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Abstract
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OBJECTIVE: Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors associated with MDD diagnosis; (3) time at which MDD is diagnosed post-spinal cord injury (SCI) and interaction of inferred mobility status (IMS) in a commercially insured population over three years.
DESIGN: Retrospective longitudinal cohort design. SETTING: A commercial insurance claims database from January 1, 2010 - December 31, 2013. PARTICIPANTS: Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history of MDD ≤30 days pre-SCI (n=1,409). INTERVENTION: Not applicable. MAIN OUTCOMES: Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A stratified survival analysis using IMS, based upon durable medical equipment (DME) claims, was also completed.
RESULTS: Post-SCI, 20.87% of the sample was diagnosed with new-onset MDD. Significant (p<0.05) risk factors included: employed, length of index hospitalization, discharged from index hospitalization with healthcare services, rehabilitation services post-SCI, and two of five IMS comparisons. Median time to MDD was 86 days. Survival analysis demonstrated a significant difference between six of ten IMS comparisons. Regarding new-onset or recurring MDD, 30.66% of the sample was diagnosed post-SCI. Significant risk factors included: female, employed, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, MDD >30 days pre-SCI, catheter claims, and two of five IMS comparisons. Median time to MDD was 74 days. Survival analysis demonstrated a significant difference between four of ten IMS comparisons.
CONCLUSIONS: Prevalence of MDD post-SCI is greater than the general population. Stratification by IMS illustrated that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI.
Copyright © 2019. Published by Elsevier Inc.
Language: en |