Symptoms of Depression Over Time in Adults With Pediatric-Onset Spinal Cord Injury

Published:December 05, 2013DOI:



      To investigate the prevalence of depressive symptoms in adults with pediatric-onset spinal cord injury (SCI) and explore potential risk factors that may be associated with elevated symptoms.


      Longitudinal, cohort survey over a period of 2 to 9 years. Follow-up occurred approximately every year, a total of 868 interviews were conducted, and most participants contributed to at least 3 waves of data (72%; range, 2–8; mean, 4.34±2.16).




      Adults (N=214; 133 men; mean age at first interview, 29.52±5.21y; range, 24–42y) who sustained an SCI prior to age 19 (mean age at injury, 13.93±4.37y; range, 0–18y). Participants tended to have complete injuries (71%) and tetraplegia (58%).


      Not applicable.

      Main Outcome Measures

      Participants completed measures assessing psychosocial functioning, physical independence, participation, and depression at each time point. Multilevel growth modeling analyses were used to explore depression symptoms across time.


      Depression symptoms at initial status were typically minimal (3.07±.24; 95% confidence interval, 2.6–3.54) but fluctuated significantly over time (P<.01). Several factors emerged as significant predictors of depressive symptoms in the final model, including less community participation (P<.01), incomplete injury (P=.02), hazardous drinking (P=.02), bladder incontinence (P=.01), and pain (P=.03). Within individuals, as bowel accidents (P<.01) and pain increased (P<.01), depression scores increased; however, marriage resulted in decreases in depression scores for individuals (P=.02).


      These findings suggest that most patients with pediatric-onset SCI are psychologically resilient, but strategies to minimize secondary health complications and foster community participation and engagement should be considered.


      List of abbreviations:

      AUDIT-C (Alcohol Use Disorders Identification Test), CHART (Craig Handicap Assessment and Reporting Technique), MDD (major depressive disorder), MLM (multilevel modeling), PHQ-9 (Patient Health Questionnaire-9), SCI (spinal cord injury)
      To read this article in full you will need to make a payment


