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Running head: AN EXAMINATION OF THE CORRELATION BETWEEN SPINAL CORD

INJURIES AND
DEPRESION

An Examination of the Correlation between Spinal Cord Injuries and Depression


Allison Maleska
Minnesota State University, Mankato
Linda Rossow, MS, RN, BC
N436 Psychosocial Integrity
4/6/16

AN EXAMINATION OF THE CORRELATION BETWEEN SPINAL CORD INJURIES AND


DEPRESION

Introduction
Spinal cord injury (SCI) is caused by trauma or damage to the spinal cord, resulting in
either a temporary or permanent alteration in the function of the spinal cord (Lewis, Dirksen,
Heitkemper, Bucher, 2014). In the United States alone, it is estimated that there are 276,000
people living with a SCI and there are approximately 12,500 new SCI cases each year. The
average age of injury is 42 years old and males account for 80% of new SCI cases. The most
common causes of SCI in the United States are automotive accidents, falls, acts of violence, and
sports and recreational activities. The most common causes of reduced life expectancy among
SCI patients are pneumonia and septicemia (National Spinal Cord Injury Statistical Center
(NSCISC), 2015). Over the years, there have been improvements in treatment and therapy for
patients with a SCI. Therefore, patients who suffer from a SCI can expect to live a long life after
initial injury (Lewis, Dirksen, Heitkemper, Bucher, 2014).
Correlation between Spinal Cord Injury and Depression
Although the life expectancy for patients with SCIs has been increasing, these patients
still face the risk of suffering from disruptions in individual and developmental growth, body
image issues, alterations in family dynamics, relationship losses, economic hardships, and health
complications secondary to the SCI (Lewis, Dirksen, Heitkemper, Bucher, 2014). Many
individuals who suffer from a SCI adapt to living independently overtime, although some more
serious cases may require personal care attendants for some activities while others may require
around the clock care (Lewis, Dirksen, Heitkemper, Bucher, 2014). These hardships, transition
periods, life changes and health complications may be very difficult for someone with a SCI to
deal with and can lead to changes in mental health status. It is estimated that 1 in 5 individuals
with a SCI suffer from depression (University of Washington, 2016).

AN EXAMINATION OF THE CORRELATION BETWEEN SPINAL CORD INJURIES AND


DEPRESION

Depression, also known as major depressive disorder (MDD), is defined as a mood


disorder that causes a persistent feeling of sadness and loss of interest (Mayo Clinic, 2016). The
Mayo Clinic explains that it affects every aspect of your life by affecting the way you feel, think
and behave (2016). The University of Washington explains that the exact cause of depression is
unknown but a variety of factors such as stress, health problems and changes in life events can
lead to a change in the neurotransmitters in the brain (2016). This explains why individuals who
suffer from a spinal cord injury may also suffer from depression or other mental health disorders.
Current Research
A recent study found that 46% of patients enrolled with SCI reported depressive
symptoms but only a small minority developed a chronic depression (Shonenberg et al., 2014).
Researchers found that only 12 % of the patients with depressive symptoms developed these
symptoms 4 years after the initial injury. Another study from 2011, had similar findings. They
found that the prevalence of Major Depressive Disorder (MDD) at 1 year after the SPC was 11%
but at 5 years post SCI, the prevalence of MDD dropped to 9.7% (Arango-Lasprilla, Ketchum,
Starkweather, Nicholls, & Wilk, 2011). Shonenberg et al., believe that it is most common for
depressive symptoms to appear soon after discharge from the hospital due to changes in
environment, lack of support outside of the hospital and the reality of their condition setting in
once they are outside of the protected hospital environment. Their findings suggest that overtime
as patients adjust to their new lifestyle, their depressive symptoms decrease and they gain
stability (Shonenberg et al., 2014). Adjusting to a new lifestyle and a decrease in depressive
symptoms was most likely to occur when patients were able to maintain their former hobbies or
interests or were able to develop or participate in new activities they enjoyed. Interestingly,
Shonenberg et al. found that social support did not have an effect on mental health in the

