Adults with traumatic spinal cord injury at significantly increased risk for psychological morbidities

Adults with traumatic spinal cord injuries exhibited increased incidence of psychological morbidities and multimorbidity compared with those without these injuries, according to results of a longitudinal cohort study published in Mayo Clinic Proceedings.

“Clinicians caring for adults with spinal cord injury need to be aware of the increased risk [for] developing mental health disorders in this patient population,” Mark D. Peterson, PhD, MS, of the department of physical medicine and rehabilitation at University of Michigan Medicine, said in a press release. “This may be particularly important during these recent times of social distancing due to COVID-19, as these patients often already experience social isolation.”

Although prior studies have established a relationship between age-related noncommunicable diseases, cognitive dysfunction and depression among populations without spinal cord injuries, researchers have yet to study the extent to which depression and other psychological conditions are comorbid with age-related chronic diseases following spinal cord injury, according to Peterson and colleagues. Further, research is sparse regarding the natural history or incidence of psychological morbidities and chronic diseases among adults with spinal cord injury.

In the current study, the investigators sought to compare the longitudinal incidence of psychological morbidities and multimorbidity and chronic disease estimates among adults with vs. without spinal cord injuries. They examined insurance claims of 6,847 privately insured beneficiaries with an ICD-9, Clinical Modification diagnostic code for a traumatic spinal cord injury who had medical coverage at any time between January 2001 and December 2017.

Results showed that compared with adults without a traumatic spinal cord injury, those with one had a higher incidence of adjustment reaction, anxiety disorders, depressive disorders, alcohol dependence, drug dependence, psychogenic pain, dementia, insomnia and psychological multimorbidity. For example, incidence for those with vs. without a traumatic spinal cord injury was 19.3% vs. 14.1% for anxiety disorders, 29.3% vs. 9.3% for depressive disorders and 37.4% vs. 23.9% for psychological multimorbidity. The researchers reported significantly higher adjusted HRs of each psychological outcome for individuals with spinal cord injury, and these ranged from 1.18 (95% CI, 1.08-1.29) for anxiety disorders to 3.32 (95% CI, 1.93-5.71) for psychogenic pain. Those with spinal cord injuries also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity, except HIV infection/AIDS. The researchers propensity matched adults for age, education, race, sex and chronic diseases and still reported a significantly higher incidence of most psychological disorders and psychological multimorbidity among those with spinal cord injuries.

“Future research and clinical efforts are needed to better understand the health care burden associated with these conditions in the traumatic [spinal cord injury] population,” Peterson and colleagues wrote. “These findings should be used to inform the development of appropriate clinical screening algorithms and design of early behavioral interventions to reduce the risk for disease onset/progression in this higher risk population.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.