Abstract
Study Design:
A systematic review of the literature concerning the nature of the psychological morbidity in people with spinal cord injury (SCI).
Objectives:
SCI is believed to place the individual at a high risk of psychological morbidity. The objective of this paper was to examine systematically the prevalence of negative psychological states in people with SCI, as well as to explore mediating and contextual factors.
Methods:
Search engines such as Medline and PsycInfo were systematically searched using specific key words, such as SCI, depression, anxiety and so on. Only studies that fulfilled certain criteria such as the use of valid measures in assessing psychological morbidity were used in the review process.
Results:
The systematic review revealed that clarification is still needed concerning the psychological consequences of people with SCI. However, findings suggest that approximately 30% of people with SCI are at risk of having a depressive disorder although in rehabilitation, and approximately 27% are at risk of having raised depressive symptoms when living in the community. The review also established that people with SCI have higher comparative risks of anxiety disorder, elevated levels of anxiety, feelings of helplessness and poor quality of life (QOL).
Conclusion:
People with SCI have an increased risk of suffering debilitating levels of psychological morbidity. Future research needs to clarify the extent and nature of psychological morbidity following SCI by conducting prospective and comprehensive research in large heterogeneous samples of people with SCI during the rehabilitation phase and following reintegration into the community.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Middleton J, Tran Y, Craig A . Relationship between quality of life and self-efficacy in persons with spinal cord injuries. Arch Phys Med Rehabil 2007; 88: 1643–1648.
Elliott TR, Frank RG . Depression following spinal cord injury. Arch Phys Med Rehabil 1996; 77: 816–823.
O'Connor PJ . Trends in spinal cord injury. Acc Analysis Prev 2006; 38: 71–77.
Wyndaele M, Wyndaele JJ . Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord 2006; 44: 523–529.
Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM . Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006; 87: 1079–1085.
Ho CH, Wuermser L, Priebe MM, Chiodo AE, Scelza WM, Kirshblum SC . Spinal cord injury medicine. 1. Epidemiology and classification. Arch Phys Med Rehabil 2007; 88: S49–S54.
Buckelew SP, Frank RG, Elliott TR, Chaney J, Hewett J . Adjustment to spinal cord injury: stage theory revisited. Paraplegia 1991; 29: 125–130.
Elliott TR, Kennedy P . Treatment of depression following spinal cord injury: An evidence-based review. Rehab Psychol 2004; 49: 134–139.
Fullerton DT, Harvey RF, Klein MH . Psychiatric disorders in patients with spinal cord injuries. Arch Gen Psychiatry 1981; 38: 1369–1371.
Craig AR, Hancock KM, Dickson HG . A longitudinal investigation into anxiety and depression in the first 2 years following a spinal cord injury. Paraplegia 1994; 32: 675–679.
Craig A, Hancock K, Dickson H . Improving the long-term adjustment of spinal cord injured persons. Spinal Cord 1999; 37: 345–350.
North NT . The psychological effects of spinal cord injury: a review. Spinal Cord 1999; 37: 671–679.
Heinemann AW, Doll MD, Armstrong KJ, Schnoll S, Yarkony GM . Substance use and receipt of treatment by persons with long-term spinal cord injuries. Arch Phys Med Rehabil 1991; 72: 482–487.
Stanford RE, Soden R, Bartrop R, Mikk M, Taylor TKF . Spinal cord and related injuries after attempted suicide: psychiatric diagnosis and long-term follow-up. Spinal Cord 2007; 45: 437–443.
DeVivo MJ, Black KJ, Richards S, Stover SL . Suicide following spinal cord injury. Paraplegia 1991; 29: 620–627.
Judd FK, Brown DJ . Suicide following acute traumatic spinal cord injury. Paraplegia 1992; 30: 173–177.
Johnson RL, Gerhart KA, McCray J, Menconi JC, Whiteneck GG . Secondary conditions following spinal cord injury in a population-based sample. Spinal Cord 1998; 36: 45–50.
Krause JS . Self-reported problems after spinal cord injury: Implications for rehabilitation practice. Topics Spinal Cord Inj Rehabil 2007; 12: 35–44.
Jacobs KS, Zachariah K, Bhattacharji S . Depression in individuals with spinal cord injury: methodological issues. Paraplegia 1995; 33: 377–380.
Buckelew SP, Baumstark KE, Frank RG, Hewett JE . Adjustment following spinal cord injury. Rehab Psychol 1990; 35: 101–109.
Dryden DM, Duncan Saunders L, Rowe BH, May LA, Yiannakoulias N, Svenson LW et al. Depression following Traumatic Spinal Cord Injury. Neuroepidemiology 2005; 25: 55–61.
Frank RG, Kashani JH, Wonderlich SA, Lising A, Visot LR . Depression and adrenal function in spinal cord injury. Am J Psychiatry 1985; 142: 252–253.
Howell T, Fullerton DT, Harvey RF, Klein M . Depression in spinal cord injured patients. Paraplegia 1981; 19: 284–288.
Judd FK, Stone J, Webber J, Brown D, Burrows JD . Depression following spinal cord injury: a prospective in-patient study. Br J Psychiatry 1989; 154: 668–671.
Kennedy P, Rogers B . Anxiety and depression after spinal cord injury: a longitudinal analysis. Arch Phys Med Rehabil 2000; 81: 932–937.
Kishi Y, Robinson RG, Forrester AW . Prospective longitudinal study of depression following spinal cord injury. J Neuropsychol Clin Neurosc 1994; 6: 237–244.
Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG . Symptoms of major depression in people with spinal cord injury: Implications for screening. Arch Phys Med Rehabil 2004; 85: 1749–1756.
