Relationship Between Depression During Inpatient Rehabilitation and Health, Participation, and Satisfaction With Life at 1-Year Postinjury for Individuals With Spinal Cord Injury: Findings From the Spinal Cord Injury Model Systems Database.

OBJECTIVE

To determine the relationship between depression during inpatient rehabilitation and health, participation, and satisfaction with life at 1-year postinjury in persons with spinal cord injury (SCI).

DESIGN

Prospective cohort study.

SETTING

SCI Model Systems.

PARTICIPANTS

Individuals ≥18 years of age (N=3298) enrolled in an SCI Model Systems Center between 2016 and 2024 who had complete data for the Patient Health Questionnaire-9 (PHQ-9) at the time of inpatient rehabilitation and had completed the 1-year follow-up interview.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Urinary tract infections, pressure injury, rehospitalizations, days hospitalized, pain severity, self-perceived health status, cumulative Craig Handicap and Reporting Technique score, and Satisfaction with Life Scale score at the 1-year follow-up.

RESULTS

Those meeting criteria for depression (vs no depression) using a PHQ-9 score ≥10 were more likely to report ≥1 rehospitalizations [odds ratio (OR, 1.30; P=.04), hospitalization ≥14 days (OR, 1.43; P=.04), a higher pain severity (OR,1.56; P<.01), a lower self-perceived health status (OR, 0.54; P<.01), lower cumulative Craig Handicap and Reporting Technique scores (-22.2; P<.01), and a lower Satisfaction with Life Scale score (OR, 0.46; P<.01) at the 1-year follow-up. There was no association between depression and urinary tract infections or risk of pressure injury. Compared with the PHQ-9 ≥10 criterion, the use of a stricter criterion for depression resulted in a higher likeliness of poor health and participation outcomes and increased likeness of pressure injury (OR,1.66; P=.01).

CONCLUSIONS

The results from this study indicate a possible link between depression and poorer postdischarge outcomes among individuals with SCI. Future research should investigate whether this can be mitigated by early initiation of treatment in the inpatient setting. The PHQ-9 appears to be a good marker for identification of individuals at risk for poorer outcomes after discharge and should be used to screen for those who need intervention for depressive symptoms during inpatient rehabilitation.