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Depression in patients with spinal cord injuries: A synthesis of cognitive and somatic processes

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Abstract

Depression in some patients with spinal cord injuries may be clinically significant and, when present, should be treated to decrease morbidity including decreased physical functioning. Depression associated with spinal cord injury (SCI) may be misevaluated, due to (1) nonspecific multifactorial production of depression symptoms and (2) SCI-specific decrease in somatic sensory central nervous system input. The Somatic Suppression Hypothesis suggests that SCI patients have difficulty experiencing any intense emotion because of suppression of physiological arousal. In addition, cognitive processes that may reduce depression in SCI patients include: (1) attribution of somatic symptoms of depression to medical (biological) causes, (2) realistic, positive expectations for physical improvement, and (3) the perception that the disability of the SCI is only minimally related to the patient’s self-care after complete evaluation. Health personnel should accept lack of depression in SCI, and should encourage positive realistic expectations of recovery.

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References

  • American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders (Third Edition, Revised). Authors, Washington, D.C., 1987.

    Google Scholar 

  • Barsky, A. (1979). Patients who amplify bodily sensations.Annals of Internal Medicine, 91, 63–70.

    PubMed  Google Scholar 

  • Barsky, A., Goodson, J., Lane, R., & Cleary, P. (1988). The amplification of somatic symptoms.Psychosomatic Medicine, 50, 510–519.

    PubMed  Google Scholar 

  • Barsky, A.J., Wyshak, G., & Klerman, G.C. (1990). The somatosensory amplification scale and its relation to hypochondriasis.Journal of Psychiatric Research, 24, 323–334.

    Article  PubMed  Google Scholar 

  • Beck, A.T. (1987). Cognitive models of depression.Journal of Cognitive Psychotherapy, 1, 5–37.

    Google Scholar 

  • Beck, A.T., Rush, A.J., Shaw, B., & Emery, G. (1979).Cognitive therapy of depression. New York: Guilford.

    Google Scholar 

  • Beck, A.T., Steer, R., Kovacs, M., & Garrison, B. (1985). Hopelessness and eventual suicide: A 10-year prospective study of patients hospitalized with suicidal ideation.American Journal of Psychiatry, 142, 559–563.

    PubMed  Google Scholar 

  • Bilodean, C.B., & Hackett, T.P. (1971). Issues raised in a group setting by patients recovering from myocardial infarction.American Journal of Psychiatry, 128, 73–78.

    Google Scholar 

  • Bracken, M., Shepard, M., & Webb, S. (1981). Psychological response to acute spinal cord injury: An epidemiological study.Paraplegia, 19, 271–283.

    PubMed  Google Scholar 

  • Bulman, R.J., & Wortman, C. (1977). Attributions of blame and coping in the “Real World”: Severe accident victims react to their lot.Journal of Personality and Social Psychology, 35, 351–363.

    Article  PubMed  Google Scholar 

  • Cunningham, J., Strassberg, D., & Roback, H. (1978). Group psychotherapy for medical patients.Comprehensive Psychiatry, 19, 135–140.

    Article  Google Scholar 

  • Cushman, L., & Dijkers, M. (1990). Depressed mood in spinal cord injured patients: Staff perceptions and patient realities.Archives of Physical Medicine and Rehabilitation, 71, 191–196.

    PubMed  Google Scholar 

  • Dworkin, S.F., Von Korff, M.R., & LeResche, L. (1990). Multiple pain and psychiatric disturbances: An epidemiological investigation.Archives of General Psychiatry, 47, 239–245.

    PubMed  Google Scholar 

  • Dyer, J., & Kreitman, N. (1984). Hopelessness, depression and suicidal intent in parasuicide.British Journal of Psychiatry, 144, 127–133.

    PubMed  Google Scholar 

  • Finkestein, S.P., Weintraub, R.J., & Karmauz, N. (1987). Antidepressant therapy for post-stroke depression: Retrospective study.Archives of Physical Medicine and Rehabilitation, 68, 772–776.

