ABSTRACT
PURPOSE: To examine the relationship between depression and pain severity during inpatient rehabilitation for those with new onset of spinal cord injury or spinal cord disease (SCI/D), along with patient characteristics, neurological function and etiology. METHOD: This cross-sectional study reviewed medical records of 100 adults with SCI/D including their admission scores on the Patient Health Questionnaire 9 (PHQ-9), a measure of depression, and pain ratings collected at admission and discharge. RESULTS: Upon admission, 28% reported moderate-to-severe symptoms of depression and 69% reported pain. PHQ-9 scores were associated with pain only among those with the least severe impairments, for whom higher scores were associated with greater pain. While depression levels did not differ by etiology, those with traumatic injuries had higher pain ratings. CONCLUSIONS: In general, depressive symptoms were not associated with pain severity in this sample. Etiology was associated with pain, those with traumatic SCI reporting more pain at admission. Among demographic characteristics, age was related to pain, with younger subjects reporting higher levels. These findings suggest that certain characteristics may predispose patients to pain and depression upon admission to rehabilitation. By determining who is at risk for these symptoms, clinicians can adopt treatments that prevent these from becoming chronic conditions.
Subject(s)
Depression/etiology , Inpatients/psychology , Pain/complications , Pain/etiology , Spinal Cord Injuries/etiology , Spinal Cord Injuries/psychology , Activities of Daily Living , Adult , Aged , Cross-Sectional Studies , Depression/psychology , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Pain/psychology , Pain Measurement , Psychiatric Status Rating Scales , Retrospective Studies , Severity of Illness Index , Socioeconomic Factors , Spinal Cord Diseases/complications , Spinal Cord Diseases/rehabilitation , Surveys and Questionnaires , Time FactorsABSTRACT
OBJECTIVE: To examine the applicability of marital resource (marriage has substantial benefits for well-being over not being married) or marital crisis (marital dissolution leads to poorer well-being) models to the spinal cord injury (SCI) population by studying the effects of sex, marital status, and marital transitions on well-being. DESIGN: Prospective cohort study from the SCI Model Systems National Database. SETTING: Community. PARTICIPANTS: Men (n=4864) and women (n=1277) who sustained traumatic SCI and completed a minimum of 1 follow-up interview beginning at 1 year through 15 years postinjury. INTERVENTIONS: None. MAIN OUTCOMES MEASURES: Life satisfaction, depressive symptoms, and self-perceived health status by using linear mixed models for longitudinal data. RESULTS: In general, well-being improved over time since injury. Hypothesis testing supported the marital crisis model, as marital loss through being or becoming separated or divorced and being or becoming widowed, had the most consistent and negative impact across well-being outcomes, whereas being or becoming married had an advantage for only lower depression symptoms over time. However, marital dissolution or loss did not have a uniformly adverse impact on well-being outcomes, and this effect often was moderated by sex, such that widows had higher depressive symptoms and poorer self-perceived health than widowers, but separated or divorced women had higher life satisfaction and self-perceived health than men. Irrespective of sex, being separated or divorced versus being single was associated with higher depressive symptoms over time. CONCLUSIONS: Results support the marital crisis model and that women and men can experience marital dissolution differently. All marital loss does not result in compromised well-being and all marriage does not enhance well-being, highlighting complex dynamics worthy of further investigation in this population.