title: Mental health and risk of secondary medical complications in adults with pediatric-onset spinal cord injury.
abstract: OBJECTIVE
  To investigate mental health problems in adults with pediatric-onset spinal cord injury (SCI) and explore how these problems relate to the risk of negative outcomes over time.
  
  
  METHODS
  The study included 466 adults who sustained an SCI prior to age 19 years and had been injured for at least 1 year. Participants were interviewed on an approximately annual basis using a study-specific questionnaire and standardized measures of depression, anxiety, substance use, and community involvement. Generalized estimating equations were used to assess the risk of negative outcomes across time as a function of depression, anxiety, and substance misuse.
  
  
  RESULTS
  Of the participants who reported on each domain of mental health, 26% reported misuse of alcohol or drugs (122/466), 21% reported problems with depression (78/360), and 29% reported problems with anxiety (49/168). Depression was associated with increased odds of pressure ulcers, urinary tract infections, hospitalizations, pain, and smoking and lower levels of economic independence and mobility. Anxiety was associated with increased odds of hospitalization, pain, and smoking. Substance misuse predicted an increased risk of pressure ulcers, pain, and smoking and decreased odds of occupational involvement. When examining the effect of mental health with time, results showed that depression accelerated the risk of urinary tract infections, respiratory complications, and hospitalizations and anxiety and depression accelerated risk for lower occupational independence.
  
  
  CONCLUSIONS
  The added burden that mental health difficulties pose for medical and psychosocial outcomes highlight the importance of monitoring and treating mental health symptoms in pediatric-onset SCI.
authors.affiliation: Shriners Hospitals for Children-Chicago , Chicago, Illinois ; Marquette University , Milwaukee, Wisconsin.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: January
authors.affiliation: Shriners Hospitals for Children-Chicago , Chicago, Illinois ; Loyola University Chicago , Chicago, Illinois.
authors.forename: Kathy
authors.initials: K
authors.lastname: Zebracki
authors.affiliation: Shriners Hospitals for Children-Chicago , Chicago, Illinois.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Chlan
authors.affiliation: Shriners Hospitals for Children-Chicago , Chicago, Illinois ; Rush Medical College , Chicago, Illinois.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Vogel
keywords: anxiety; depression; mental health; pediatric onset; spinal cord injury; substance use