    Google Scholar 

  • Frank, R., Umlauf, R., Wonderlich, S., Askanzi, G., Buckelew, S., & Elliott, T. (1987). Differences in coping styles among persons with spinal cord injury: A cluster-analytic approach.Journal of Consulting and Clinical Psychology, 55, 727–731.

    Article  PubMed  Google Scholar 

  • Friedman, H.S., & Booth-Kewley, S. (1987). The “Disease-Prone Personality”: A meta-analytic view of the construct.American Psychologist, 42, 539–555.

    Article  PubMed  Google Scholar 

  • Fullerton, D., Harvey, R., Klein, M., & Howell, T. (1981) Psychiatric disorders in patients with spinal cord injuries.Archives of General Psychiatry 38: 1369–1371.

    PubMed  Google Scholar 

  • Fryer, A.J., & Sandberg, D. (1988). Pharmacological treatment of panic disorder.American Psychiatric Press Review of Psychiatry, 7, 88–120.

    Google Scholar 

  • Gentry, W.D., Foster, S., & Haney, T. (1972). Denial as a determinant of anxiety and perceived health status in the coronary care unit.Psychosomatic Medicine, 34, 39–44.

    PubMed  Google Scholar 

  • Green, B., Pratt, C., & Grigsby, T. (1984). Self-concept among persons with long-term spinal cord injury.American Journal of Physical Medicine and Rehabilitation, 65, 751–754.

    Google Scholar 

  • Hackett, T.P., Cassem, N.H., & Wishnie, H.A. (1968). The coronary care unit: An appraisal of its psychological hazards.New England Journal of Medicine, 279, 1365–1370.

    Article  PubMed  Google Scholar 

  • Hickman, J. (1987). Evaluation of the Virginia spinal cord injury system community cadre network. Woodrow Wilson Rehabilitation Center, Fishersville, Virginia.

    Google Scholar 

  • Hohmann, G. (1966). Some effects of spinal cord lesions on experienced emotional feelings.Psychophysiology, 3, 143–156.

    PubMed  Google Scholar 

  • Howell, T., Fullerton, D., Harvey, R., & Klein, M. (1981). Depression in spinal cord injured patients.Paraplegia, 19, 284–288.

    PubMed  Google Scholar 

  • Judd, F., Burrows, G., & Brown, M. (1989). Depression following acute spinal cord injury.Paraplegia, 24, 358–363.

    Google Scholar 

  • Judd, F., Stone, J., Webber, J., Brown, D., & Burrows, G. (1980). Depression following spinal cord injury: A prospective inpatient study.British Journal of Psychiatry, 154, 668–671.

    Google Scholar 

  • Kathol, R., & Petty, F. (1981). Relationship of depression to medical illness: A critical review.Journal of Affective Disorders, 3, 111–121.

    Article  PubMed  Google Scholar 

  • Katon, W. (1984). Depression: Relationship to somatization and chronic mental illness.Journal of Clinical Psychiatry, 45, 4–11.

    PubMed  Google Scholar 

  • Katon, W., Kleinman, A., & Rosen, G. (1982a). Depression and somatization: A review. Part I.American Journal of Medicine, 72, 127–135.

    Article  PubMed  Google Scholar 

  • Katon, W., Kleinman, A., & Rosen, G. (1982b). Depression and somatization: A review. Part II.American Journal of Medicine, 72, 241–247.

    Article  PubMed  Google Scholar 

  • Katon, W., Ries, R., & Kleinman, A. (1984). Part II: A prospective DSM-III study of 100 consecutive somatization patients.Comprehensive Psychiatry, 25, 305–314.

    Article  PubMed  Google Scholar 

  • Katon, W., & Russo, J. (1989). Somatic symptoms and depression.Journal of Family Practice, 29, 65–69.

    PubMed  Google Scholar 

  • Katon, W., & Sullivan, M. (1990). Depression and chronic medical illness.Journal of Clinical Psychiatry, 51, (# 6 Supplement), 3–11.

    PubMed  Google Scholar 

  • Kovacs, M., Rush, A.J., Beck, A.T., & Hollon, S. (1981). Depressed outpatients treated with cognitive therapy or pharmacotherapy.Archives of General Psychiatry, 38, 33–39.

