Depression After Spinal Cord Injury: Comorbidities, Mental Health Service Use, and Adequacy of Treatment

Objective: To provide data for depression rates and psychiatric comorbid conditions, mental health service use, and adequacy of depression treatment in depressed and nondepressed adults with spinal cord injury (SCI). Design: Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS). Setting: Community setting. Participants: Community-residing people with traumatic SCI (N=947). Interventions: Not applicable. Main Outcome Measures: Patient Health Questionnaire-9 (PHQ-9) Depression Scale, psychiatric history questionnaire, Cornell Service Index (mental health service use), and current medication use. Results: The prevalence of probable major depression (PHQ-9 score >= 10) was 23%. There was a high lifetime prevalence of other psychiatric conditions, particularly anxiety disorders. In depressed participants, 29% currently were receiving any antidepressant and 11% were receiving guideline-level antidepressant dose and duration, whereas 11% had been receiving any psychotherapy in the past 3 months and 6% had been receiving guideline-level psychotherapy in the past 3 months. Serotonergic antidepressants and individual psychotherapy were the most common types of treatment received, and there was a wide range of provider types and treatment settings. Demographic and clinical variables were not associated with receipt of mental health service or guideline-level care. Conclusions: Findings from this study document the low rate of mental health treatment for persons with SCI and probable major depression. These findings have implications for improving the effectiveness of depression treatment in people with SCI.