Advertisement

Depression Trajectories During the First Year After Spinal Cord Injury

Published:October 22, 2015DOI:https://doi.org/10.1016/j.apmr.2015.10.083

      Abstract

      Objective

      To determine the number and type of longitudinal depression trajectories during the first year after spinal cord injury (SCI) and to identify baseline predictors of these trajectories.

      Design

      Cohort study.

      Setting

      Rehabilitation and postacute community settings.

      Participants

      Of 168 consecutive admissions to inpatient rehabilitation for acute SCI, 141 (115 men, 26 women) patients were enrolled in a randomized controlled trial telephone follow-up intervention, which showed no outcome differences, and completed assessments on at least 2 of the 4 follow-up occasions (3, 6, 9, and 12 months after SCI). Participants were on average 41 years old, most were non-Hispanic (96%) and white (86%), and 61.7% had tetraplegia.

      Interventions

      Data were drawn from the ineffective randomized controlled trial.

      Main Outcome Measure

      Patient Health Questionnaire-9 (PHQ-9).

      Results

      Unconditional linear latent class growth analysis models of PHQ-9 total scores revealed an optimal 3-class solution: stable low depression (63.8%), mild to moderate depression (29.1%), and persistent moderate to severe depression (7.1%). Preinjury mental health history and baseline pain, quality of life, and grief predicted class membership.

      Conclusions

      The modal response to SCI was stable low depression, whereas persistent moderate to severe depression primarily represented a continuation or relapse of preinjury depression. This line of research has the potential to improve identification of subgroups destined for poor outcomes and to inform early intervention studies.

      Keywords

      List of abbreviations:

      PHQ-9 (Patient Health Questionnaire-9), SCI (spinal cord injury)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      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