Fuhrer MJ, Rintala DH, Hart KA, Clearman R, Young ME . Depressive symptomatology in persons with spinal cord injury who reside in the community. Arch Phys Med Rehabil 1993; 74: 255–260.
Hancock K, Craig AR, Tennant C, Chang E . The influence of spinal cord injury on coping styles and self-perceptions: a controlled study. Austral NZ J Psychiatry 1993; 27: 450–456.
Kemp BJ, Kahan JS, Krause JS, Adkins RH, Nava G . Treatment of major depression in individuals with spinal cord injury. The J Spinal Cord Med 2003; 27: 22–28.
Kemp BJ, Krause JS . Depression and life satisfaction among people ageing with post-polio and spinal cord injury. Dis Rehabil 1999; 21: 241–249.
Krause JS, Kemp B, Coker J . Depression after spinal cord injury: relation to gender, ethnicity, aging and socioeconomic indicators. Arch Phys Med Rehabil 2000; 81: 1099–1109.
MacDonald MR, Neilson WR, Cameron MG . Depression and activity patterns of spinal cord injured persons living in the community. Arch Phys Med Rehabil 1987; 68: 339–343.
Scivoletto G, Petrelli A, Di Lucente L, Castellano V . Psychological investigation of spinal cord injury patients. Spinal Cord 1997; 35: 516–520.
Craig A, Tran Y, Lovas J, Middleton J . Spinal cord injury and its association with negative psychological states. Int J Psychosoc Rehabil 2008; 12: 115–121.
Nichols K . Psychological Care for Ill and Injured People: A Clinical Guide. Open University Press: Maidenhead, 2003.
Frank RG, Elliott TR, Corcoran JR, Wonderlich SA . Depression after spinal cord injury: is it necessary? Clin Psychol Rev 1987; 7: 611–630.
Tate D, Forchheimer M, Maynard F, Dijkers M . Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap. Arch Phys Med Rehabil 1994; 73: 175–183.
Craig AR, Hancock KM, Chang E, Dickson HG . Immunizing against depression and anxiety following spinal cord injury. Arch Phys Med Rehabil 1998; 79: 375–377.
Craig AR, Hancock K, Dickson H, Chang E . Long-term psychological outcomes in spinal cord injured persons: Results of a controlled trial using cognitive behaviour therapy. Arch Phys Med Rehabil 1997; 78: 33–38.
Krause JS, Brotherton SS, Morrisette DC, Newman SD, Karakostas TE . Does pain interference mediate the relationship of independence in ambulation with depressive symptoms after spinal cord injury? Rehabil Psychol 2007; 52: 162–169.
Rintala DH, Loubser PG, Castro J, Hart KA, Fuhrer MJ . Chronic pain in a community-based sample of men with spinal cord injury: prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being. Arch Phys Med Rehabil 1998; 79: 604–614.
Norrbrink Budh C, Hultling C, Lundeberg T . Quality of sleep in individuals with spinal cord injury: a comparison between patients with and without pain. Spinal Cord 2005; 43: 85–95.
Craig AR, Hancock KM, Dickson HG . Spinal cord injury: a search for determinants of depression two years after the event. Br J Clin Psychol 1994; 33: 221–230.
Chung MC, Preveza E, Papandreou K, Prevezas N . The relationship between post-traumatic stress disorder following spinal cord injury and locus of control. J Affective Dis 2006; 93: 229–232.
Kennedy P, Evans MJ . Evaluation of post-traumatic distress in the first 6 months following SCI. Spinal Cord 2001; 39: 381–386.
Radnitz CL, Schlein IS, Hsu L . The effect of prior trauma exposure on the development of PTSD following spinal cord injury. J Anx Dis 2000; 14: 313–324.
Craig AR, Hancock K, Chang E . The influence of spinal cord injury on coping styles and self-perceptions two years after the event. Australian New Zeal J Psychiatry 1994; 28: 307–312.
Wollaars MM, Post MW, van Asbeck FWA, Brand N . Spinal cord injury pain: the influence of psychologic factors and impact on quality of life. The J Clin Pain 2007; 23: 383–391.
Charlifue SW, David MA, Weitzenkamp A, Gale BA, Whiteneck G . Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being. Arch Phys Med Rehabil 1999; 80: 1429–1434.
Federoff JP, Starkstein SE, Forrester AW, Geisler FH, Jorge RE, Arndt SV et al. Depression in patients with acute traumatic brain injury. The Am J Psychiatry 1992; 149: 918–923.
Elovic E, Kirschblum S . The epidemiology of spinal cord injury and traumatic brain injury: the scope of the problem. Top Spinal Cord Injury Rehabil 1999; 5: 1–20.
Cairns DM, Adkins RH, Scott MD . Pain and depression in acute traumatic spinal cord injury: Origins of chronic problematic pain? Arch Phys Med Rehabil 1996; 77: 329–335.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM IV. APA: Washington, DC, 1994.
Acknowledgements
This research was supported by a New South Wales Premier SCI Grant (RIPG4), and by a grant from the Australian Research Council (LP0560590).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Craig, A., Tran, Y. & Middleton, J. Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord 47, 108–114 (2009). https://doi.org/10.1038/sc.2008.115
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2008.115
Keywords
This article is cited by
-
The prevalence and profile of spinal cord injury in public healthcare rehabilitation units in Gauteng, South Africa
Spinal Cord Series and Cases (2023)
-
Greener on the other side? an analysis of the association between residential greenspace and psychological well-being among people living with spinal cord injury in the United States
Spinal Cord (2022)
-
Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain
Spinal Cord (2022)
-
Autonomic variability, depression and the disability paradox in spinal cord injury
Spinal Cord Series and Cases (2022)
-
National survey of mental health and suicidal thoughts in people with spinal cord injury
Spinal Cord (2022)
