Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries

Abstract

Objectives: Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction.

Design: Cross-sectional.

Setting: A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center.

Participants/Methods: Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained.

Results: Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life.

Conclusions: Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.

Keywords:

• Spinal cord injuries
• Social adjustment
• Depression
• Mental disorders
• Veterans

Acknowledgements

We are grateful to Stephen Trapp, Cheonte’ Harding, Anne Simmons, and Judy Pulliam for their assistance with for this study. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or other author affiliations.

Disclaimer statements

Contributor statement Drs. McDonald, Ellwood, and Mutchler contributed to the design of the work. Drs. McDonald and Mickens and Ms. Goldberg-Looney contributed to data acquisition and data entry. All authors contributed to interpretation of the data, drafting and revising the manuscript, gave final approval of the version to be submitted, and agreed to be accountable for the accuracy and integrity of the data.

Conflicts of interest Dr. McDonald's work has been funded by the Department of Veteran's Affairs. Drs. Mickens, Mutchler, Ellwood, and Castillo and Ms. Goldberg-Looney declare no conflicts of interest.

Ethics approval A waiver of informed consent and the study protocol were approved by the local Institutional Review Board. All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

ORCID

Scott D. McDonald http://orcid.org/0000-0003-1490-0096

Melody N. Mickens http://orcid.org/0000-0002-7126-8456

Brian J. Mutchler http://orcid.org/0000-0002-0347-0054

Additional information

Funding

This project was supported by a VA Career Development Award-2 (K2RX000703; PI: McDonald).