Depressive symptoms during inpatient rehabilitation for spinal cord injury

Background: Our purpose was to identify the underlying factor structure of the Patient Health Questionnaire-9 (PHQ-9), endorsement rates of specific symptoms, and prevalence of major depressive disorder (MDD) during inpatient rehabilitation after spinal cord injury (SCI). Design: Survey Methods: 568 participants with traumatic SCI from a Specialty hospital in the Southeastern USA were assessed a median of 44 days after SCI onset. Using the PHQ-9, we identified the rate of MDD, factor structure, percentage of item endorsement, relative contributions of somatic and non-somatic items to the total score, and the association of item endorsement with time between SCI onset and assessment. Results: Results indicated 21.9% scored at or above the cutoff of 10 used for identifying MDD, and 11.0% of the sample met the more restrictive symptom criteria for probable major depression. Two factors emerged including a somatic factor. The most highly endorsed items were sleep disturbance (34.9%), poor energy (32.9%), and appetite disturbance (30.6%). Few scores were observed at either extreme, as only 9.5% reported no depressive symptoms and 2.5% reported extreme symptomatology scores (20-27; scale range is 0-27). Conclusions: Validity of MDD diagnosis during inpatient rehabilitation with the PHQ-9 may be compromised by exaggerated endorsement of somatic symptoms leading to overestimates of depressive disorders. The limited number of scores at the extreme ends of the scale suggests that depressive symptoms may not begin to crystallize until after the initial hospitalization.