Incidence of Depression According to Lesion Level and Disability Severity after Spinal Cord Injury: A Nationwide Cohort Study in South Korea (Preprint)

Abstract

Spinal cord injury (SCI)—damage to the spinal cord from trauma or disease—can result in devastating neurological dysfunction and may be accompanied by psychological morbidities. Depression is a common psychiatric comorbidities that negatively impacts the quality of life, motivation for rehabilitation, recovery from injury and increases complications.

We investigated the incidence of depression in patients with spinal cord injury and the effect of the disability severity and the lesion level of SCI on the incidence of depression.

Population-based cohort study using Korean National Health Insurance Service database. The operational definition of patients with SCI was defined by one or more admission claims with the appropriate ICD-10 code. A total of 5,129 incident SCI patients were identified from January 1, 2010, to December 31, 2018. Newly diagnosed depression after SCI was identified using the ICD-10 codes F32‒F33) during the follow-up period. Cox proportional hazards regression to report adjusted hazard ratio (aHR), including 95% confidence interval (CI).

The incidence rate of depression in SCI patients was 87.3 per 1,000 person-years and aHR was 2.88 (95% CI 2.69−3.08) compared to the control group. Severe disability and cervical SCI increased the risk of depression (aHR 5.09, 95% CI 4.34−5.97; aHR 3.99, 95% CI 3.51−4.53, respectively). The incidence rate of depression was especially high within the first year after SCI. Male sex and young age were independent of risk factors for depression.

This present study suggest that depression is highly prevalent with SCI, especially patients with severe disability and cervical SCI. Physicians should monitor the occurrence of depression in patients with SCI, especially within one year after SCI.