Correlates of depression among spinal cord injury patients attending national spinal injury hospital, Nairobi.

Abstract

Introduction: Spinal cord injury remains a major public health issue in developing countries as well as worldwide. It is a devastating condition causing profound life changes for millions of people around the world. Road traffic accidents have been reported to be a major cause of spinal cord injury and is expected to take third position in the disease and injury burden.Patients with spinal injury are faced by a myriad of challenges; physical, psychological, financial as well as social challenges.Existing literature documents high rates of depression and psychological morbidity following spinal cord injury.jykk Thus there is need for regular screening of these patients for depression as well as identifying the risk factors associated with depression. This will help mitigate the risk factors and ensure timely treatment for depression for better treatment outcomes. Setting: The study was conducted at the National spinal injury hospital, Nairobi among spinal cord injury patients attending the out-patient clinic. Study design: This was a descriptive cross sectional study with a sample size of (n=139) persons who had sustained spinal cord injury with over one year duration of injury and over 18 years of age completing a single interview for socio- demographic, pain intensity and patient health questionnaire (PHQ-9) scales. The objectives: To determine the factors that may be a risk to development of depression among persons with spinal cord injury. Data collection instruments: Socio-demographic questionnaire was used to collect demographic data of the patients; Patient Health Questionnaire-9(PHQ-9 scale) to determine the

depression levels and Numerical Pain intensity scale used to measure the pain intensity among the participants. Data analysis: After data collection, the information was coded and data entered into Statistical Package for Social Sciences version 20 (SPSS 20). Data was summarized using descriptive statistics and presented in frequency tables and charts. Categorical data was analyzed using Chisquare statistic with the Significance level set at <0.05. Further multivariate analysis was done using logistic regression to investigate the independent predictive value for the identified risk factors for depression (being quadriplegic, inadequate social support, lack of self-efficacy and increased pain intensity), with the significance set at < 0.05. Results: The overall prevalence of depression according to PHQ-9 scores was 25.8%. Quadriplegic patients were found to have 4 times risk of developing depression as compared with paraplegic patients (OR 4.044 [95% C.I of OR 1.357- 12.051], P= 0.012);patients with severe pain intensity were reported to have 3 fold risk of developing depression (OR 3.104 [95% C.I of OR 1.765- 5.46], P< 0.05) as compared with those who experienced mild pain or no pain at all .Other factors that were significantly related to depression were decreased support systems (P=0.010) and lack of self –efficacy (P=0.016). Demographic factors were found not to have a significant relationship to depression. Conclusions Depressive symptoms are common among patients with spinal cord injury and more so among those who are quadriplegic. The decreased support system, lack of self- efficacy and increased pain intensity.The study shows that there is need for regular screening and treatment for depression among patients with spinal cord injury. The results of the study forms a baseline for future studies on the mental health status of patients with spinal cord injury and further studies with larger samples are recommended especially in Kenya.