title: Evaluating a spinal cord injury-specific model of depression and quality of life.
abstract: OBJECTIVE
  To determine whether demographic, injury, health, and functional factors similarly have the same predictive relation with both somatic and nonsomatic symptoms of depression, as well as whether somatic and nonsomatic symptoms of depression have the same association with quality of life (QOL).
  
  
  METHODS
  Secondary analysis of cross-sectional survey data.
  
  
  METHODS
  Community
  
  
  METHODS
  Patients with traumatic spinal cord injury (N=4976) who completed an interview at 1 year postinjury between 2006 and 2011.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Somatic and nonsomatic symptoms of depression from the Patient Health Questionnaire-9 and QOL measured by the Satisfaction With Life Scale.
  
  
  RESULTS
  Structural equation modeling showed that the hypothesized model provided a good fit to the data, but modification of the model led to a significant improvement in model fit: Δχ(2)(1)=226.21, P<.001; comparative fit index=.976; χ(2)(199)=585.39, P<.001; root mean square error of approximation=.027 (90% confidence interval, .025-.030). The health-related factors including pain severity, pain interference, and health status were similarly associated with both somatic and nonsomatic symptoms of depression. QOL was negatively associated with nonsomatic symptoms of depression but was unrelated to somatic symptoms of depression.
  
  
  CONCLUSIONS
  Assessment of depression after spinal cord injury should include a careful assessment of health concerns given the relation between health-related factors and both somatic and nonsomatic symptoms of depression. Treatments of depressive symptoms may be improved by targeting health concerns, such as pain, along with a specific focus on nonsomatic symptoms to improve the QOL.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: narhart@uw.edu.
authors.forename: Narineh
authors.initials: N
authors.lastname: Hartoonian
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Hoffman
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: TIRR Memorial Hermann and University of Texas Health Science Center, Houston, TX.
authors.forename: Heather B
authors.initials: HB
authors.lastname: Taylor
authors.affiliation: College of Health Professions, Medical University of South Carolina, Charleston, SC.
authors.forename: James K
authors.initials: JK
authors.lastname: Krause
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000523:psychology*; D015599:Trauma Severity Indices
keywords: Depression; Quality of life; Rehabilitation; Spinal cord injuries