title: Prevalence of depression after spinal cord injury: a meta-analysis.
abstract: OBJECTIVE
  To use meta-analysis to synthesize point prevalence estimates of depressive disorder diagnoses for persons who have sustained a spinal cord injury (SCI).
  
  
  METHODS
  We searched PsycINFO, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Dissertation Abstracts International (DAI) for studies examining depression after SCI through 2013. We also conducted a manual search of the reference sections of included studies.
  
  
  METHODS
  Included studies contained persons with SCI; used a diagnostic measure of depression (ie, an unstructured, semi-structured, or structured clinical interview, and/or a clinician diagnosis); and provided a diagnosis of major or minor depressive episodes for the subjects in the study. Diagnostic criteria were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (including Research Diagnostic Criteria) criteria.
  
  
  METHODS
  The 2 authors of this study screened the titles and abstracts of 1053 unique studies for inclusion in this meta-analysis. Nineteen studies, containing 35,676 subjects and 21 effect size estimates, were included.
  
  
  RESULTS
  The mean prevalence estimate of depression diagnosis after SCI was 22.2%, with a lower-bound estimate of 18.7% and an upper bound estimate of 26.3%. Random effects and mixed effects models were used in this work. A small number of study moderators were explored, including sample sex composition, Diagnostic and Statistical Manual of Mental Disorders version used, data collection method (primary vs secondary), sample traumatic etiology composition, sample injury level and completeness composition, and sample diagnostic composition. Data collection method, Diagnostic and Statistical Manual of Mental Disorders version, and diagnostic composition significantly predicted variation in observed effect size estimates, with primary data collection studies having lower estimates compared with secondary data analysis studies, studies using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria having higher estimates compared with studies using Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria, and samples comprising individuals diagnosed only with major depression having lower prevalence estimates.
  
  
  CONCLUSIONS
  The existing data on depression after SCI indicate that the prevalence of depression after SCI is substantially greater than that in the general medical population. These results underscore the importance of continued research on measuring depression in persons with SCI and on treatments for depression after SCI.
authors.affiliation: American Institutes for Research, Chicago, IL. Electronic address: rwilliams@air.org.
authors.forename: Ryan
authors.initials: R
authors.lastname: Williams
authors.affiliation: Department of Counseling, Educational Psychology, and Research, College of Education, Health and Human Sciences, University of Memphis, Memphis, TN.
authors.forename: Adrian
authors.initials: A
authors.lastname: Murray
mesh_terms: D003866:Depressive Disorder / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000523:psychology*
keywords: Depression; Meta-analysis; Prevalence; Rehabilitation; Review, systematic; Spinal cord injuries