Prevalence and risk factors for depression among patients with spinal cord injury attended at Kilimanjaro Christian Medical Centre from August 2021 to May 2022

Abstract

Background: Depression after SCI inhibits physical rehabilitation and exacerbates physical health complications, which results in more extended lengths of stay for inpatient care, less independence following discharge, poor compliance with self-care, higher medical expenses, and increased risk of suicide.

Objective: To determine the prevalence and risk of depression among patients with SCI who attended Kilimanjaro Christian Medical Center from August 2021 to June 2022.

Methodology: This is a hospital-based analytical cross-sectional study conducted at KCMC orthopedic and physiotherapy departments whereby 129 patients with SCI were captured, and those who were below 18 years, with less than 2 weeks of history of spinal cord injury, polytrauma patients, patients with a history of psychiatric illness and SCI patients with cognitive speech problems were excluded from the study .74 patients were interviewed using questionnaire and Swahili version of PHQ-9 depression assessment questionnaire. The associations were measured using the Fischer exact test and Odds ratio with 95% CI with a significance level set at p<0.05.

Results: 74 participants were included in this study, the median age of the study participants being 36 years, ranging (from 21 to 74) years, and predominantly males being 55 (74.3%). The prevalence of Depression after SCI was found to be 35.1%. Factors such as SCI duration of ≥ 6 months (OR=3.50, 95% CI: 2.44 – 28.0, p=0.001), having pressure sore (OR=8.40, 95% CI: 1.02 – 6.92, p<0.001), having bowel dysfunction (OR= 3.20, 95% CI: 2.02 – 6.75, p=0.001), having sexual dysfunction (OR=3.80, 95% CI: 3.50 – 4.80, p=0.001) and non-surgical management of SCI  (OR=11.40, 95% CI: 1.41 – 91.86, p=0.023), have more odds of developing depression after SCI and were statistically significance.

Conclusion: More than a third of patients with SCI had depression. The risk factors of depression after SCI included patients with Complete SCI (ASIA A), Cervical spine injury, patients managed conservatively, those with prolonged hospital stay, patients without health insurance and patients with complications after SCI such as pressure ulcers, neurogenic bowel, neurogenic bladder, and sexual dysfunction.