title: Anxiety and Depression in Patients with Traumatic Spinal Cord Injury: A Nationwide Population-Based Cohort Study.
abstract: BACKGROUND
  Traumatic spinal cord injury (tSCI) may involve new-onset anxiety and depression post-discharge. However, long-term population-based studies have lacked access to follow-up conditions in terms of new-onset anxiety and depression. The objective of this study was to estimate the long-term risk of new-onset anxiety and depression post-discharge.
  
  
  METHODS
  The Longitudinal Health Insurance Database 2000 (LHID2000) from Taiwan's National Health Insurance Research Database was used in this study. Individuals with tSCI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes of 806 and 952 from 1999-2008. The comparison cohort (other health conditions group) was randomly selected from the LHID2000 and was 1:1 matched by age, sex, index year, and comorbidities to reduce the selection bias. All study participants were retrospectively followed for a maximum of 3 years until the end of follow-up, death, or new-onset anxiety (ICD-9-CM: 309.2-309.4) or depression (ICD-9-CM: 296.2, 296.5, 296.82, 300.4, 309.0-309.1, and 311). Persons who were issued a catastrophic illness card for tSCI were categorized as having a severe level of SCI (Injury Severity Score [ISS] ≥16). Poisson regression was used to estimate the incidence rate ratios of anxiety or depression between patients with tSCI and other health conditions. The relative risk of anxiety or depression was estimated using a Cox regression analysis, which was adjusted for potential confounding factors.
  
  
  RESULTS
  Univariate analyses showed that the tSCI patients (n = 3556) had a 1.33 times greater incidence of new-onset anxiety or depression (95% confidence interval [CI]: 1.12-1.57) compared to the other health conditions group (n = 3556). After adjusting for potential risk factors, the tSCI patients had a significant 1.29-fold increased risk of anxiety or depression compared to the group with other health conditions (95% CI: 1.09-1.53). Individuals with tSCI, including patients who were under the age of 35, patients who were males, patients who had a low income, and patients without a Charlson Comorbidity Index score, all had a higher long-term risk of anxiety or depression than the other health conditions group (IRRs: 1.84, 1.63, 1.29, and 1.39, respectively). For all tSCI patients, those with an Injury Severity Score (ISS) ≥16 had an almost 2-fold higher risk of anxiety or depression (adjusted Hazard Ratio: 1.85; 95% CI: 1.17-2.92) compared to those with ISS <16.
  
  
  CONCLUSIONS
  Our findings indicated that tSCI patients have a high risk of anxiety or depression post-discharge, especially among the younger tSCI patients (age <50 years), compared with the other health conditions group. This information could help physicians understand the long-term risk of new-onset anxiety or depression in tSCI patients post-discharge.
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.|Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.|Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.
authors.forename: Sher-Wei
authors.initials: SW
authors.lastname: Lim
authors.affiliation: Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
authors.forename: Yow-Ling
authors.initials: YL
authors.lastname: Shiue
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Chung-Han
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.|Department of Medical Research, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.
authors.forename: Shou-Chun
authors.initials: SC
authors.lastname: Yu
authors.affiliation: Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Pei-Hsin
authors.initials: PH
authors.lastname: Kao
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Jinn-Rung
authors.initials: JR
authors.lastname: Kuo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D013997:Time Factors; D015599:Trauma Severity Indices