A longitudinal study of depression in survivors of spinal cord injury

Study design: Cohort study. Objectives: The objective of this study is to assess depression over a 5-year period in persons with spinal cord injury (SCI) and to assess risk factors for depression over time. Setting: Rehabilitation hospitals in the Southeast and Midwest. Methods: Participants included 801 adults with residual effects from a traumatic SCI averaging over 15 years post injury. Participants responded to two questionnaires, one in 2002 (Time1) and another in 2008 (Time 2). Probable major depression (PMD) was measured by the Older Adult Health and Mood Questionnaire. Results: In all, 22.1% of participants had PMD at Time 1 and 20.2% at Time 2. There was a nonsignificant trend for change in PMD status (P = 0.058). Of those who had PMD at Time 1, 55.7% had PMD at Time 2. Between the two time points, the most change occurred in the group with clinically significant symptomatology. Demographic factors (race-gender, age, time since injury) and health behaviors (pain medication use, hours out of bed, days out of the house, exercise) were significantly associated with PMD over time. Socioeconomic factors (income, education) were significantly related to depression but were not significant after controlling for behavioral factors. Conclusion: Depression is fairly consistent over time in persons with SCI, with the majority of change coming from those in the clinically significant symptomatology group. Examining depression at multiple time points, our results underscore the importance of health behaviors in relation to PMD, even after controlling for demographic, injury and environmental factors. Spinal Cord (2012) 50, 72-77; doi:10.1038/sc.2011.83; published online 2 August 2011