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Feb 26
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Quality of Life With SCI

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Author: Kelsey Zhao | Reviewer: Rachel Abel | Published: 26 February 2025 | Updated: ~

Key Points

  • A good quality of life (QoL) is not uncommon for people with SCI. There is no relationship between injury level or severity and QoL.
  • Involvement in the community through work, school, volunteer work, and social activities is associated with higher QoL.
  • Social support from family, friends, peers, and the community is associated with higher QoL.
  • The frequency of medical complications and how much they interfere with life reduces QoL.
  • QoL can be impacted by the accessibility of the community, work, and home environments.

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What is quality of life?

A woman on a wheelchair having a conversation with another woman sitting at the table

Quality of life (QoL) measures the different parts of an individual’s life to try and paint a picture of how well they are doing and how satisfied they are with their life. This might include things that an outsider could measure, like housing, income, employment, and health status. This can also include things that are based on an individual’s own values and aspirations, like whether they are satisfied with their current life and whether they feel their wants and needs are fulfilled.

QoL can be difficult to measure since individuals have different values and expectations for life. These values, expectations, and priorities can also change over an individual’s lifetime. Assessments used in research will not always accurately reflect how an individual weights different life components. QoL scores can also be influenced by regional differences in cultural values, access to care, and the accessibility of the surrounding environment.

Does spinal cord injury impact quality of life?

Contrary to popular belief, people with SCI generally have good QoL. On average, people with SCI score lower on QoL tests than the general population. However, a lower average does not mean that all people with SCI see their QoL as low, or that all people with SCI will have a lower score than people who do not have an SCI. In studies of people with cervical SCIs, the majority of participants felt that their QoL is average or better than average.

Most studies find little to no relationship between level of injury, injury severity, and QoL. Rather, higher QoL is limited by the physical and social barriers that prevent people from accessing community, activities, and employment.

What can increase quality of life for people with SCI?

Sam Sullivan speaking with Simon in libraryEmployment

Numerous studies show that work is strongly related to higher QoL for people with SCI. This is true whether the person is working full-time, part-time, or in an unpaid position.

In a study that looked at the QoL of people with SCI in six different countries, employment was one of the only factors found to be associated with higher QoL regardless of location. One large study also found that satisfaction with life increased over time for people who were employed or students.

Is it hard to find suitable work with SCI?

Differences in age, injury, work experience, and what is defined as work make it hard to pin down an exact number, but research estimates that about 35% of people with SCI are employed. The low rates of employment are likely due to a mix of personal and environmental factors.

Physical and health limitations

After an SCI, job opportunities can be limited by physical impairments and health. For example, someone might not be able to return to the work they did before their injury because it is too physically demanding. Health complications related to SCI like pain and fatigue, and managing care routines can also limit energy and time, making it more difficult to work.

Workplace environment

That said, people with SCI are often underemployed even when they want to and are able to work. Finding suitable work can be difficult because of issues like lack of transportation, inaccessible workplaces, fear of losing financial or health benefits, and employer discrimination towards people with disabilities. This is extremely concerning because of the connection between work and QoL. There is evidence that workplace support and accommodations increase employment for people with physical disabilities.

Local rehabilitation programs or SCI peer programs may have services to help people with SCI reach work and career goals.

Community involvement

One study found that people with SCI felt they had a greater sense of community than the general population. Community involvement can include recreational activities, hobbies, and positions in community organizations and can contribute to a higher QoL.

Social support

Social support refers to one’s relationships with other people, and the interactions, support, and care provided by this network of people, including family members, friends, and peer community. There is consistent evidence that more social support is linked to higher QoL in people with SCI.
Social interaction and participation in social activities are also linked to higher QoL. In some studies, it has the highest positive impact on life satisfaction of all factors. Marriage/having a partner is found to either improve or have no effect on QoL.

Independence

Independence in personal care and transportation is associated with higher QoL. One large study found that life satisfaction increased over the years for people with SCI who lived independently.

Psychological factors

Feeling like you have control over your life was related to higher QoL in several studies. Research has also shown strong associations between symptoms of depression and anxiety and lower quality of life. The connection between QoL and psychological factors highlight the importance of mental health support and treatment in SCI rehabilitation.

What can decrease quality of life for people with SCI?

Health complications

Having an SCI usually comes with additional health complications over one’s lifetime. These conditions can be directly or indirectly related to the SCI and could include:

Read our articles on the areas listed here and many other Topics!

