title: Identifying depression severity risk factors in persons with traumatic spinal cord injury.
abstract: OBJECTIVE
  Examine the relationship between demographic characteristics, health-, and injury-related characteristics, and substance misuse across multiple levels of depression severity.
  
  
  METHODS
  204 persons with traumatic spinal cord injury (SCI) volunteered as part of screening efforts for a randomized controlled trial of venlafaxine extended release for major depressive disorder (MDD). Instruments included the Patient Health Questionnaire-9 (PHQ-9) depression scale, the Alcohol Use Disorders Identification Test (AUDIT), and the Substance Abuse in Vocational Rehabilitation-Screener (SAVR-S), which contains 3 subscales: drug misuse, alcohol misuse, and a subtle items scale. Each of the SAVR-S subscales contributes to an overall substance use disorder (SUD) outcome. Three proportional odds models were specified, varying the substance misuse measure included in each model.
  
  
  RESULTS
  44% individuals had no depression symptoms, 31% had mild symptoms, 16% had moderate symptoms, 6% had moderately severe symptoms, and 3% had severe depression symptoms. Alcohol misuse, as indicated by the AUDIT and the SAVR-S drug misuse subscale scores were significant predictors of depression symptom severity. The SAVR-S substance use disorder (SUD) screening outcome was the most predictive variable. Level of education was only significantly predictive of depression severity in the model using the AUDIT alcohol misuse indicator.
  
  
  CONCLUSIONS
  Likely SUD as measured by the SAVR-S was most predictive of depression symptom severity in this sample of persons with traumatic SCI. Drug and alcohol screening are important for identifying individuals at risk for depression, but screening for both may be optimal. Further research is needed on risk and protective factors for depression, including psychosocial characteristics.
authors.affiliation: Department of Counseling, Educational Psychology, and Research, University of Memphis.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Williams
authors.affiliation: James A. Haley Veterans' Hospital.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wilson
authors.affiliation: Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.affiliation: SASSI Institute.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Lazowski
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Rehabilitation Medicine and Epidemiology, University of Washington.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.affiliation: Department of Rehabilitation Medicine, University of Washington.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult