Journal of Neurology

, Volume 259, Issue 6, pp 1142–1150 | Cite as

Low depressive symptoms in acute spinal cord injury compared to other neurological disorders

  • Katayun Hassanpour
  • Sabina Hotz-Boendermaker
  • Petra Dokladal
  • European Multicenter Study for Human Spinal Cord Injury Study group
  • Armin Curt
Original Communication


The aim of the study was to reveal the incidence and time course of depressive symptoms following acute spinal cord injury (SCI) in relation to clinical outcomes for comparison to other neurological disorders with severe impairment. In patients with acute traumatic SCI (n = 130), combined follow up assessments of neurological and functional outcomes, pain and patient-rated affective factors (e.g. mood, anxiety) were prospectively (1, 3, 6, 12 months after injury) collected during rehabilitation and follow up in out-patient clinics. We related these to the severity of depressive symptoms (no, mild, moderate and severe) based on the Beck Depression Inventory (BDI) scores. The mean 65% of patients showed no depressive symptoms and 30% mild depressive symptoms, while less than 5% presented moderate to severe depressive symptoms. The group findings and symptoms in individual patients remained stable over 1 year though patients revealed significant clinical recovery. Although two-thirds of the patients experienced pain, BDI scores were not related to pain intensity. BDI mean scores were only slightly higher than in control populations, but rather low compared to patients with other neurological disorders (e.g. stroke and multiple sclerosis) that are also associated with severe functional impairment. The prevalence of depressive symptoms following acute SCI is rather low and remains stable within the first year after injury despite the severe neurological impairment and loss of independency. In comparison to other neurological disorders that also involve brain function SCI patients seem to be less challenged by depressive symptoms that constitute additional burdens to respond to the severe functional impairments.


Depressive symptoms Spinal cord injury Beck Depression Inventory ASIA Neurological disorders 



We would like to thank the EM-SCI study group, especially René Koller from Zurich and Dr. F. Röhrich of the Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Germany). The following centers participated in this study: K. Röhl, MD, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Germany); N. Weidner and R. Rupp, University Clinic of Heidelberg (Germany); R.D. Sambale, MD, Orthopädische Klinik Hessisch-Lichtenau (Germany); J. Harms, MD, SRH Klinikum Karlsbad-Langensteinbach (Germany); D. Maier, MD, Berufsgenossenschaftliche Klinik in Murnau (Germany), Y.-B. Kalke, MD, Rehabilitationskrankhaus Ulm (Germany) and, M. Schubert, MD, Balgrist University Hospital, Zurich (Switzerland). We are grateful to Boris Quednow, MD, Psychiatric University Hospital Zurich, for his helpful comments on the manuscript. We would also like to thank all the patients for their willingness to invest their time in this study. Supported by the International Foundation for Research in Paraplegia (IFP) and the International Spinal Research Trust (ISRT; Stage II of the Clinical Initiative: CLI006) and the Swiss National Science Foundation (SNF, PMPDP3-124282).

