Depression, healthcare utilization, and comorbid psychiatric disorders after spinal cord injury

Abstract

Background

Depression is often comorbid with other psychiatric conditions in the general population, with resultant impact on severity of conditions and healthcare utilization. It is unclear to what degree this is also true among persons with spinal cord injury (SCI).

Objective

This study examined rates at which psychiatric conditions were comorbid with depression after SCI, and the association between a depression diagnosis and healthcare and pharmaceutical drug use.

Methods

Retrospective analysis of data (N = 41 213) abstracted from Veterans Health Administration administrative databases between fiscal years (FYs) 1997 and 2007 to examine overall rates of depression. Administrative data from FY 2007 was used to examine rates of psychiatric disorders comorbid with depression, and to compare veterans with SCI and depression to veterans with SCI but no depression on healthcare and pharmaceutical use.

Results

Twenty-eight percent (n = 11 506) of 41 213 veterans who received SCI care between FY 1997 and FY 2007 were diagnosed with depressive disorders. Among the veterans with SCI and depression diagnoses in 2007 (n = 2615), 70% were also diagnosed with another psychiatric illness, with posttraumatic stress disorder and other anxiety disorders being the most common. Veterans with SCI and depression had more healthcare visits and received more pharmaceutical prescriptions than their counterparts without depression.

Conclusions

Persons with SCI and depression are likely to experience comorbid psychiatric illnesses, with associated increased healthcare visits and medication use. Research and theory on depression after SCI should develop toward describing and addressing psychiatric and medical co-morbidities that are normative in this population.

Keywords:

• Depression
• Comorbidity
• Healthcare
• Posttraumatic stress disorder
• Spinal cord injury

Acknowledgements

This research was supported by a grant from the Department of Veterans Affairs, HSRD Service, SCI Quality Enhancement Initiative (SCI QUERI). The authors acknowledge the data analysis assistance of Karen Austin, MPH. This paper presents the views of the authors; it does not necessarily represent the views or policies of the Department of Veterans Affairs or the HSRD Service.