Developing an algorithm capable of discriminating depressed mood in people with spinal cord injury

Abstract

Study design: Cross-section design. Objectives: The development of reliable screen technology for predicting those at risk of depression in the long-term remains a challenge. The objective of this research was to determine factors that classify correctly adults with spinal cord injury (SCI) with depressed mood and to develop a diagnostic algorithm that could be applied for prediction of depressed mood in the long-term. Setting: SCI rehabilitation unit, rehabilitation outpatient clinic and Australian community. Methods: Participants included 107 adults with SCI. The assessment regimen included demographic and injury variables, negative mood states, pain intensity, health-related quality of life and self-efficacy. Participants were divided into those with 'normal' mood versus those with elevated depressed mood. Discriminant function analysis (DFA) was then used to isolate factors that in combination, best classify the presence or absence of depressed mood. Results: At the time of assessment, 24 participants (22.4%) had elevated depressed mood. DFA identified six factors that discriminated between those with depressed mood (Po0.01) and those with normal mood, explaining 61% of the variance. Factors consisted of pain intensity, mental health, emotional and social functioning, self-efficacy and fatigue. DFA correctly classified 91.7% (n ¼ 22 of 24) of those with depressed mood and 95.2% (n ¼ 79 of 83) of those without. Demographic, injury and physical health function variables were not found to discriminate depressed mood. Conclusion: Clinical implications of applying a diagnostic algorithm for detecting depression in adults with SCI are discussed. Prospective research is needed to test the predictive efficacy of the algorithm.

Factors predicting resilience in people with spinal cord injury during transition from inpatient rehabilitation to the community

“…7 Although it is an encouraging finding that at least 60-70% of people with SCI report satisfactory levels of resilience, it remains a concern that a large minority of participants (just over 30%) remain highly vulnerable to problems such as maladaptive coping, hopelessness and negativity in the longer term. This rate of vulnerability is similar to rates of depressive mood or probable depression in people with SCI in the long term, 4,5 and it reinforces the need for increased resources to be invested into research that focuses on recovery, such as developing efficacious rehabilitation strategies that boost and sustain resilience in adults with SCI. For example, rehabilitation strategies should (i) strengthen self-efficacy by reinforcing the connection between the person's behavior and intended outcomes using self-management skills such as selfmonitoring; (ii) lower negative mood states by teaching fear reduction and anxiety management skills; and (iii) strengthen social and vocational support networks.…”

“…1,2 Complications include chronic pain, fatigue and psychological morbidity. [3][4][5] Given the challenging nature of living with such a potentially distressing injury, recent studies have investigated resilience following SCI. 1,[6][7][8][9] Resilience is a complex process that varies according to context, time, age, sex and cultural origin, and it involves qualities that enable one to adjust to and cope with adversity in an adaptive manner.…”

A Clinical Perspective on the Need for Psychosocial Care Guidelines in Spinal Cord Injury Rehabilitation

“…self-efficacy) and coping styles can enhance or become a barrier to adjustment [9,13,22,26] Mood states Elevated negative mood states will impede adjustment and possibly result in higher risks of attempted suicide [4][5][6][7][8]25,27,28] The Biopsychosocial Model should guide SCI rehabilitation, as it integrates biological, psychological and social dimensions of physical and mental health outcomes, and it has been successfully applied previously to SCI care [29,30].…”

“…This is the case in Australia, if not in many SCI units worldwide. Psychosocial management is certainly required when specific problems are examined, for instance, high occurrence of psychological morbidity [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Rates of depression are estimated to range between 20 to 40% of the adult SCI population, almost 10 times the rates of depressive mood in the able-bodied [4,8,28].…”

“…Psychosocial management is certainly required when specific problems are examined, for instance, high occurrence of psychological morbidity [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Rates of depression are estimated to range between 20 to 40% of the adult SCI population, almost 10 times the rates of depressive mood in the able-bodied [4,8,28]. Incapacitating severe chronic fatigue and pain can be experienced by at least 50% of adults with SCI [7,12,13,22,23], unemployment is prevalent in the majority of adults with SCI [14,15,21], and suicide rates can be more than twice the rate in the able-bodied population [20].…”