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Craig A.
        • Tran Y.
        • Middleton J.
        Psychological morbidity and spinal cord injury: a systematic review.
        Spinal Cord. 2009; 47: 108-114
        • Kennedy P.
        • Rogers B.A.
        Anxiety and depression after spinal cord injury: a longitudinal analysis.
        Arch Phys Med Rehabil. 2000; 81: 932-937
        • Migliorini C.
        • Tonge B.
        • Taleporos G.
        Spinal cord injury and mental health.
        Aust N Z J Psychiatry. 2008; 42: 309-314
        • Tate D.G.
        • Forchheimer M.B.
        • Karana-Zebari D.
        • Chiodo A.E.
        • Kendall Thomas J.Y.
        Depression and pain among inpatients with spinal cord injury and spinal cord disease: differences in symptoms and neurological function.
        Disabil Rehabil. 2012; 35: 1204-1212
        • Craig A.R.
        • Hancock K.M.
        • Dikson H.G.
        A longitudinal investigation into anxiety and depression in the first 2 years following a spinal cord injury.
        Paraplegia. 1994; 32: 675-679
        • Dryden D.M.
        • Voaklander D.C.
        • Saunders L.D.
        • et al.
        Depression following traumatic spinal cord injury.
        Neuroepidemiology. 2005; 25: 55-61
        • Kishi Y.
        • Robinson R.G.
        • Forrester A.W.
        Prospective longitudinal study of depression following spinal cord injury.
        J Neuropsychiatry Clin Neurosci. 1994; 6: 237-244
        • Bombardier C.H.
        • Richards J.S.
        • Krause J.S.
        • Tulsky D.
        • Tate D.G.
        Symptoms of major depression in people with spinal cord injury: implications for screening.
        Arch Phys Med Rehabil. 2004; 85: 1749-1756
        • Krause J.S.
        • Kemp B.
        • Coker J.
        Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators.
        Arch Phys Med Rehabil. 2000; 81: 1099-1109
        • Saunders L.L.
        • Krause J.S.
        • Focht K.L.
        A longitudinal study of depression in survivors of spinal cord injury.
        Spinal Cord. 2012; 50: 72-77
        • Dorsett P.
        • Geraghty T.
        Depression and adjustment after spinal cord injury: a three-year longitudinal study.
        Top Spinal Cord Inj Rehabil. 2004; 9: 43-56
        • Richards J.S.
        Psychological adjustment to spinal cord injury during first postdischarge year.
        Arch Phys Med Rehabil. 1986; 67: 362-365
        • Ullrich P.M.
        • Lincoln R.K.
        • Tackett M.J.
        • Miskevics S.
        • Smith B.M.
        • Weaver F.M.
        Pain, depression, and health care utilization over time after spinal cord injury.
        Rehabil Psychol. 2013; 58: 158-165
        • Fann J.R.
        • Bombardier C.H.
        • Richards J.S.
        • Tate D.G.
        • Wilson C.S.
        • Temkin N.
        Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment.
        Arch Phys Med Rehabil. 2011; 92: 352-360
        • Post M.
        • van Leeuwn C.
        Psychosocial issues in spinal cord injury: a review.
        Spinal Cord. 2012; 50: 382-389
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • Starkweather A.
        • Nicholls E.
        • Wilk A.R.
        Factors predicting depression among persons with spinal cord injury 1 to 5 years post injury.
        Neurorehabilitation. 2011; 29: 9-21
        • Hoffman J.M.
        • Bombardier C.H.
        • Graves D.E.
        • Kalpakjian C.Z.
        • Krause J.S.
        A longitudinal study of depression from 1 to 5 years after spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 411-418
        • Krause J.S.
        • Broderick L.
        Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset.
        Arch Phys Med Rehabil. 2004; 85: 1257-1264
        • Tate D.G.
        • Forchheimer M.B.
        • Krause J.S.
        • Meade M.A.
        • Bombardier C.H.
        Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates.
        Arch Phys Med Rehabil. 2004; 85: 1837-1847
        • Stanford R.E.
        • Soden R.
        • Bartrop R.
        • Mikk M.
        • Taylor T.K.
        Spinal cord and related injuries after attempted suicide: psychiatric diagnosis and long-term follow-up.
        Spinal Cord. 2007; 45: 437-443
        • National Spinal Cord Injury Statistical Center
        Annual statistical report for the Spinal Cord Injury Model Systems–complete public version.
        Univ of Alabama at Birmingham, Birmingham2012
        • Zebracki K.
        • Vogel L.
        Epidemiology of childhood-onset spinal cord injuries in the United States.
        in: Rahimi-Movaghar V. Jazayeri S. Vaccaro A. Epidemiology of spinal cord injuries. Nova Science Publishers, New York2012: 19-28
        • Anderson C.J.
        • Vogel L.C.
        • Chlan K.M.
        • Betz R.R.
        • McDonald C.M.
        Depression in adults who sustained spinal cord injuries as children or adolescents.
        J Spinal Cord Med. 2007; 30: S76-S82
        • Elliott T.R.
        • Frank R.G.
        Depression following spinal cord injury.
        Arch Phys Med Rehabil. 1996; 77: 816-823
        • American Spinal Injury Association
        International Standards for Neurological Classification of Spinal Cord Injury.
        American Spinal Injury Association, Atlanta2011
        • Whiteneck G.G.
        • Charlifue S.W.
        • Gerhart K.A.
        • Overhosler J.D.
        • Richardson G.N.
        Quantifying handicap: a new measure of long-term rehabilitation outcomes.
        Arch Phys Med Rehabil. 1992; 73: 519-526
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders DSM-IV.
        4th ed. American Psychiatric Association, Washington (DC)1994
        • Uniform Data System for Medical Rehabilitation
        The guide for Uniform Data Set for Medical Rehabilitation (including the FIM™ instrument).
        UDSMR, Buffalo1997
        • Ware J.E.
        • Kosinski M.
        • Keller S.D.
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Bush K.
        • Kivlahan D.
        • McDonell M.
        • Fihn S.
        • Bradley K.
        The AUDIT Alcohol Consumption Questions (AUDIT-C): an effective brief screening test for problem drinking.
        Arch Intern Med. 1998; 158: 1789-1795
        • DeLucia C.
        • Pitts S.C.
        Applications of individual growth curve modeling for pediatric psychology research.
        J Pediatr Psychol. 2006; 31: 1002-1023
        • Kessler R.
        • Berglund P.
        • Demler O.
        • Jin R.
        • Walters E.
        Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R).
        Arch Gen Psychiatry. 2005; 62: 593-602
        • Bonanno G.A.
        • Kennedy P.
        • Galatzer-Levy I.R.
        • Lude P.
        • Elfstrom M.L.
        Trajectories of resilience, depression, and anxiety following spinal cord injury.
        Rehabil Psychol. 2012; 57: 236-247
        • Hasin D.S.
        • Goodwin R.D.
        • Stinson F.S.
        • Grant B.F.
        Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on alcoholism and related conditions.
        Arch Gen Psychiatry. 2005; 62: 1097-1106
        • Bombardier C.H.
        • Fann J.R.
        • Tate D.G.
        • et al.
        An exploration of modifiable risk factors for depression after spinal cord injury: which factors should we target?.
        Arch Phys Med Rehabil. 2012; 93: 775-781