Depression after spinal cord injury: Comorbidities, mental health service use, and adequacy of treatment

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Study assessed depression rates and psychiatric comorbid conditions, mental health service use, and adequacy of depression treatment in depressed and non-depressed adults with spinal cord injury (SCI). Participants were 947 community-residing people with traumatic SCI recruited from the Project to Improve Symptoms and Mood after SCI (PRISMS). Outcome measures included the Patient Health Questionnaire-9 Depression Scale, a psychiatric history questionnaire, the Cornell Service Index (mental health service use), and current medication use. Results indicated that the prevalence of probable major depression was 23 percent. There was a high lifetime prevalence of other psychiatric conditions, particularly anxiety disorders. In depressed participants, 29 percent currently were receiving any antidepressant and 11 percent were receiving guideline level antidepressant dose and duration, whereas 11 percent had been receiving any psychotherapy in the past 3 months and 6 percent had been receiving guideline-level psychotherapy in the past 3 months. Serotonergic antidepressants and individual psychotherapy were the most common types of treatment received, and there was a wide range of provider types and treatment settings. Demographic and clinical variables were not associated with receipt of mental health service or guideline-level care. Findings from this study document the low rate of mental health treatment for persons with SCI and probable major depression. These findings have implications for improving the effectiveness of depression treatment in people with SCI.

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