title: Pain, depression, and health care utilization over time after spinal cord injury.
abstract: OBJECTIVE
  The aim of this research was to examine comorbid pain and depression after spinal cord injury (SCI) in terms of: frequency, longitudinal course, and associations with medical conditions and use of SCI specialty care.
  
  
  METHODS
  Three consecutive standardized annual psychological evaluations were reviewed for 286 persons with SCI receiving care at an SCI specialty care center. Chart abstraction included medical and demographic information, a depression scale, and a pain scale. Administrative databases were used to collect SCI specialty care utilization data. Participants were categorized as having elevated pain, elevated depression, both elevated pain and depression, or neither elevated, using cut-off scores on the pain and depression scales. ANOVA and repeated measures ANOVA were used to compare study groups.
  
  
  RESULTS
  Approximately 20% of the sample showed both elevated pain and depression at Year 1. Persons with elevated pain and depression showed higher scores on those measures than did persons with either pain or depression alone. Pain scores tended to be stable over time. Depression scores tended to improve over 3 years, but persons with elevated pain and depression showed less improvement on depression scores than did persons with depression alone. Persons with pain and depression tended to utilize more SCI specialty care.
  
  
  CONCLUSIONS
  Pain and depression are often comorbid after SCI. This comorbidity is associated with higher pain and depression severity, more persistent pain and depression over time, and more use of SCI specialty care. Comorbid pain and depression should be anticipated among persons with SCI and addressed in care plans.
authors.affiliation: Department of Veterans Affairs, Spinal Cord Injury and Disorders Services, VA Puget Sound Healthcare System. philip.ullrich@va.gov
authors.forename: Philip M
authors.initials: PM
authors.lastname: Ullrich
authors.forename: Randi K
authors.initials: RK
authors.lastname: Lincoln
authors.forename: M Jan
authors.initials: MJ
authors.lastname: Tackett
authors.forename: Scott
authors.initials: S
authors.lastname: Miskevics
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
mesh_terms: D000704:Analysis of Variance; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000523:psychology*; D014481:United States; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data