Depression trajectories during the first year after spinal cord injury

Publication date: Available online 23 October 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Charles H. Bombardier, Leah M. Adams, Jesse R. Fann, Jeanne M. Hoffman
ObjectiveLittle is known about the course of emotional adjustment after spinal cord injury. This study was conducted 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.DesignCohort studySettingInpatient rehabilitation and post-acute community settings in the Northwestern United States.Participants141 of 168 (115 males and 26 females) consecutive admissions to inpatient rehabilitation for acute SCI were enrolled in a randomized controlled trial (RCT) telephone follow up intervention which showed no outcome differences and completed assessments on at least two of the four follow-up occasions (3, 6, 9, and 12 months after SCI). Participants were on average 41 years old, mostly non-Hispanic (96%), white (86%), and 61.7% had tetraplegia.Intervention(s)The data are drawn from the ineffective RCT.Main Outcome Measure(s)Patient Health Questionnaire-9 (PHQ-9)ResultsUnconditional linear latent class growth analysis models of PHQ-9 total scores revealed an optimal three-class solution: stable low depression (63.8%), mild-moderate depression (29.1%), and persistent moderate to severe depression (7.1%). Preinjury mental health history as well as baseline pain, quality of life, and grief predicted class membership.ConclusionsThe modal response to SCI was stable low depression, while persistent moderate to severe depression primarily represented a continuation or relapse of preinjury depression. This line of research has potential to improve identification of subgroups destined for poor outcomes and to inform early intervention studies.



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