DEPRESSION FOLLOWING A SPINAL-CORD INJURY

Object: Depression is a common problem following a spinal cord injury (SCI) and can greatly interfere with the rehabilitation process becaus e of reduced energy, negative expectations, and social withdrawal. Und erstanding various factors which influence a vulnerability to depressi on may improve the diagnosis and treatment of depressive disorders and can improve rehabilitation outcome. Method: A thorough literature sea rch was conducted using Medline, PsychLit, PyschInfo, and Social Scien ce Citation Index to identify relevant articles published between 1967 and 1995. Results: A diathesis-stress model is proposed to explain th e increased risk of depressive symptoms after a SCI. Biological change s associated with SCI and pre-existing cognitive biases may influence the individual's vulnerability to stressful life events following the injury. The nature and frequency of stressful life events following th e injury can tax the individual's coping resources. Furthermore, the p erceived quality of social support and the severity of conflict within the family can influence the individual's adaptation. Conclusions: So cial support and recent stressors should be assessed to identify patie nts at high risk for depression. Patients are less likely to become de pressed if their independence is fostered and they are encouraged to d evelop new sources of self-esteem. Relatives can be counseled to help maintain supportive relationships within the family.