    PubMed  Google Scholar 

  • Lesko, L.M., Massie, M.J., & Holland, J.C. (1987). Oncology. In A. Stoudemire, & B.S. Fogel (Eds.).Principles of medical psychiatry (pp. 495–520). New York: Grune & Stratton.

    Google Scholar 

  • Levenson, J.L., Kay, R., Monteferrante, J., et al. (1984). Denial predicts favorable outcome in unstable angina pectoris.Psychosomatic Medicine, 46, 25–32.

    PubMed  Google Scholar 

  • Lewinsohn, P., Steinmetz, J., Larson, D., & Franklin, J. (1981). Depression-related cognitions: Antecedent or consequence?Journal of Abnormal Psychology, 90, 213–219.

    Article  PubMed  Google Scholar 

  • Lipowsky, Z.J. (1990). Somatization and depression.Psychosomatics, 31, 13–21.

    Google Scholar 

  • Lipsey, J.R., Robinson, R.G., & Pearlson, G.D. (1984). Nortriptyline treatment of post-stroke depression.Lancet, 1, 297–300.

    Article  PubMed  Google Scholar 

  • Mastrovito, R., & Moynihan, R. (1988). Self help and mutual support programs in cancer. In J.C. Holland, & J.H. Rowlands (Eds.).Handbook of psychiatric oncology. New York: Oxford University Press.

    Google Scholar 

  • Mueller, A. (1962). Psychologic factors in rehabilitation of paraplegic patients.Archives of Physical Medicine and Rehabilitation, 43, 151–159.

    Google Scholar 

  • Nagler, B. (1950). Psychiatric aspects of cord injury.American Journal of Psychiatry, 107, 49–56.

    PubMed  Google Scholar 

  • Nestoros, J., Demers-Desrosiers, L., & Dalicandro, L. (1982). Levels of anxiety and depression in spinal cord-injured patients.Psychosomatics, 23, 823–830.

    PubMed  Google Scholar 

  • Nielson, W., & MacDonald, M. (1988). Attributions of blame and coping following spinal cord injury: Is self-blame adaptive?Journal of Social and Clinical Psychology, 7, 163–175.

    Google Scholar 

  • Nisbett, R., & Schachter, S. (1966). Cognitive manipulation of pain.Journal of Experimental and Social Psychology, 2, 227–236.

    Article  Google Scholar 

  • Persky, V.W., Kempthorne-Rawson, J., & Shekelle, R.B. (1987). Personality and risk of cancer: 20-year follow-up of the Western Electric study.Psychosomatic Medicine, 49, 435–449.

    PubMed  Google Scholar 

  • Ray, C., & West, J. (1984). Social, sexual and personal implications of paraplegia.Paraplegia, 22, 75–86.

    PubMed  Google Scholar 

  • Reisenzein, R. (1983). The Schachter theory of emotion: Two decades later.Psychological Bulletin, 94, 239–264.

    Article  PubMed  Google Scholar 

  • Richards, J.S. (1986). Psychologic adjustment to spinal cord injury during the first postdischarge year.Archives of Physical Medicine and Rehabilitation, 67, 362–365.

    Article  PubMed  Google Scholar 

  • Richards, J.S., Hirt, M., & Melamed, L. (1982). Spinal cord injury: A sensory restriction perspective.Archives of Physical Medicine and Rehabilitation, 63, 195–199.

    PubMed  Google Scholar 

  • Rodin, G., & Voshart, K. (1986). Depression in the medically ill: An overview.American Journal of Psychiatry, 143, 697–705.

    Google Scholar 

  • Rush, A.J., Beck, A.T., Kovacs, M., & Hollon, S. (1977). Comparative efficacy of cognitive therapy and pharmacotherapy in the treatment of depressed outpatients.Cognitive Therapy and Research, 1, 17–38.

    Article  Google Scholar 

  • Schachter, S., & Singer, J. (1962). Cognitive, social, and physiological determinants of emotional state.Psychological Review, 69, 379–399.

