Abstract
BackgroundFew studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression.MethodsUsing an administrative database, we assessed patients for whom the diagnosis was unspecified injuries of cervical spinal cord (International Classification of Diseases and Injuries-10th (ICD-10) code; S14.1). We categorized patients with codes for depressive episode (ICD-10 code; F32) or recurrent depressive disorder (F33), or those prescribed antidepressants (tricyclic, tetracyclic, Selective Serotonin Reuptake Inhibitors, Serotonin Noradrenaline Reuptake Inhibitors, Trazodone, Sulpiride, or Mirtazapine) as having a depressive state. We compared the rate of each acute treatment between the depressive state group and the non-depressive state group using chi-square tests, and a multiple logistic regression model was used to identify the association between the acute treatment and depressive state.ResultsThere were 151 patients who were judged to be in a depressive state, and the other 2115 patients were categorized into the non-depressive state group. Intervention of intravenous anesthesia, tracheostomy, artificial respiration, and gastrostomy had a significant positive correlation with depressive state. Multiple logistic regression analysis showed that tracheostomy (odds ratio [OR] 2.18; 95% confidence interval [CI], 1.09–4.38) and artificial respiration (OR 2.28; 95% CI, 1.32–3.93) were significantly associated with depressive state, and men had a 36% reduction in the risk of depressive state compared with women (OR 0.64; 95% CI, 0.44–0.94), whereas age, wound-treatment, all of the orthopedic procedures, intravenous anesthesia, and gastrostomy were not associated with depressive state.ConclusionsThese findings suggest that tracheostomy, artificial respiration and female gender in the acute phase after cervical SCI might be associated with the development of depression.
Highlights
Depressive symptoms in patients with spinal cord injury (SCI) are linked to negative outcomes, including pressure ulcers,[1] urinary tract infections,[2] and increased medical expenses.[2,3,4,5] Probable major depression is one of the predictive factors of early mortality in people with SCI.[6]
Male sex was associated with a 36% reduction in the risk of being in a depressive state compared with female sex, whereas age and receipt of wound treatment, any orthopedic procedure, intravenous anesthesia, and gastrostomy were not associated with depressive state
The multiple logistic regression model containing the variables of age, sex, and all interventions provided for the patients in the depressive state group showed significant positive correlations between tracheostomy and artificial respiration and depressive state
Summary
Depressive symptoms in patients with spinal cord injury (SCI) are linked to negative outcomes, including pressure ulcers,[1] urinary tract infections,[2] and increased medical expenses.[2,3,4,5] Probable major depression is one of the predictive factors of early mortality in people with SCI.[6]. Few studies have assessed whether treatment of acute cervical spinal cord injury (SCI) patients contributes to depression. Intervention of intravenous anesthesia, tracheostomy, artificial respiration, and gastrostomy had a significant positive correlation with depressive state. Multiple logistic regression analysis showed that tracheostomy (odds ratio [OR] 2.18; 95% confidence interval [CI], 1.09–4.38) and artificial respiration (OR 2.28; 95% CI, 1.32–3.93) were significantly associated with depressive state, and men had a 36% reduction in the risk of depressive state compared with women (OR 0.64; 95% CI, 0.44–0.94), whereas age, woundtreatment, all of the orthopedic procedures, intravenous anesthesia, and gastrostomy were not associated with depressive state. Conclusions: These findings suggest that tracheostomy, artificial respiration and female gender in the acute phase after cervical SCI might be associated with the development of depression
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