AN EXAMINATION OF THE CORRELATION BETWEEN SPINAL CORD INJURIES AND


DEPRESION

immediate time after patients with a SCI were discharged from the hospital (2014). This was
thought to be due to the fact that many patients who suffer from a SCI often spend much of the
initial years after the injury in physical therapy, occupational therapy, and other supportive
environments that allow them to be surrounded by sympathetic and supportive staff. It is not
until later when they gain stability and independence that their social support and interactions
become a more integral part of their lives (Shonenberg et al., 2014).
Researchers found that there are also certain factors in regards to demographics, injury
and discharge that increase an individuals risk for developing MDD after a SCI. For those
individuals at 1 year post SCI, the most at risk population are those who are between the ages of
35-55, unemployed, have an indwelling catheter and have significant deficit in neurologic
function. At five years post injury, those most at risk for MDD are those individuals who are
females, between the ages of 35-55, with a high school education or less, have an indwelling
catheter and have a significant deficit in neurologic function (Arango-Lasprilla, Ketchum,
Starkweather, Nicholls, & Wilk, 2011).
Treatment and Recommendations
The World Health Organization (WHO), explains that many of the medical and mental
health complications associated with SCIs do not result from the injury itself but are secondary
to barriers such as limitations in physical and social environments, inadequate medical care an
rehabilitation services. It is recommended that in order to avoid these consequences, individuals
facing a SCI should receive timely care, access to ongoing healthcare services, education and
products, access to appropriate rehabilitation and access to appropriate assistive devices that
maximize their abilities and independence (WHO, 2016). Medical treatment options for

AN EXAMINATION OF THE CORRELATION BETWEEN SPINAL CORD INJURIES AND


DEPRESION

depression include medications such as antidepressants, electroconvulsive therapy, and cognitive


behavioral therapy (Rogers, 2012).
Nurses play a very important role in helping those who suffer from depression. It is
suggested that nurses assess for and address feelings of hopelessness and powerlessness, risk for
suicide, self-care deficits, risk for self-directed violence, feelings of ineffective role performance,
and low self-esteem when working with a patient who suffers from a SCI and potentially
depression. Nurses can also apply interventions such as being a listening ear, empathizing with
patient and exploring underlying feelings, educating the patient, supplying the patient a variety
of resources in the community, validating their feelings and opinions, and exploring options to
help them better adapt to their situation (Rogers, 2012).
As a nurse, no matter where I am employed, I will be working with patients and families
who suffer from a wide variety of mental illnesses. I will always be prepared and take with me
the knowledge I learned during my mental health clinical and classroom experience to best help
my patients because there is often a correlation between many medical illnesses and mental
illness. One example is the correlation between spinal cord injuries and depression. A spinal cord
injury is a very serious condition that can lead to many lifestyle changes, health complications,
and mental health changes. Depression and depression like symptoms are often seen in SCI
patients due to these traumatic life altering consequences. Although a SCI can be very traumatic,
there are many ways in which nurses and other healthcare professionals can help these patients
adapt to their new situation and treat their depression.

AN EXAMINATION OF THE CORRELATION BETWEEN SPINAL CORD INJURIES AND


DEPRESION

References
Arango-Lasprilla, J. C., Ketchum, J. M., Starkweather, A., Nicholls, E., & Wilk, A. R. (2011).
Factors predicting depression among persons with spinal cord injury 1 to 5 years post
injury. Neurorehabilitation, 29(1), 9-21
Rogers, V. (2012). Affective Disorders. In J.S. Jone, J. J. Fitzpatrick, & V. L. Rogers. (Eds.),
Psychiatric mental health nursing: An interpersonal approach (pp. 217 241). New
York, NY: Springer.
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L. (2014). Medical surgical nursing:
Assessment and management of clinical problems. St. Louis, MO: Elsevier.
Mayo Clinic. (2016). Depression (major depressive disorder). Retrieved from
http://www.mayoclinic.org/diseases-conditions/depression/basics/definition/con20032977
National Spinal Cord Injury Statistical Center. (2015). Spinal cord injury (SCI) facts and figures
at a glance. Retrieved from https://www.nscisc.uab.edu/Public/Facts%202015.pdf
Schnenberg, M., Reimitz, M., Jusyte, A., Maier, D., Badke, A., & Hautzinger, M. (2014).
Depression, Posttraumatic Stress, and Risk Factors Following Spinal Cord Injury.
International Journal Of Behavioral Medicine, 21(1), 169-176
University of Washington. (2016). SCI pamphlets: Staying healthy after a spinal cord injury.
Retrieved from http://sci.washington.edu/info/pamphlets/depression_sci.asp
World Health Organization. (2016). Spinal cord injury. Retrieved from
http://www.who.int/mediacentre/factsheets/fs384/en/