Actionable Nuggets for SCI (2nd ed., 2013)
It is estimated that half of individuals with a spinal cord injury (SCI) also experience a significant mental health problem. The most common among these is depression, with a prevalence of 23-37% of people with SCI. Other mental health issues include anxiety, clinically-significant stress, and post-traumatic stress disorder.
Screen for depression annually in patients with SCI, using the PHQ-9 or PHQ-2, and treat at standard guideline levels.
Additional information: Patient health questionnaire – PHQ9
Evidence-based Best Practice:
Risks for mental health problems are 2 – 4 times greater among people with spinal cord injuries than among non-disabled individuals. Rates of suicide are 3 – 5 times those reported in the general population. Symptoms of depression can be overlooked or misidentified in people with spinal cord injuries, because depressive symptoms like fatigue and sleep disturbances are often attributed to SCI. Risk factors for depression with SCI include: younger age and shorter time since onset of SCI; lack of rewarding activities, such as work or education; multiple co-morbidities or complications; marital disruption; substance abuse; pre-existing condition or family history.
The PHQ-9 has been shown to be an effective screening tool, with excellent sensitivity, specificity, and reliability in the SCI population. The very brief PHQ-2 (1st two questions of the PHQ-9) has been found to have 86% sensitivity and 78% specificity in the primary care setting, using the 2-point cut-score.
Studies show that only 29% of SCI patients with depression receive treatment – either psychological or pharmacological. Only 11% of those treated pharmacologically are treated with dosages and durations consistent with clinical guidelines (PHQ-9 scores ≥ 10).
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