Depression after spinal cord injury: Relation to gender, ethnicity, aging, and socioeconomic indicators

Objective: To investigate the relation among aging, gender, ethnicity, socioeconomic indicators, and depressive symptoms after spinal cord injury (SCI). Design: Survey was done to collect cross-sectional data. A mediational model was used to analyze the interrelationships between predictors and depressive outcome variables. Setting: A large Southeastern rehabilitation hospital. Participants: Participants, identified from outpatient records who met the following inclusion criteria: (1) traumatic SCI; (2) at least 18 years old at the time of study; and (3) injured for at least 1 year. There was an initial pool of 1923 potential participants in 1997, of whom 1391 (72%) participated. Main Outcome Measures: The Older Adult Health and Mood Questionnaire, a 22-item measure of depressive symptoms designed following Diagnostic and Statistical Manual of Mental Disorders (DSM III-R) criteria, was used to measure depression. It has been validated against clinical assessments by psychiatrists and psychologists. Results: Forty-eight percent of the participants reported clinically significant symptoms. Minority participants, particularly women, were at a substantially higher risk for depressive symptoms. This risk diminished but did not disappear after controlling for years of education and income, both of which were highly negatively correlated with depressive symptoms. Aging factors were modestly positively correlated with depression, although education or income did not mediate these associations. Conclusions: Symptoms of depression are highly prevalent after SCI and are related to aging, gender or ethnicity, and socioeconomic status indicators (education and income).