SCI Psychosocial

OT Dude Academy’s Free NBCOT® Exam Prep Course Spinal Cord Injury (SCI) SCI Psychosocial

Depression is common in clients with SCI – about 1 in 5 clients, or 11% to 37%.1  A 2015 meta-analysis by Williams and Murry concluded that depression after an SCI is substantially greater than that of the general medical population.2  A cross-sectional study of 134 adults who were referred to an outpatient rehabilitation center at Tehran University of Medical Sciences found a higher incidence of depression in females who had tetraplegia, suicidal thoughts, and a history of a suicide attempt from a low education level. Another factor in the prevalence of depression was being taken care for by a family member other than a spouse or parents.3  Sociodemographic variables such as age, gender, education, income, functional impairments, and health status are related to depression symptoms.4 5 6 7 8 9 

As pain after a SCI is common, it may influence depression onset and ongoing treatment, especially several years after injury. Additional risk factors for depression include decreasing health status and unsafe alcohol use. 10 

Other psychosocial barriers experienced with SCI include anxiety, coping, and adjustment to disability.11 

Clients are encouraged to be involved in problem-solving and managing their care early in the rehabilitation process.12  Intervention programs that increase active living and enhance self-efficacy across the lifespan have been helpful. 13 14  Physical activity and sports have also been effective for short-term depressive symptoms.15  Addressing spirituality may have a positive impact on quality-of-life and mood among clients with SCI.16  Anderson et al. found that faith-based cognitive behavioral (F-CBT) psychotherapies for depression and anxiety demonstrated a significant advantage over standard CBT.17 

Group intervention from peers may also be beneficial.12  Peer mentoring, such as in a rehabilitation setting may enhance the understanding of the daily challenges of managing a SCI.18  Peer mentors may be valuable as they may be perceived as being equal in a mentor-mentee bond and the mentor to be the most credible source of information regarding life with SCI. Mentees may feel a level of acceptance and help with normalization of the experience due to the mentor having experienced similar a situation as the mentee. Mentees appreciated talking to a mentor of the same gender who was sociable, had a positive outlook, and had a similar level of injury.19 

Management includes CBT, antidepressants, exercise, and physical activity to improve mood. Clients may benefit from a referral to physicians, psychiatrists, psychologists, or other specialists.20  Additional therapies that were found to help alleviate depressive symptoms associated with pain include rest and sleep, TENS, acupuncture, massage therapy, heat, and cold, and relaxation. Massage and heat were rated to be the most effective.21  Mindfulness training, such as virtually over the Internet, may be viable and provide benefits to SCI survivors, particularly in those who have reduced sensory awareness from their injury.22  Clients with SCI who come from a low-income background have shown improved adherence to treatment for depression with the availability and assistance making telephone appointments (such as due to language barriers), transportation assistance, and family involvement.23 

