Evaluating a Spinal Cord Injury–Specific Model of Depression and Quality of Life

Abstract

ObjectivesTo determine whether demographic, injury, health, and functional factors similarly have the same predictive relation with both somatic and nonsomatic symptoms of depression, as well as whether somatic and nonsomatic symptoms of depression have the same association with quality of life (QOL). DesignSecondary analysis of cross-sectional survey data. SettingCommunity ParticipantsPatients with traumatic spinal cord injury (N=4976) who completed an interview at 1 year postinjury between 2006 and 2011. InterventionsNot applicable. Main Outcome MeasuresSomatic and nonsomatic symptoms of depression from the Patient Health Questionnaire-9 and QOL measured by the Satisfaction With Life Scale. ResultsStructural equation modeling showed that the hypothesized model provided a good fit to the data, but modification of the model led to a significant improvement in model fit: Δχ2(1)=226.21, P<.001; comparative fit index=.976; χ2(199)=585.39, P<.001; root mean square error of approximation=.027 (90% confidence interval, .025–.030). The health-related factors including pain severity, pain interference, and health status were similarly associated with both somatic and nonsomatic symptoms of depression. QOL was negatively associated with nonsomatic symptoms of depression but was unrelated to somatic symptoms of depression. ConclusionsAssessment of depression after spinal cord injury should include a careful assessment of health concerns given the relation between health-related factors and both somatic and nonsomatic symptoms of depression. Treatments of depressive symptoms may be improved by targeting health concerns, such as pain, along with a specific focus on nonsomatic symptoms to improve the QOL.