      References

        • Craig A.
        • Tran Y.
        • Middleton J.
        Psychological morbidity and spinal cord injury: a systematic review.
        Spinal Cord. 2009; 47: 108-114
        • Quale A.J.
        • Schanke A.K.
        Resilience in the face of coping with a severe physical injury: a study of trajectories of adjustment in a rehabilitation setting.
        Rehabil Psychol. 2010; 55: 12-22
        • Judd F.K.
        • Stone J.
        • Webber J.E.
        • Brown D.J.
        • Burrows G.D.
        Depression following spinal cord injury. A prospective in-patient study.
        Br J Psychiatry. 1989; 154: 668-671
        • 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
        • Craig A.R.
        • Hancock K.M.
        • Dickson H.G.
        A longitudinal investigation into anxiety and depression in the first 2 years following a spinal cord injury.
        Paraplegia. 1994; 32: 675-679
        • 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
        • Muthen B.
        • Muthen L.K.
        Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes.
        Alcohol Clin Exp Res. 2000; 24: 882-891
        • Bonanno G.
        • Kennedy P.
        • Galatzer-Levy I.
        • Lude P.
        • Elfström M.
        Trajectories of resilience, depression, and anxiety following spinal cord injury.
        Rehabil Psychol. 2012; 57: 236-247
        • 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
        • Craig A.R.
        • Hancock K.
        • Dickson H.
        • Chang E.
        Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy.
        Arch Phys Med Rehabil. 1997; 78: 33-38
        • Dorstyn D.
        • Mathias J.
        • Denson L.
        • Robertson M.
        Effectiveness of telephone counseling in managing psychological outcomes after spinal cord injury: a preliminary study.
        Arch Phys Med Rehabil. 2012; 93: 2100-2108
        • Duchnick J.J.
        • Letsch E.A.
        • Curtiss G.
        Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial.
        Rehabil Psychol. 2009; 54: 123-132
        • Kennedy P.
        • Duff J.
        • Evans M.
        • Beedie A.
        Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries.
        Br J Clin Psychol. 2003; 42: 41-52
        • King C.
        • Kennedy P.
        Coping effectiveness training for people with spinal cord injury: preliminary results of a controlled trial.
        Br J Clin Psychol. 1999; 38: 5-14
        • 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.
        • 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
        • Dryden D.M.
        • Saunders L.D.
        • Rowe B.H.
        • et al.
        Depression following traumatic spinal cord injury.
        Neuroepidemiology. 2005; 25: 55-61
        • Cairns D.M.
        • Adkins R.H.
        • Scott M.D.
        Pain and depression in acute traumatic spinal cord injury: origins of chronic problematic pain?.
        Arch Phys Med Rehabil. 1996; 77: 329-335
        • Hoffman J.M.
        • Bombardier C.H.
        • Burns S.P.
        Scheduled telephone follow-up to improve outcomes after spinal cord injury rehabilitation.
        in: American Spinal Injury Association Annual Meeting. 2013 (Chicago (IL); 2013 Sep 4)
        • Bradley K.A.
        • DeBenedetti A.F.
        • Volk R.J.
        • Williams E.C.
        • Frank D.
        • Kivlahan D.R.
        AUDIT-c as a brief screen for alcohol misuse in primary care.
        Alcohol Clin Exp Res. 2007; 31: 1208-1217
        • Andrews F.M.
        • Withey S.B.
        Social indicators of well-being.
        Plenum Pr, New York1976
        • McCrae R.R.
        Well-being scales do not measure social desirability.
        J Gerontol. 1986; 41: 390-392
        • The EuroQol Group
        Euroqol–a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
        • Prigerson H.G.
        • Horowitz M.J.
        • Jacobs S.C.
        • et al.
        Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V AND ICD-11.
        PLoS Med. 2009; 6: e1000121
        • Klyce D.W.
        • Bombardier C.H.
        • Davis T.J.
        • et al.
        Distinguishing grief from depression during acute recovery from spinal cord injury.
        Arch Phys Med Rehabil. 2015; 96: 1419-1425
        • Kalpakjian C.Z.
        • McCullumsmith C.B.
        • Fann J.R.
        • et al.
        Post-traumatic growth following spinal cord injury.
        J Spinal Cord Med. 2014; 37: 218-225
        • Tedeschi R.G.
        • Calhoun L.G.
        The posttraumatic growth inventory: measuring the positive legacy of trauma.
        J Trauma Stress. 1996; 9: 455-471
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Int Med. 2001; 16: 606-613
        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders.
        4th ed. Text revision ed. American Psychiatric Association, Washington (DC)2000
        • Bombardier C.H.
        • Kalpakjian C.Z.
        • Graves D.E.
        • Dyer J.R.
        • Tate D.G.
        • Fann J.R.
        Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation.
        Arch Phys Med Rehabil. 2012; 93: 1838-1845
        • Jung T.
        • Wickrama K.
        An introduction to latent class growth analysis and growth mixture modelling.
        Soc Personal Psychol Compass. 2008; 2: 302-317
        • Bonanno G.A.
        • Westphal M.
        • Mancini A.D.
        Resilience to loss and potential trauma.
        Ann Rev Clin Psychol. 2011; 7: 511-535
        • Catalano D.
        • Chan F.
        • Wilson L.
        • Chiu C.Y.
        • Muller V.R.
        The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model.
        Rehabil Psychol. 2011; 56: 200-211
        • Kemp B.J.
        • Kahan J.S.
        • Krause J.S.
        • Adkins R.H.
        • Nava G.
        Treatment of major depression in individuals with spinal cord injury.
        J Spinal Cord Med. 2004; 27: 22-28
        • Fann J.R.
        • Bombardier C.H.
        • Richards J.S.
        • et al.
        Venlafaxine extended-release for depression following spinal cord injury: a randomized clinical trial.
        JAMA Psychiatry. 2015; 72: 247-258
        • Monden K.R.
        • Trost Z.
        • Catalano D.
        • et al.
        Resilience following spinal cord injury: a phenomenological view.
        Spinal Cord. 2014; 52: 197-201
        • Adamson B.C.
        • Ensari I.
        • Motl R.W.
        Effect of exercise on depressive symptoms in adults with neurologic disorders: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2015; 96: 1329-1338
        • Shear M.K.
        • Wang Y.
        • Skritskaya N.
        • Duan N.
        • Mauro C.
        • Ghesquiere A.
        Treatment of complicated grief in elderly persons: a randomized clinical trial.
        JAMA Psychiatry. 2014; 71: 1287-1295
        • Cardenas D.D.
        • Nieshoff E.C.
        • Suda K.
        • et al.
        A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury.
        Neurology. 2013; 80: 533-539
        • 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
        • Martin Ginis K.A.
        • Jetha A.
        • Mack D.E.
        • Hetz S.
        Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis.
        Spinal Cord. 2010; 48: 65-72
        • 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
        • Bombardier C.H.
        • Stroud M.W.
        • Esselman P.C.
        • Rimmele C.T.
        Do preinjury alcohol problems predict poorer rehabilitation progress in persons with spinal cord injury?.
        Arch Phys Med Rehabil. 2004; 85: 1488-1492
        • Bombardier C.H.
        • Fann J.R.
        • Temkin N.R.
        • Esselman P.C.
        • Barber J.
        • Dikmen S.S.
        Rates of major depressive disorder and clinical outcomes following traumatic brain injury.
        JAMA. 2010; 303: 1938-1945
        • Banerjea R.
        • Findley P.A.
        • Smith B.
        • Findley T.
        • Sambamoorthi U.
        Co-occurring medical and mental illness and substance use disorders among veteran clinic users with spinal cord injury patients with complexities.
        Spinal Cord. 2009; 47: 789-795
        • Macciocchi S.
        • Seel R.T.
        • Thompson N.
        • Byams R.
        • Bowman B.
        Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.
        Arch Phys Med Rehabil. 2008; 89: 1350-1357
        • Elliott T.R.
        • Herrick S.
        • Witty T.
        Social support and depression following spinal cord injury.
        Rehabil Psychol. 1992; 37: 37-48