Symptoms of depression over time in adults with pediatric-onset spinal cord injury

Abstract

Objective: To investigate the prevalence of depressive symptoms in adults with pediatric-onset spinal cord injury (SCI) and explore potential risk factors that may be associated with elevated symptoms.

Design: Longitudinal, cohort survey over a period of 2 to 9 years. Follow-up occurred approximately every year, a total of 868 interviews were conducted, and most participants contributed to at least 3 waves of data (72%; range, 2-8; mean, 4.34±2.16).

Setting: Community.

Participants: Adults (N=214; 133 men; mean age at first interview, 29.52±5.21y; range, 24-42y) who sustained an SCI prior to age 19 (mean age at injury, 13.93±4.37y; range, 0-18y). Participants tended to have complete injuries (71%) and tetraplegia (58%).

Interventions: Not applicable.

Main outcome measures: Participants completed measures assessing psychosocial functioning, physical independence, participation, and depression at each time point. Multilevel growth modeling analyses were used to explore depression symptoms across time.

Results: Depression symptoms at initial status were typically minimal (3.07±.24; 95% confidence interval, 2.6-3.54) but fluctuated significantly over time (P<.01). Several factors emerged as significant predictors of depressive symptoms in the final model, including less community participation (P<.01), incomplete injury (P=.02), hazardous drinking (P=.02), bladder incontinence (P=.01), and pain (P=.03). Within individuals, as bowel accidents (P<.01) and pain increased (P<.01), depression scores increased; however, marriage resulted in decreases in depression scores for individuals (P=.02).

Conclusions: These findings suggest that most patients with pediatric-onset SCI are psychologically resilient, but strategies to minimize secondary health complications and foster community participation and engagement should be considered.

Keywords: Depression; Longitudinal studies; Pediatrics; Rehabilitation; Spinal cord injuries.