Abstract
Study design:
Longitudinal analysis of SCI registry merged with VHA administrative-data and Medicare claims files (FY1999–2002).
Objectives:
To estimate the prevalence of mental illness (MI) and substance use disorders (SUDs) among veteran health administration (VHA) clinic users with spinal cord injuries (SCI) and examine subgroup variations by demographic, socioeconomic characteristics, and duration and level of SCI.
Setting:
VHA clinic users (N=8338) with SCI who were alive by the end of FY2002.
Methods:
ICD-9-CM codes were used to identify individual MI (anxiety disorders, bipolar, depressive disorders, psychoses, post-traumatic stress disorder (PTSD) and schizophrenia) and categories of SUDs (tobacco, alcohol and drug abuse). Chi-square tests and multinomial logistic regression were used to examine the demographic and socio-economic profile of VHA users with SCI and MI and/or SUD.
Results:
Over a 2-year period, 46% VHA users with SCI had either a MI or SUDs: 20% had MI only; 12% had SUD only and 14% had both. The most common MI was depressive disorder (27%) and tobacco use was highly prevalent (19%). African-Americans (versus whites) were less likely to be diagnosed with MI only. Increased duration of SCI lowered the likelihood of MI and/or SUDs. Mood and anxiety disorders were highly prevalent in veterans with SCI with chronic physical conditions such as diabetes, heart disease, hypertension, and respiratory diseases.
Conclusions:
Mental illness and SUDs are highly prevalent in the VHA population with SCI and is complicated by the high rates of chronic physical conditions, presenting challenges in their healthcare management
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
Lin VW (ed) Spinal Cord Medicine: Principles and Practice. Demos; New York, 2003.
Dryden DM, Saunders LD, Rowe BH et al. Depression following traumatic spinal cord injury. Neuroepidemiology. 2005; 25: 55–61.
Pollard C, Kennedy P . A longitudinal analysis of emotional impact, coping strategies and post-traumatic psychological growth following spinal cord injury: a 10-year review. Br J Health Psychol 2007; 12: 347–362.
Craig A, Tran Y, Middleton J . Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord 2009; 47: 108–114.
Stimpson NJ, Thomas HV, Weightman AL, Dunstan F, Lewis G . Psychiatric disorder in veterans of the persian gulf war of 1991.A systematic review. Br J Psychiatry 2003; 182: 391–403.
Chung MC, Preveaz E, Papandreaou K, Prevezas N . The relationship between posttraumatic stress disorder following spinal cord injury and locus of control. Affect Disord 2006; 93: 229–232.
Radnitz CL, Hsu L, Tirch DD, Willard J, Lillian LB, Walczak S et al. A comparison of posttraumatic stress disorder in veterans with and without spinal cord injury. J Abnorm Psychol. 1998; 107: 676–680.
Radnitz CL, Broderick CP, PerezStrumolo L, Tirch DD . The prevalence of psychiatric disorders in veterans with spinal cord injury: a controlled comparison. J Nerv Ment Dis 1996; 184: 431–433.
Young ME, Rintala DH, Rossi CD, Hart KA, Fuhrer MJ . Alcohol and marijuana use in a community-based sample of persons with spinal cord injury. Arch Phys Med Rehabil 1995; 76: 525–532.
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.
Fullerton DT, Harvey RF, Klein MH, Howell T . Psychiatric disorders in patients with spinal cord injuries. Arch Gen Psychiatry 1981; 38: 1369–1371.
Imai K, Kadowaki T, Aizawa Y, Fukutomi K . Problems in the health management of persons with spinal cord injury. J Clin Epidemiol 1996; 49: 505–510.
VA.Fact Sheet: VA and Spinal Cord Injury. Available at: http://www1.va.gov/opa/fact/spinalcfs.asp; Accessed 25 November 2008.
Banerjea R, Sambamoorthi U, Smelson D, Pogach LM . Chronic illness with complexities: mental illness and substance use among veteran clinic users with diabetes. Am J Drug Alcohol Abuse 2007; 33: 807–821.
Leucht S, Burkard T, Henderson J, Maj M, Sartorius N . Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 2007; 116: 317–333.
Elliott TR, Frank RG . Depression following spinal cord injury. Arch Phys Med Rehabil 1996; 77: 816–823.
Samsa G, Hoenig H, Carswell J, Sloane R, Bovender CR, VanDeusenLukas C et al. Developing a national registry of veterans with spinal cord dysfunction: experiences and implications. Spinal Cord 1998; 36: 57–62.
Smith BM, Weaver FM, Ullrich PM . Prevalence of depression diagnoses and use of antidepressant medications by veterans with spinal cord injury. Am J Phys Med Rehabil 2007; 86: 662–671.
Hatzenbuehler ML, Keyes KM, Narrow WE, Grant BF, Hasin DS . Racial/ethnic disparities in service utilization for individuals with co-occurring mental health and substance use disorders in the general population: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2008; 69: 1112–1121.
DellOrto AE, Power PW (eds) The Psychological and Social Impact of Illness and Disability. Springer Publishing Co; New York, 2007.
Acknowledgements
This research was supported by Grants from Dr Sambamoorthi (IEA-05-255) and Dr Pogach, (REA-03–021). The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Banerjea, R., Findley, P., Smith, B. et al. Co-occurring medical and mental illness and substance use disorders among veteran clinic users with spinal cord injury patients with complexities. Spinal Cord 47, 789–795 (2009). https://doi.org/10.1038/sc.2009.42
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2009.42
Keywords
This article is cited by
-
Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury
Quality of Life Research (2024)
-
Increased psychological distress among individuals with spinal cord injury is associated with central neuropathic pain rather than the injury characteristics
Spinal Cord (2018)
-
Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders
Osteoporosis International (2017)
