Trajectories and Predictors of the Course of Mental Health After Spinal Cord Injury

Abstract

van Leeuwen CM, Hoekstra T, van Koppenhagen CF, de Groot S, Post MW. Trajectories and predictors of the course of mental health after spinal cord injury. ObjectiveTo study the course and predictors of mental health in the period between the start of active spinal cord injury (SCI) rehabilitation and 5 years after discharge. The hypothesis was that different mental health trajectories would be identified. DesignMulticenter prospective cohort study with measurements at the start of active rehabilitation, after 3 months, at discharge, 1, 2, and 5 years after discharge. SettingEight Dutch rehabilitation centers with specialized SCI units. ParticipantsPersons (N=206) with recently acquired SCI aged between 18 and 65 years. InterventionsNot applicable. Main Outcome MeasureThe 5-item Mental Health Index with a total score between 0 (lowest mental health) and 100 (highest mental health). ResultsLevels of mental health increased between the start of active rehabilitation and 3 months later, remained stable thereafter, and increased again between 2 and 5 years after discharge. Latent class growth mixture modeling revealed 5 trajectories: (1) high scores (above 80) at all time-points (52%), (2) low scores (≤60) at all time-points (4%), (3) early recovery from 40 to scores above 70 (13%), (4) intermediate scores from 60 to scores above 70 (29%), and (5) severe deterioration of scores above 70 to scores below 30 (2%). Pain, sex, and education level were predictors to distinguish between the 5 trajectories. ConclusionsFive different mental health trajectories were identified between the start of active rehabilitation and 5 years after discharge. About one third of the persons with SCI still perceived moderate to severe mental health problems 5 years after discharge. Pain, sex, and education level only predicted a small part of the variance in mental health trajectories.