title: An exploration of modifiable risk factors for depression after spinal cord injury: which factors should we target?
abstract: OBJECTIVE
  To identify modifiable risk factors for depression in people with spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Outpatient and community settings.
  
  
  METHODS
  Community-residing people with SCI (N=244; 77% men, 61% white; mean age, 43.1y; 43% with tetraplegia) who were at least 1 month postinjury.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Depression severity (Patient Health Questionnaire-9 [PHQ-9]), physical activity (International Physical Activity Questionnaire [IPAQ]), pleasant and rewarding activities (Environment Rewards Observation Scale [EROS]), and self-efficacy to manage the effects of SCI (Modified Lorig Chronic Disease Self-Management Scale).
  
  
  RESULTS
  Greater depression severity was associated with being 20 to 29 years of age, not completing high school, not working or attending school, and being ≤4 years post-SCI. After controlling for demographic and injury characteristics (adjusted R(2)=.13), lower EROS scores (change in adjusted R(2)=.34) and lower self-efficacy (change in R(2)=.13) were independent predictors of higher PHQ-9 scores. Contrary to predictions, physical activity as measured by the IPAQ did not predict depression severity.
  
  
  CONCLUSIONS
  Our findings suggest that having fewer rewarding activities, and to a lesser extent, having less confidence in one's ability to manage the effects of SCI are independent predictors of greater depression severity after SCI. Interventions such as behavior activation, designed to increase rewarding activities, may represent an especially promising approach to treating depression in this population.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. chb@uw.edu
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.forename: Denise G
authors.initials: DG
authors.lastname: Tate
authors.forename: J Scott
authors.initials: JS
authors.lastname: Richards
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wilson
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Warren
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Temkin
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D007899:Leisure Activities / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012044:Regression Analysis; D012307:Risk Factors; D020377:Self Efficacy; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications / Q000523:psychology*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors; D014478:Unemployment / Q000523:psychology; D055815:Young Adult