Conflict of interest



  1. 1.
    Consortium for Spinal Cord Medicine (1998) Clinical practice guidelines: neurogenic bowel management in adults with spinal cord injury. J Spinal Cord Med 21:248–293Google Scholar
  2. 2.
    Alajbegovic A, Loga N, Tiro N, Alajbegovic S, Cindro V, Hozo I (2009) Cognitive and depressive disorders in multiple sclerosis. Acta Clin Croat 48:3–8PubMedGoogle Scholar
  3. 3.
    ASIA (2003) International Standards for Neurological Classification of Spinal Cord Injury Chicago: American Spinal Injury AssociationGoogle Scholar
  4. 4.
    Ayuso-Mateos JL (2001) Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatr 179:308–316CrossRefGoogle Scholar
  5. 5.
    Benedict RH, Fishman I, McClellan MM, Bakshi R, Weinstock-Guttman B (2003) Validity of the Beck Depression Inventory-Fast Screen in multiple sclerosis. Mult Scler 9:393–396PubMedCrossRefGoogle Scholar
  6. 6.
    Binks TM, Radnitz CL, Moran AI, Vinciguerra V (1997) Relationship between level of spinal cord injury and posttraumatic stress disorder symptoms. Ann N Y Acad Sci 821:430–432PubMedCrossRefGoogle Scholar
  7. 7.
    Boekamp JR, Overholser JC, Schubert DS (1996) Depression following a spinal cord injury. Int J Psychiatry Med 26:329–349PubMedCrossRefGoogle Scholar
  8. 8.
    Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG (2004) Symptoms of major depression in people with spinal cord injury: implications for screening. Arch Phys Med Rehabil 85:1749–1756PubMedCrossRefGoogle Scholar
  9. 9.
    Cairns DM, Adkins RH, Scott MD (1996) Pain and depression in acute traumatic spinal cord injury: origins of chronic problematic pain? Arch Phys Med Rehabil 77:329–335PubMedCrossRefGoogle Scholar
  10. 10.
    Craig A, Tran Y, Middleton J (2009) Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord 47:108–114PubMedCrossRefGoogle Scholar
  11. 11.
    Elliott TR, Frank RG (1996) Depression following spinal cord injury. Arch Phys Med Rehabil 77:816–823PubMedCrossRefGoogle Scholar
  12. 12.
    Erban P, Woertgen C, Luerding R, Bogdahn U, Schlachetzki F, Horn M (2006) Long-term outcome after hemicraniectomy for space occupying right hemispheric MCA infarction. Clin Neurol Neurosurg 108:384–387PubMedCrossRefGoogle Scholar
  13. 13.
    Frank RG, Kashani JH, Wonderlich SA, Lising A, Visot LR (1985) Depression and adrenal function in spinal cord injury. Am J Psychiatry 142:252–253PubMedGoogle Scholar
  14. 14.
    Hackett ML, Yapa C, Parag V, Anderson CS (2005) Frequency of depression after stroke: a systematic review of observational studies. Stroke 36:1330–1340PubMedCrossRefGoogle Scholar
  15. 15.
    Healey AK, Kneebone II, Carroll M, Anderson SJ (2008) A preliminary investigation of the reliability and validity of the Brief Assessment Schedule Depression Cards and the Beck Depression Inventory-Fast Screen to screen for depression in older stroke survivors. Int J Geriatr Psychiatry 23:531–536PubMedCrossRefGoogle Scholar
  16. 16.
    Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS (2011) A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil 92:3411–3418Google Scholar
  17. 17.
    Hohmann GW (1975) Psychological aspects of treatment and rehabilitation of the spinal cord injured person. Clin Orthop Relat Res 112:81–88Google Scholar
  18. 18.
    House A, Dennis M, Mogridge L, Warlow C, Hawton K, Jones L (1991) Mood disorders in the year after first stroke. Br J Psychiatry 158:83–92PubMedCrossRefGoogle Scholar
  19. 19.
    Jensen MP, Hoffman AJ, Cardenas DD (2005) Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord 43:704–712PubMedCrossRefGoogle Scholar
  20. 20.
    Kemp BJ, Kahan JS, Krause JS, Adkins RH, Nava G (2004) Treatment of major depression in individuals with spinal cord injury. J Spinal Cord Med 27:22–28PubMedGoogle Scholar
  21. 21.
