Abstract
Objective
Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors
associated with MDD diagnosis; (3) time at which MDD is diagnosed post–spinal cord
injury (SCI); and (4) interaction of inferred mobility status (IMS) in a commercially
insured population over 3 years.
Design
Retrospective longitudinal cohort design.
Setting
A commercial insurance claims database from January 1, 2010 to December 31, 2013.
Participants
Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history
of MDD ≤30 days pre-SCI (N=1409).
Intervention
Not applicable.
Main Outcome Measures
Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A
stratified survival analysis using IMS, based upon durable medical equipment (DME)
claims, was also completed.
Results
Post-SCI, 294 out of 1409 (20.87%) were diagnosed with new-onset MDD. Significant
(P<.05) risk factors included: employment, length of index hospitalization, discharge
from index hospitalization with healthcare services, rehabilitation services post-SCI,
and 2 of 5 IMS comparisons. Median time to MDD was 86 days. Survival analysis demonstrated
a significant difference between 6 of 10 IMS comparisons. Regarding new-onset or recurring
MDD, 432 out of 1409 (30.66%) were diagnosed post-SCI. Significant risk factors included:
female, employment, length of index hospitalization, discharge from index hospitalization
with healthcare services, rehabilitation services post-SCI, MDD>30 days pre-SCI, catheter
claims, and 2 of 5 IMS comparisons. Median time to MDD was 74 days. Survival analysis
demonstrated a significant difference between 4 of 10 IMS comparisons.
Conclusions
Prevalence of MDD post-SCI is greater than the general population. Stratification
by IMS illustrated that individuals with greater inferred reliance on DME are at a
greater risk for MDD and have shorter time to MDD diagnosis post-SCI.
Keywords
List of abbreviations:
CI (confidence interval), CPT (current procedural terminology), DME (durable medical equipment), ESI (employer-sponsored insurance), HCPCS (Healthcare Common Procedure Coding System), ICD-9 (International Classification of Diseases, 9th revision), IMS (inferred mobility status), IMS-MWC (inferred mobility status-manual wheelchair without lower extremity orthotics), IMS-MWC-LEO (inferred mobility status-manual wheelchair with lower extremity orthotics), IMS-NAD (inferred mobility status-no assistive devices or orthotics), IMS-PWC (inferred mobility status-power wheelchair), IMS-W (inferred mobility status-walker), LE (lower extremity), MDD (major depressive disorder), OR (odds ratio), 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: December 28, 2019
Footnotes
Supported by the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (MUSC) (grant no. UL1 TR001450 ) and the Foundation for Physical Therapy Research through Promotion of Doctoral Studies Scholarship. Data for the study were provided through support for the CEDAR Core funded by the MUSC Office of the Provost.
Disclosures: C.V. received a Promotion of Doctoral Studies Scholarship from the Foundation for Physical Therapy Research. The other authors have nothing to disclose.
Identification
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© 2019 by the American Congress of Rehabilitation Medicine