  1. Model Systems Knowledge Transition Center. (2020). Spinal Cord Injury Fact Sheet Booklet. Retrieved from www.MSKTC.org/SCI[↩]
  2. Williams, R., & Murray, A. (2015). Prevalence of depression after spinal cord injury: a meta-analysis. Archives of physical medicine and rehabilitation, 96(1), 133-140.[↩]
  3. Khazaeipour, Z., Taheri-Otaghsara, S. M., & Naghdi, M. (2015). Depression following spinal cord injury: its relationship to demographic and socioeconomic indicators. Topics in spinal cord injury rehabilitation, 21(2), 149-155.[↩]
  4. Arango-Lasprilla, J. C., Ketchum, J. M„ Starkweather, A., Nicholls, E., & Wilk, A. R. (2011). Factors predicting depression among persons with spinal cord injury 1 to 5 years post-injury. NeuroRehabilitation, 29, 9-21.[↩]
  5. Bombardier, C. H., Richards, J. S., Krause, J. S., Tulsky, D., & Tate, D. G. (2004). Symptoms of major depression in people with spinal cord injury: Implications for screening. Archives of Physical Medicine and Rehabilitation, 85, 1749-1756. http://dx.doi.Org/10.1016/j.apmr.2004.07.348[↩]
  6. Fuhrer, M. J., Rintala, D. H., Flart, K. A., Clearman, R., & Young, M. E. (1993). Depressive symptomatology in persons with spinal cord injury who reside in the community. Archives of Physical Medicine and Re­ habilitation, 74, 255-260.[↩]
  7. Hoffman, J. M., Bombardier, C. H., Graves, D. E., Kalpakjian, C. Z., & Krause, J. S. (2011). A longitudinal study of depression from 1 to 5 years after spinal cord injury. Archives of Physical Medicine and Rehabilita­tion, 92, 411-418. http://dx.doi.Org/10.1016/j.apmr.2010.10.036[↩]
  8. Krause, J. S., Kemp, B., & Coker, J. (2000). Depression after spinal cord injury: Relation to gender, ethnicity, aging, and socioeconomic indica­ tors. Archives o f Physical Medicine and Rehabilitation, 81, 1099-1109. http://dx.doi.org/10.1053/apmr.2000.7167[↩]
  9. Saunders, L. L., Krause, J. S., & Focht, K. L. (2012). A longitudinal study of depression in survivors of spinal cord injury. Spinal Cord, 50, 72-77. http://dx.doi.org/10.1038/sc.2011.83[↩]
  10. Cairns D., Adkins R., Scott M. Pain, and depression in acute traumatic spinal cord injury: origins of chronic problematic pain?. Arch Phys Med Rehabil. 1996; 77: 329-335[↩]
  11. Mehta, S., Orenczuk, S., Hansen, K. T., Aubut, J. A. L., Hitzig, S. L., Legassic, M., & Teasell, R. W. (2011). An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabilitation Psychology, 56(1), 15.[↩]
  12. Atkins, M. S. (2014). Spinal cord injury. In M. V. Radomski & C. A. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (7th ed., pp. 1168–1214). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.[↩][↩]
  13. Rose, A., Piatt, J. A., Zahl, M„ & Kim, K. (2008). The effect of a self-efficacy-based forum on life satisfaction for individuals with spinal cord injury or disease. Annual in Therapeutic Recreation, 16, 49-56.[↩]
  14. Zahl, M. L., Compton, D. M., Kim, K„ & Rosenbluth, J. P. (2008). SCI/D forum to increase active living: The effect of a self-efficacy and self-affirmation based SCI/D forum on active living in adults with spinal cord injury/disease. SCI Psychosocial Process, 21, 5-13.[↩]
  15. Kennedy, P., Taylor, N., & Hindson, L. (2006). A pilot investigation of a psychosocial activity course for people with spinal cord injuries. Psy­chology, Health & Medicine, 11, 91-99. http://dx.doi.org/10.1080/13548500500330494[↩]
  16. Wilson, C. S., Forchheimer, M., Heinemann, A. W., Warren, A. M., & McCullumsmith, C. (2017). Assessment of the relationship of spiritual well-being to depression and quality of life for persons with spinal cord injury. Disability and rehabilitation, 39(5), 491-496.[↩]
  17. Anderson N, Heywood-Everett S, Siddiqi N, et al. Faithadapted psychological therapies for depression and anxiety: systematic review and meta-analysis. J Affect Disord. 2015;176:183–196.[↩]
  18. Ljungberg, I., Kroll, T., Libin, A., & Gordon, S. (2011). Using peer mentoring for people with spinal cord injury to enhance self‐efficacy beliefs and prevent medical complications. Journal of clinical nursing, 20(3‐4), 351-358.[↩]
  19. Veith, E. M., Sherman, J. E., Pellino, T. A., & Yasui, N. Y. (2006). Qualitative analysis of the peer-mentoring relationship among individuals with spinal cord injury. Rehabilitation Psychology, 51(4), 289.[↩]
  20. Model Systems Knowledge Transition Center. (2020). Spinal Cord Injury Fact Sheet Booklet. Retrieved from www.MSKTC.org/SCI[↩]
  21. Budh, C. N., & Lundeberg, T. (2004). Non-pharmacological pain-relieving therapies in individuals with spinal cord injury: a patient perspective. Complementary therapies in medicine, 12(4), 189-197.[↩]
  22. Hearn, J. H., & Finlay, K. A. (2018). Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial. Spinal Cord, 56(8), 750-761.[↩]
  23. Dwight-Johnson M. Lagomasino I.T.
    Hay J. et al. Effectiveness of collaborative care in addressing depression treatment preferences among low-income Latinos. Psychiatr Serv. 2010; 61: 1112-1118[↩]
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