    Kennedy P, Rogers B (2000) Reported quality of life of people with spinal cord injuries: a longitudinal analysis of the first 6 months post-discharge. Spinal Cord 38:498–503PubMedCrossRefGoogle Scholar
  22. 22.
    Kennedy P, Rogers BA (2000) Anxiety and depression after spinal cord injury: a longitudinal analysis. Arch Phys Med Rehabil 81:932–937PubMedCrossRefGoogle Scholar
  23. 23.
    Klose L (2011) Psychosoziale Aspekte juveniler Schlaganfallpatienten—Depression und ge-sundheitsbezogene Lebensqualität nach Hirninfarkt. In: Klinik für Psychiatrie und Psychotherapie. Universität Münster MünsterGoogle Scholar
  24. 24.
    Kotila M, Numminen H, Waltimo O, Kaste M (1998) Depression after stroke: results of the FINNSTROKE study. Stroke 29:368–372PubMedCrossRefGoogle Scholar
  25. 25.
    Lincoln NB, Flannaghan T (2003) Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial. Stroke 34:111–115PubMedCrossRefGoogle Scholar
  26. 26.
    Lude P, Kennedy P, Evans M, Lude Y, Beedie A (2005) Post traumatic distress symptoms following spinal cord injury: a comparative review of European samples. Spinal Cord 43:102–108PubMedCrossRefGoogle Scholar
  27. 27.
    Merrick D, Stalnacke BM (2010) Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered. BMC Res Notes 3:190Google Scholar
  28. 28.
    Osteraker AL, Levi R (2005) Indicators of psychological distress in postacute spinal cord injured individuals. Spinal Cord 43:223–229PubMedCrossRefGoogle Scholar
  29. 29.
    Philip C, Kendall SDH, Aaron T. Beck, Constance L. Hammen and Rick E. Ingram (1987) Issues and recommendations regarding use of the Beck Depression Inventory In: Cognitivetherapy and researchpp 289–29. doi: 210.1007/BF01186280
  30. 30.
    Rampello L, Chiechio S, Nicoletti G, Alvano A, Vecchio I, Raffaele R, Malaguarnera M (2004) Prediction of the response to citalopram and reboxetine in post-stroke depressed patients. Psychopharmacology (Berl) 173:73–78CrossRefGoogle Scholar
  31. 31.
    Saikkonen J, Karppi P, Huusko TM, Dahlberg A, Makinen J, Uutela T (2004) Life situation of spinal cord-injured persons in Central Finland. Spinal Cord 42:459–465PubMedCrossRefGoogle Scholar
  32. 32.
    Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ (2003) A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain 103:249–257PubMedCrossRefGoogle Scholar
  33. 33.
    Siller J (1969) Psychological situation of the disabled with spinal cord injuries. Rehabil Lit 30:290–296PubMedGoogle Scholar
  34. 34.
    Taylor L, Wicks P, Leigh PN, Goldstein LH (2010) Prevalence of depression in amyotrophic lateral sclerosis and other motor disorders. Eur J Neurol 17:1047–1053PubMedCrossRefGoogle Scholar
  35. 35.
    Tedman BM, Young CA, Williams IR (1997) Assessment of depression in patients with motor neuron disease and other neurologically disabling illness. J Neurol Sci 152 (Suppl 1):S75–79Google Scholar
  36. 36.
    Tirch D, Radnitz CL, Bauman WA (1999) Depression and spinal cord injury: a monozygotic twin study. J Spinal Cord Med 22:284–286PubMedGoogle Scholar
  37. 37.
    van Hedel HJ, Dokladal P, Hotz-Boendermaker S (2011) Mismatch between investigator-determined and patient-reported independence after spinal cord injury: consequences for rehabilitation and trials. Neurorehabil Neural Repair. Jun 2 (Epub ahead of print)Google Scholar
  38. 38.
    Widerstrom-Noga EG, Turk DC (2003) Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics. Spinal Cord 41:600–609PubMedCrossRefGoogle Scholar
  39. 39.
    Wittchen HU, Jacobi F (2005) Size and burden of mental disorders in Europe–a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15:357–376PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Katayun Hassanpour
    • 1
  • Sabina Hotz-Boendermaker
    • 1
  • Petra Dokladal
    • 1
  • European Multicenter Study for Human Spinal Cord Injury Study group
  • Armin Curt
    • 1
  1. 1.Spinal Cord Injury CenterBalgrist University HospitalZurichSwitzerland

Personalised recommendations