PREDICTING DEPRESSION AND PSYCHOLOGICAL DISTRESS IN PERSONS WITH SPINAL-CORD INJURY BASED ON INDICATORS OF HANDICAP

This study examined whether experiences of handicap influence levels o f depression and distress among persons with spinal cord injury (SCI) during the years after initial discharge from rehabilitation. SCI outp atients (163), who had received inpatient treatment at one of two reha bilitation centers in Michigan and who were between 2 to 7 years since injury, participated in the study. Measures of depression, of psychol ogical distress and of handicap were collected during 2 consecutive ye ars utilizing the Zung Self-Rating Scale, the Brief Symptom Inventory and the Craig Handicap Assessment and Reporting Technique (CHART) in c onjunction with the Perceived Handicap Questionnaire (PHQ), respective ly. According to the study's findings, depressed/distressed SCI subjec ts reported spending more hours in bed (P < 0.01), fewer days out of t he house (P < 0.03) and receiving more paid personal care assistance ( P < 0.02) than did other subjects. They also expended more for general medical expenses (P < 0.001) and reported less access to readily avai lable transportation (P < 0.003). CHART total scores, reflecting a sim ple objective measure of handicap as described by Whiteneck et al. (Wh iteneck GG, Charlifue SW, Gerhart KA, Overholser JD, Richardson GN: Gu ide for Use of the CHART. Craig Handicap Assessment and Reporting Tech nique. Craig Hospital, CO, 1988) were significantly associated with bo th distress and depression as measured during the second year of data collection. Other significant predictors of depression and distress in cluded subjects' self-perceived handicap (measured by the PHQ), gender , marital status and age. Together both measures of handicap were amon g the strongest predictors of depression and distress after discharge by SCI subjects who were on average 4.5 years post-injury.