Depression treatment preferences after acute traumatic spinal cord injury

Abstract

Objective: To examine preferences for depression treatment modalities and settings and predictors of treatment preference in persons with spinal cord injury (SCI).

Design: Cross-sectional surveys.

Setting: Rehabilitation inpatient services.

Participants: Persons with traumatic SCI (N=183) undergoing inpatient rehabilitation.

Interventions: Not applicable.

Main outcome measures: Patient Health Questionnaire-9 depression scale, history of psychiatric diagnoses and treatments, and a depression treatment preference survey.

Results: Among inpatients with SCI (28% had Patient Health Questionnaire-9 score ≥10 indicating probable major depression), a physical exercise program was the most preferred treatment option (78% somewhat or very likely to try) followed by antidepressants prescribed by a primary care provider (63%) and individual counseling in a medical or rehabilitation clinic (62%). All modalities were preferred over group counseling. Although not statistically significant, more depressed individuals stated a willingness to try antidepressants and counseling than nondepressed individuals. Subjects preferred treatment in a medical/rehabilitation setting over a mental health setting. Those with a prior diagnosis of depression and a history of antidepressant use were significantly more willing to take an antidepressant. Age ≥40 years was a significant predictor of willingness to receive individual counseling.

Conclusions: Treatment preferences and patient education are important factors when choosing a depression treatment modality for patients with SCI. The results suggest that antidepressants, counseling, and exercise may be promising components of depression treatment in this population, particularly if they are integrated into medical or rehabilitation care.

Keywords: CI; Depression; MDD; OR; PHQ-9; Patient Health Questionnaire-9; Patient satisfaction; Rehabilitation; SCI; Spinal cord injuries; Therapeutics; confidence interval; major depressive disorder; odds ratio; spinal cord injury.