title: Depression treatment preferences after acute traumatic spinal cord injury.
abstract: OBJECTIVE
  To examine preferences for depression treatment modalities and settings and predictors of treatment preference in persons with spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional surveys.
  
  
  METHODS
  Rehabilitation inpatient services.
  
  
  METHODS
  Persons with traumatic SCI (N=183) undergoing inpatient rehabilitation.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Patient Health Questionnaire-9 depression scale, history of psychiatric diagnoses and treatments, and a depression treatment preference survey.
  
  
  RESULTS
  Among inpatients with SCI (28% had Patient Health Questionnaire-9 score ≥10 indicating probable major depression), a physical exercise program was the most preferred treatment option (78% somewhat or very likely to try) followed by antidepressants prescribed by a primary care provider (63%) and individual counseling in a medical or rehabilitation clinic (62%). All modalities were preferred over group counseling. Although not statistically significant, more depressed individuals stated a willingness to try antidepressants and counseling than nondepressed individuals. Subjects preferred treatment in a medical/rehabilitation setting over a mental health setting. Those with a prior diagnosis of depression and a history of antidepressant use were significantly more willing to take an antidepressant. Age ≥40 years was a significant predictor of willingness to receive individual counseling.
  
  
  CONCLUSIONS
  Treatment preferences and patient education are important factors when choosing a depression treatment modality for patients with SCI. The results suggest that antidepressants, counseling, and exercise may be promising components of depression treatment in this population, particularly if they are integrated into medical or rehabilitation care.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Psychiatry and Behavioral Sciences and Epidemiology, University of Washington, Seattle, WA. Electronic address: fann@uw.edu.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Crane
authors.affiliation: The Institute for Rehabilitation and Research, Houston, TX.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Graves
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Claire Z
authors.initials: CZ
authors.lastname: Kalpakjian
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Denise G
authors.initials: DG
authors.lastname: Tate
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
mesh_terms: D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use; D003376:Counseling; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D057240:Patient Preference / Q000706:statistics & numerical data*; D013119:Spinal Cord Injuries / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents
keywords: CI; Depression; MDD; OR; PHQ-9; Patient Health Questionnaire-9; Patient satisfaction; Rehabilitation; SCI; Spinal cord injuries; Therapeutics; confidence interval; major depressive disorder; odds ratio; spinal cord injury