI patients.

Conclusion

Gender, disease duration, family economic status, education level, level of nerve injury, and pain level may be the independent risk factors of MDD incidence in patients with spinal cord injury.

Faecal incontinence with concurrent disorders of gut-brain interaction: A worse outcome

BACKGROUND

Faecal incontinence is a common debilitating condition associated with poor quality of life that generates substantial economic strain on healthcare systems.

OBJECTIVES

We aimed to evaluate, in a tertiary referral population presenting with faecal incontinence, the impact of suffering additional disorders of gut-brain interaction (DGBI) on symptom severity, anxiety, depression and quality of life.

METHODS

Design: Retrospective cohort study.

SETTING

Tertiary referral Neurogastroenterology centre.

PATIENTS

All patients presenting with faecal incontinence from 2007 to 2020 were included.

MAIN OUTCOME MEASURES

The results from structured medical and surgical questionnaires including Rome III Integrative Questionnaire, Faecal Incontinence Severity Index, Hospital Anxiety and Depression Scale, SF-36, and anorectal physiology were analysed using Stata version 17. Patients were categorised into 3 groups: 0-1 additional DGBI, 2 DGBIs, and 3+ DGBI. Statistical significance was defined as p < 0.05 (two-tailed).

KEY RESULTS

Faecal incontinence patients (n = 249; mean age 63.4 ± 12.6 years; 93.6% female, 48.1% urge subtype) met diagnostic criteria for mean 2.2 additional DGBI each, mostly affecting bowel (n = 231, 42.4%) and anorectal (n = 150, 27.5%) regions. A greater number of DGBIs was associated with higher faecal incontinence symptom severity (p < 0.001), higher anxiety (p = 0.002) and depression (p = 0.003), and worse quality of life in areas of mental health (p = 0.037) and social effect (p < 0.001). Patients with a greater number of concurrent DGBI demonstrated a greater family history of gastrointestinal problems (p = 0.004). There were no associations found between a greater amount of DGBIs and anorectal physiology.

CONCLUSIONS AND INFERENCES

A greater number of additional DGBIs in faecal incontinence patients was associated with worse faecal incontinence symptoms, higher anxiety and depression scores, and worse quality of life but was unrelated to physiology. This highlights the need to proactively search for comorbid DGBI in patients presenting with faecal incontinence.