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Using Inferred Mobility Status to Estimate the Time to Major Depressive Disorder Diagnosis Post–Spinal Cord Injury

Published:December 28, 2019DOI:https://doi.org/10.1016/j.apmr.2019.11.014

      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)
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