Psychological interventions for depression during post-acute inpatient rehabilitation after traumatic or non-traumatic spinal injury: a matched-case control study.

Abstract

Purpose: Addressing a significant gap in post-acute research and recognizing the high prevalence of depression (22.2%) in people with spinal cord injury (SCI), this study focuses on the vital role of psychosocial care. We examine and compare the biopsychosocial characteristics of two groups of inpatients admitted to a rehabilitation unit within two months post-injury: those with depression at admission and those without. Our objectives are: (i) to conduct a broad biopsychosocial comparison between these two groups across the entire cohort, and (ii) to perform a matched comparison within a subgroup, controlled for age, time from injury to admission, and functional independence. In both comparisons, we assess the total number and types of psychological interventions received by each group.

Methods: We conducted a retrospective observational study on 1,147 patients (18.2% with depression at admission) admitted to a specialized hospital between 2005 and 2023. Depression was measured using the Hospital Anxiety and Depression Scale (HADS), and independence in activities of daily living (ADLs) was assessed using the motor Functional Independence Measure-subscale (mFIM). Patients were categorized at admission into two groups based on their HADS scores: the Normal-HADS group (NDG, no depression) and the Border-HADS or Case-HADS group (DG, depression). We compared 209 patients in the DG to: (i) all 938 patients in the NDG, and (ii) a matched subset of 209 NDG patients based on age, mFIM at admission, and time from injury to admission.

Results: (i) No significant differences were found between the NDG and DG in age at injury (49.6 vs. 48.3), proportion of non-traumatic etiologies (50.9% vs. 51.2%), complete injuries (28.5% vs. 27.8%), or tetraplegia (33.9% vs. 39.7%). However, while NDG scored significantly higher in mFIM at admission and discharge, DG showed higher mFIM efficiency. The mean total number of psychological interventions was also higher in DG (7.5 vs. 6.2) along with the mean number of psychotherapy interventions (5.9 vs. 5.0). (ii) NDG had a significantly longer length of stay, but DG exhibited higher mFIM efficiency. No significant differences were noted between groups in the mean number of psychological interventions or any of the six types of interventions. Socioeconomic comparisons showed a higher proportion of blue-collar workers in DG (64.1% vs. 35.3%) and white-collar workers in NDG (36.2% vs. 13.9%). Low education (< 9 years) was more prevalent in DG (61.8% vs. 50.0%), and a stable, sufficient income was more common in NDG (75.1% vs. 54.4%).

Conclusions: In the matched groups, despite socioeconomic disadvantages and shorter hospital stays, the DG showed higher mFIM efficiency due to shorter stays rather than greater functional gains. Both groups received similar psychological interventions, yet some NDG patients developed depression and anxiety, underscoring the need to reevaluate and optimize psychological support throughout rehabilitation.