    Article  PubMed  Google Scholar 

  • Schubert, D.S.P., Burns, R., Paras, W., & Sioson, E. (1992). Increase of medical hospital length of stay by depression in stroke and amputation patients.Psychotherapy & Psychosomatics, 57, 61–66.

    Article  Google Scholar 

  • Schubert, D.S.P., & Foliart, R.H. (1993). Increased depression in multiple sclerosis.Psychosomatics, 14, 124–130.

    Google Scholar 

  • Schubert, D.S.P., Taylor, C., Lee, S., Mentari, A., & Tamaklo, W. (1992). Physical consequences of depression in the stroke patient.General Hospital Psychiatry, 14, 69–76.

    Article  PubMed  Google Scholar 

  • Schulberg, H.C., McClelland, M., & Burns, B.J. (1987). Depression and physical illness: The prevalence causation and diagnosis of comorbidity.Clinical Psychology Review, 7, 145–167.

    Article  Google Scholar 

  • Siller, J. (1969). Psychological situation of the disabled with spinal cord injuries.Rehabilitation Literature, 30, 290–296.

    PubMed  Google Scholar 

  • Silverman, J., Silverman, J., & Eardley, D. (1984). Do maladaptive attitudes cause depression?Archives of General Psychiatry, 41, 28–30.

    PubMed  Google Scholar 

  • Stern, M.J., Pascale, L., & McLoone, J.B. (1976). Psychological adaptation following an acute myocardial infarction.Journal of Chronic Diseases, 29, 513–526.

    Article  PubMed  Google Scholar 

  • Stern, M.J., Pax, L., & Ackerman, A. (1977). Life adjustment post-myocardial infarction.Archives of Internal Medicine, 137, 1680–1685.

    Article  PubMed  Google Scholar 

  • Stover, S., & Fine, P. (1987). The epidemiology and economics of spinal cord injury.Paraplegia, 25, 225–228.

    PubMed  Google Scholar 

  • Sullivan, M., Katon, W., Dobie, R.B.,et al. (1988). Disabling tinnitus: Association with affective disorder.General Hospital Psychiatry, 10, 285–291.

    Article  PubMed  Google Scholar 

  • Teasdale, J., Fennell, M., Hibbert, G., & Amies, P. (1984). Cognitive therapy for major depressive disorder in primary care.British Journal of Psychiatry, 144, 400–406.

    Article  PubMed  Google Scholar 

  • Trieschmann, R.B. (1980).Spinal cord injuries: Psychological, social, and vocational adjustment. New York: Pergamon.

    Google Scholar 

  • Trieschmann, R.B. (1988).Spinal cord injuries: Psychological, social, and vocational adjustment, Second Edition. New York: Pergamon.

    Google Scholar 

  • Valins, S. (1966). Cognitive effects of false heart-rate feedback.Journal of Personality and Social Psychology, 4, 400–408.

    Article  PubMed  Google Scholar 

  • Weintraub, M., Segal, R., & Beck, A.T. (1974). An investigation of cognition and affect in the depressive experience of normal men.Journal of Consulting and Clinical Psychology, 42, 911.

    Article  PubMed  Google Scholar 

  • Wilson, W.C., & Thompson, D.O. (1983). The Virginia community cadre network: Community reintegration for persons with SCI.Rehabilitation Literature, 44, 19–23.

    PubMed  Google Scholar 

  • Wright, B., & Fletcher, B. (1982). Uncovering hidden resources: A challenge in assessment.Professional Psychology, 13, 229–235.

    Article  Google Scholar 

  • Zonderman, A.B., Costa, P.T., Jr., & McCrae, R.R. (1989). Depression as a risk for cancer morbidity and mortality in a nationally representing sample.Journal of American Medical Association, 282, 1191–1195.

    Article  Google Scholar 

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Overholser, J.C., Schubert, D.S.P. Depression in patients with spinal cord injuries: A synthesis of cognitive and somatic processes. Current Psychology 12, 172–183 (1993). https://doi.org/10.1007/BF02686822

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