Factors predicting depression among persons with spinal cord injury 1 to 5 years post injury

Objectives: Estimate changes in prevalence of Major Depressive Disorder (MDD) 1 to 5 years post spinal cord injury (SCI); Identify demographic, injury, and discharge factors associated with MDD at 1 and 5 years post-injury; Identify modifiers of changes in MDD. Design: Retrospective. Setting: Model Spinal Cord Injury System. Participants: 2,256 adult participants enrolled in the National Spinal Cord Injury Statistical Center between 1999 and 2004. Main Outcome Measure: MDD as determined by the Patient Health Questionnaire-9 (PHQ-9). Results: Prevalence of MDD was 11.9% at 1 year and 9.7% at 5 years post SCI. Odds of MDD decreased significantly 1 to 5 years post-injury (odds ratio=1.26, 95% confidence interval=1.02, 1.56). At 1 year post-injury, the odds of MDD was greater for persons 35-55 years old at injury, unemployed, having an indwelling catheter or voiding bladder management at discharge, and higher scores on ASIA motor index. At 5 years post-injury, the odds of MDD were greater for females, persons 35-55 years old at injury, those with a high school education or less, those having an indwelling catheter, voiding, and no bladder management at discharge, and higher scores on ASIA motor index. Sex was the only significant modifier. Conclusions: MDD occurs commonly 1 to 5 years post SCI. Sociodemographic, injury, and discharge factors are associated with the development and changes in depression. Future research should expand upon current findings in order to identify, prevent, and reduce the prevalence of MDD after SCI.