Citation

Fann JR, Crane DA, Graves DE, Kalpakjian CZ, Tate DG, Bombardier CH. Arch. Phys. Med. Rehabil. 2013; 94(12): 2389-2395.

Affiliation

Department of Rehabilitation Medicine, University of Washington, Seattle WA; Psychiatry and Behavioral Sciences and Epidemiology, University of Washington, Seattle WA. Electronic address: fann@uw.edu.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.apmr.2013.07.004

PMID

23872078

Abstract

OBJECTIVE: To examine preferences for depression treatment modalities and settings and predictors of treatment preference in persons with SCI. Depression is common and disabling following spinal cord injury (SCI). Patient centered health care involves educating and partnering with patients to arrive at a mutually acceptable treatment approach. DESIGN: Cross-sectional surveys. SETTING: Rehabilitation inpatient services in Seattle, WA, Ann Arbor, MI, and Houston, TX. PARTICIPANTS: Persons with traumatic SCI undergoing inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient Health Questionnaire-9 depression scale, history of psychiatric diagnoses and treatments, and a depression treatment preference survey. RESULTS: Among 183 inpatients (28% had PHQ-9 ≥ 10 indicating probable major depression), a physical exercise program was the most preferred treatment option (78% somewhat or very likely to try), followed by antidepressants prescribed by a primary care provider (63%) and individual counseling in a medical or rehabilitation clinic (62%), if they became depressed. All modalities were preferred over group counseling. Although not statistically significant, more depressed individuals stated a willingness to try antidepressants and counseling compared with non-depressed individuals and subjects preferred treatment in a medical / rehabilitation setting over a mental health setting. Those with a prior diagnosis of depression and those with a history of antidepressant use were significantly more willing to take an antidepressant, and age ≥ 40 years was a significant predictor of willingness to receive individual counseling. CONCLUSIONS: Treatment preferences and patient education are important factors when choosing a depression treatment modality for patients with SCI. The results suggest that antidepressants, counseling and exercise may be promising components of depression treatment in this population, particularly if they are integrated into medical or rehabilitation care.

Language: en