title: An examination of depression through the lens of spinal cord injury. Comparative prevalence rates and severity in women and men.
abstract: OBJECTIVE
  This study describes the prevalence of probable major depressive disorder (MDD) as well as other depressive disorders (ODD) and severity of depressive symptoms in a national sample of women with spinal cord injury (SCI) and compares them with a case-matched sample of men with SCI.
  
  
  METHODS
  A sample of 585 women was drawn and case-matched with men from the SCI Model System National SCI Database according to level/completeness of injury, follow-up year, and age. The outcome measure of depression was the Patient Health Questionnaire.
  
  
  RESULTS
  Prevalence rates for women were 7.9% for probable MDD and 9.7% for ODD; rates for men were 9.9% and 10.3%, respectively. Logistic regression revealed that women who were divorced or at year 1 follow-up had a higher odds of having probable MDD (odds ratio [OR], 3.4 and 2.9, respectively). Employed women and men had significantly lower odds of probable MDD (OR, 0.274 and 0.358, respectively). Statistically significant differences were not found in gender comparisons for either probable MDD or symptom severity, which also were not associated with injury characteristics.
  
  
  CONCLUSIONS
  The most significant, and unexpected, research finding is the absence of gender differences in probable MDD and symptom severity. Results challenge notions that depression will necessarily follow SCI; that injury characteristics determine the development and severity of depression; and that women experience a greater burden of depression than men. The main clinical implication is that depression screening and referral should be a routine feature of health care for women living with SCI, as well as for their male counterparts. Furthermore, nearly one fourth of women and men reported experiencing some or greater difficulty in daily life and relationships in the absence of probable depressive disorder, warranting monitoring of subsyndromal depression as well.
authors.affiliation: University of Michigan Model Spinal Cord Injury Care System, Ann Arbor, Michigan 48109, USA. clairez@umich.edu
authors.forename: Claire Z
authors.initials: CZ
authors.lastname: Kalpakjian
authors.forename: Kathie J
authors.initials: KJ
authors.lastname: Albright
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D003866:Depressive Disorder / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology