title: A longitudinal study of depression from 1 to 5 years after spinal cord injury.
abstract: OBJECTIVE
  To describe rates of probable major depression and the development and improvement of depression and to test predictors of depression in a cohort of participants with spinal cord injury (SCI) assessed at 1 and 5 years after injury.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  SCI Model System.
  
  
  METHODS
  Participants (N=1035) who completed 1- and 5-year postinjury follow-up interviews from 2000 to 2009.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Probable major depression, defined as Physician Health Questionnaire-9 score of 10 or higher.
  
  
  RESULTS
  Probable major depression was found in 21% of participants at year 1 and 18% at year 5. Similar numbers of participants had improvement (25%) or worsening (20%) of symptoms over time, with 8.7% depressed at both 1 and 5 years. Increased pain (odds ratio [OR], 1.10), worsening health status (OR, 1.39), and decreasing unsafe use of alcohol (vs no unsafe use of alcohol; OR, 2.95) are risk factors for the development of depression at 5 years. No predictors of improvement in depression were found.
  
  
  CONCLUSIONS
  In this sample, probable major depression was found in 18% to 21% of participants 1 to 5 years after injury. To address this high prevalence, clinicians should use these risk factors and ongoing systematic screening to identify those at risk for depression. Worsening health problems and lack of effective depression treatment in participants with SCI may contribute to high rates of chronic or recurrent depression in this population.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. jeanneh@uw.edu
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Hoffman
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Graves
authors.forename: Claire Z
authors.initials: CZ
authors.lastname: Kalpakjian
authors.forename: James S
authors.initials: JS
authors.lastname: Krause
mesh_terms: D000328:Adult; D000367:Age Factors; D003865:Major Depressive Disorder / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation*; D015599:Trauma Severity Indices