Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury

Abstract

Objective: To conduct a prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury (SCI), determine psychotropic medication usage, and establish predictors of psychological disorders after transition to the community.

Design: Longitudinal design with multiple measures.

Setting: Assessment occurred in SCI units and the community.

Participants: Adults with SCI (N=88) admitted over a period of 32 months into 3 SCI units.

Interventions: Participants completed inpatient rehabilitation for an acute SCI. Longitudinal assessment occurred up to 6 months postdischarge.

Main outcome measures: Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI. The Mini International Neuropsychiatric Interview, a structured diagnostic psychiatric interview, was conducted to determine the presence of psychological disorders. Medical measures included severity of secondary conditions or complications. Psychological measures included measures of anxiety and depressive mood, resilience, pain catastrophization, self-efficacy, and cognitive capacity.

Results: Rates of psychological disorders of 17% to 25% were substantially higher than rates found in the Australian community. The occurrence of psychological disorder comorbidities was also very high. Anxiety was significantly elevated in those with a psychological disorder. Psychotropic medications were prescribed to more than 36% of the sample, with most being antidepressants. Factors predictive of psychological disorders included years of education, premorbid psychiatric/psychological treatment, cognitive impairment, secondary complications, resilience, and anxiety.

Conclusions: SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge. Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community. Additional resources should be invested in improving the mental health of adults with SCI.

Keywords: Anxiety; Chronic pain; Depression; Mental disorders; Rehabilitation; Spinal cord injuries.