The more health complications disrupt regular life, the greater the impact on QoL. For example, more frequent UTIs are associated with lower QoL as they limit daily activities and increase experiences of spasticity. How much pain interferes with life is also related to QoL. One study found that over a 2-year period, if pain interfered less with life over time, QoL increased, and vice versa. Pain also contributes to higher rates of mental health conditions for people with SCI, which are commonly associated with lower QoL.

Further, the more health conditions one experiences at once, the more QoL decreases. There is some evidence that when there are no health complications, the average QoL for people with SCI is similar to the average QoL of non-SCI populations.

Does accessibility impact quality of life?

Since community involvement and access to services is so important to QoL for people with SCI, access to the community environment can have a big effect on health and QoL. Many of the factors that hinder access can be improved by changing policies, practices, and the physical environment.

Community Access

Although accessibility features are required in many public places, what is accessible for one person may not be for another. The environment outside and inside can still be inaccessible to people with SCI for many reasons. Things like unmaintained sidewalks; physical barriers in parks, beaches, and swimming pools; a lack of adjustable equipment in a health care centre; and obstacles inside and outside of buildings, can prevent people with SCI from participating in the community and accessing health care. This lack of access to community spaces and resources can have a negative impact on QoL.

Housing Access

Not having suitable housing with adaptations for SCI can have a negative impact on QoL. Living in a home that hinders one’s ability to do daily activities or participate in activities can be very stressful. The inaccessible homes of family and friends can also affect QoL.

Read our article on Housing After SCI for more information!

Transportation Access

A lack of accessible transportation can lower QoL by blocking access to community resources, health care, and activities, especially for people in living in rural or remote areas. Owning a private adapted vehicle may be too expensive, not suited to one’s particular needs, or not available in the area. Public transportation like buses and trains are not always available or equipped to accommodate people with SCI.

Read our article on Adapted Driving for more information!

The bottom line

Regardless of injury level and severity, many people with SCI report that they have a good quality of life. QoL can be difficult to measure because everyone has their own priorities, values, and expectations for what they consider to be a good life.

Involvement in the community through work, school, volunteer work, and social activities are some of the factors that are most strongly related to higher QoL. Social support from family, friends, peers, and the community are also important for QoL.

The disruption caused by frequent and problematic medical complications can lower QoL. Seek medical care from a health professional if pain, fatigue, spasticity, bowel/bladder problems etc. are having a big negative impact on your daily life.

 

For a review of how we assess evidence at SCIRE Community and advice on making decisions, please see SCIRE Community Evidence.

Reference list

Parts of this page have been adapted from the SCIRE Professional “Work and Employment” Module:

Escorpizo R, Smith EM, Finger ME, Miller WC (2018). Work and Employment Following Spinal Cord Injury. In: Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, Sproule S, Querée M, Benton B editors. Spinal Cord Injury Rehabilitation Evidence. Version 6.0. p 1- 35.
Available from: scireproject.com/evidence/work-and-employment/

Evidence for “What is quality of life?” is based on:

Hammell, K. W. (2004). Exploring quality of life following high spinal cord injury: a review and critique. Spinal Cord, 42(9), 491–502. https://doi.org/10.1038/sj.sc.3101636

Sakakibara, B. M., Hitzig, S. L., Miller, W. C., & Eng, J. J. (2012). An evidence-based review on the influence of aging with a spinal cord injury on subjective quality of life. Spinal Cord, 50(8), 570–578. https://doi.org/10.1038/sc.2012.19

Theofilou, P. (2013). Quality of Life: Definition and Measurement. Europe’s Journal of Psychology, 9(1), 150–162. https://doi.org/10.5964/ejop.v9i1.337

Tate, D., & Forchheimer, M. (2014). Review of Cross-Cultural Issues Related to Quality of Life After Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation, 20(3), 181–190. https://doi.org/10.1310/sci2003-181

Evidence for “Does spinal cord injury impact quality of life?” is based on:

Hill, M. R., Noonan, V. K., Sakakibara, B. M., & Miller, W. C. (2010). Quality of life instruments and definitions in individuals with spinal cord injury: a systematic review. Spinal Cord, 48(6), 438–450. https://doi.org/10.1038/sc.2009.164

Sakakibara, B. M., Hitzig, S. L., Miller, W. C., & Eng, J. J. (2012). An evidence-based review on the influence of aging with a spinal cord injury on subjective quality of life. Spinal Cord, 50(8), 570–578. https://doi.org/10.1038/sc.2012.19

Hammell, K. W. (2004). Exploring quality of life following high spinal cord injury: a review and critique. