Abstract
Introduction: Approximately 10,000 Australians have a significant neurological deficit as the result of a traumatic spinal cord injury (SCI). High rates of psychiatric co-morbidity have consistently been found in this population, along with a suicide rate of 2–3 times greater than the general population. The spinal unit at Royal North Shore Hospital is one of the largest in Australasia. All patients with a new spinal cord injury are seen by the consultation-liaison psychiatry service.
Objectives: To determine the rate of types of psychiatric disorder recorded in an acute spinal-injured population and to examine whether psychiatric morbidity is correlated with a range of underlying variables.
Method: A comprehensive, critical literature review of psychiatric morbidity in spinal cord injury was undertaken. Eighteen clinical variables of interest (demographic, psyhosocial and injury-related) were identified. The medical records and data sheets of 100 consecutive inpatients with acute SCI were hand-searched for the presence or absence of a diagnosed psychiatric disorder. The two groups were compared with regard to the incidence of each putative risk factor.
Results: Eight variables were statistically significantly associated with psychiatric co-morbidity in SCI. These were educational level attained, previous psychiatric history, history of substance abuse, history of impulsiveness, parental separation, family psychiatric history, length of stay and persistent pain. There was no correlation with age, sex, ethnicity, presence of other injuries, neurological level or completeness of spinal cord injury.
Conclusion: This study suggests that underlying psychosocial factors may confer a greater risk than spinal cord injury itself for the development of subsequent psychiatric disorders. There are important implications for psychiatric assessment in this area, early intervention and the design of prospective studies. These implications are discussed, with reference to the wider literature and to weaknesses in the study design.