Treatment of Depression Following Spinal Cord Injury: An Evidence-Based Review.

Abstract

Study Design: Evaluative research review. Objective: Depression is a significant secondary complication of spinal cord injuries (SCI); this study applies the D. L. Sackett (1989) research criteria to evaluate the quality of intervention studies of the treatment of depression among persons with SCI. Method: An extensive range of peer-reviewed published research was identified through established databases, critical reviews, and published meta-analyses. Results: Nine studies met the inclusion criteria. One antidepressant study was rated above Level III; although the psychological intervention studies had control groups, these were not randomized. Conclusion: This review demonstrates the need for randomized clinical trials of psychological and pharmacological interventions for depression and distress among persons with SCI, so that informed decisions concerning cost-effective treatments can be made. Depression has received more attention from clinicians and researchers than any other psychological issue among persons with spinal cord injuries (SCI; Elliott & Umlauf, 1995). For many years, clinical lore maintained that depression was to be expected soon after the onset of injury, and it was construed as a critical element in most anecdotal models of adjustment, typically signaling rational acceptance of the permanence of the injury (Frank, Elliott, Corcoran, & Wonderlich, 1987). Empirical study has broadened our understanding of depression considerably. Studies relying on Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM–III; American Psychiatric Association, 1980) criteria using small samples of recently injured persons and conservative diagnostic interview techniques have found the rate of major depressive episodes to range from 22.7% to over 30% (Frank, Kashani, Wonderlich, Lising, & Visot, 1985; Fullerton, Harvey, Klein, & Howell, 1981). Lower rates have been observed in studies using less stringent interview methods (13.7%; Judd & Brown, 1992) and with self-report measures based on Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM–III–R; American