The overlap of somatic-depressive symptoms and physical sequelae of spinal cord injury (SCI) has raised concerns regarding the validity of depression screens used within the SCI population. The Patient Health Questionnaire-9 (PHQ-9) measure parallels Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) criteria of major depression. The authors investigated PHQ-9 factor structure among persons with SCI at various times postinjury. Design: Data from 2,570 participants at 1 year (N ϭ 682), 5 years (N ϭ 517), 15 years (N ϭ 653), and 25 years (N ϭ 718) postinjury were used. Emergent factors were correlated with satisfaction with life. Results: A 2-factor solution emerged for all groups, with 3 affective referenced items (feeling depressed/hopeless, feeling bad about self/failure, and suicidal ideation) and 3 somatic referenced items (sleep disturbance, low energy/fatigue, and appetite disturbance) loading consistently on Affective and Somatic factors, respectively, at all time points. Factor scores negatively correlated with satisfaction with life. Conclusions: Dual factor structure of the PHQ-9 is present at various times postinjury in the SCI population. It remains unclear whether somatic item endorsement reflects depressive symptomatology per se; however, endorsement is still associated with satisfaction with life.

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Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one's acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self-reports of depressive symptoms. Sixty-seven individuals with chronic back pain completed self-report measures of catastrophizing, acceptance, and depressive symptoms. In addition, participants underwent an ischemic pain induction procedure and were asked to rate the induced pain. Catastrophizing showed significant effects on sensory and intensity but not affective ratings of the induced pain. Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self-reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.

A growing body of animal and human research suggests reciprocal associations between sleep and activity of the hypothalamic pituitary adrenocortical (HPA) axis. However, few studies have examined associations between sleep and stress-induced cortisol responses in children and adolescents. This pilot study examined associations among 3 sleep parameters (sleep-wake behavior problems, daytime sleepiness, sleep quantity) and cortisol responses to stress in 31 participants ages 10 to 17 (15 males, 16 females). During a "rest" session in which participants habituated to the laboratory, daytime sleepiness, sleep-wake behavior problems, and sleep quantity were assessed using a modified Sleep Habits Survey. On a separate day, participants completed a laboratory stress session involving 3 performance stressors. Salivary cortisol was collected during baseline, stress, and recovery periods. Significant associations between participant reported sleep-wake behavior problems and cortisol reactivity were found, with greater sleep-wake behavior problems associated with decreased cortisol responses. No associations emerged between sleep quantity and cortisol responses to stress; daytime sleepiness showed a trend toward an effect on cortisol reactivity. Although preliminary, results suggest there may be important influences of sleep quality but not quantity on HPA regulation and responses to daytime stressors in children and adolescents, and further study is warranted.

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