Abstract
Objectives
To use meta-analysis to synthesize point prevalence estimates of depressive disorder
diagnoses for persons who have sustained a spinal cord injury (SCI).
Data Sources
We searched PsycINFO, PubMed, the Cumulative Index to Nursing and Allied Health Literature
(CINAHL), and Dissertation Abstracts International (DAI) for studies examining depression
after SCI through 2013. We also conducted a manual search of the reference sections
of included studies.
Study Selection
Included studies contained persons with SCI; used a diagnostic measure of depression
(ie, an unstructured, semi-structured, or structured clinical interview, and/or a
clinician diagnosis); and provided a diagnosis of major or minor depressive episodes
for the subjects in the study. Diagnostic criteria were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (including Research Diagnostic Criteria) criteria.
Data Extraction
The 2 authors of this study screened the titles and abstracts of 1053 unique studies
for inclusion in this meta-analysis. Nineteen studies, containing 35,676 subjects
and 21 effect size estimates, were included.
Data Synthesis
The mean prevalence estimate of depression diagnosis after SCI was 22.2%, with a lower-bound
estimate of 18.7% and an upper bound estimate of 26.3%. Random effects and mixed effects
models were used in this work. A small number of study moderators were explored, including
sample sex composition, Diagnostic and Statistical Manual of Mental Disorders version used, data collection method (primary vs secondary), sample traumatic etiology
composition, sample injury level and completeness composition, and sample diagnostic
composition. Data collection method, Diagnostic and Statistical Manual of Mental Disorders version, and diagnostic composition significantly predicted variation in observed
effect size estimates, with primary data collection studies having lower estimates
compared with secondary data analysis studies, studies using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria having higher estimates compared with studies using Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria, and samples comprising individuals diagnosed only with major depression
having lower prevalence estimates.
Conclusions
The existing data on depression after SCI indicate that the prevalence of depression
after SCI is substantially greater than that in the general medical population. These
results underscore the importance of continued research on measuring depression in
persons with SCI and on treatments for depression after SCI.
Keywords
List of abbreviations:
CI (confidence interval), DSM (Diagnostic and Statistical Manual of Mental Disorders), DSM-III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition), DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition), DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), MDD (major depressive disorder), PHQ-9 (Patient Health Questionnaire-9), RDC (Research Diagnostic Criteria), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 14, 2014
Footnotes
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
