Abstract
Objective
To evaluate whether pain interference mediates the relationship between pain intensity
and probable major depression (PMD) among persons with spinal cord injury (SCI), accounting
for differences in the frequency of prescription medication use and resilience.
Design
Cross-sectional analysis using self-report assessment.
Setting
Medical university in the Southeastern United States.
Participants
There were a total of 4670 participants (N=4670), all of whom had traumatic SCI of
at least 1-year duration, identified from the Southeastern Regional SCI Model System
and 2 state-based surveillance systems.
Interventions
Not applicable.
Main Outcome Measures
The Patient Health Questionnaire-9 was used to define PMD. Covariates included demographic
and injury characteristics, pain severity, pain interference, and resilience. Separate
sets of multistage logistic regression analyses were conducted for 3 levels of prescription
pain medication use (daily, occasional/weekly, none).
Results
Pain intensity was related to a greater risk of PMD (odds ratio [OR]daily pain medication user, 1.28; 95% confidence interval [CI], 1.21-1.35; ORoccasional/weekly pain medication user, 1.26; 95% CI, 1.16-1.36; ORnonpain medication user, 1.44; 95% CI, 1.33-1.56), but this relationship disappeared after consideration
of pain interference (ORdaily pain medication user, 0.97; 95% CI, 0.90-1.04; ORoccasional/weekly pain medication user, 0.94; 95% CI, 0.84-1.05; ORnonpain medication user, 1.07; 95% CI, 0.95-1.20), which indicates pain interference was a mediator between
pain intensity and PMD and there was no direct relationship between pain intensity
and PMD. Resilience was protective of PMD in each model but was not a mediator.
Conclusions
Although pain intensity was associated with PMD, the relationship was mediated by
pain interference. Resilience was an important protective factor. Therefore, clinicians
should assess pain interference when screening for PMD and direct treatment at reducing
pain interference. Building resilience may further reduce the risk of PMD.
Keywords
List of abbreviations:
CI (confidence interval), OR (odds ratio), PHQ-9 (Patient Health Questionnaire-9), PMD (probable major depression), SCI (spinal cord injury), US (United States)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 17, 2021
Accepted:
April 2,
2021
Received in revised form:
March 31,
2021
Received:
December 30,
2020
Footnotes
Supported by grants from the South Carolina Spinal Cord Injury Research Fund (SCSCIRF) (grant nos. SCIRF 2017 SI-02, SCIRF 09-001) and from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90RT5003). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this publication do not necessarily represent the policy of the SCSCIRF, NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government or the state of South Carolina. We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on me or on any organization with which we are associated and, if applicable, we certify that all financial and material support for this research (eg, NIH or NHS grants) and work are clearly identified in the title page of the article.
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
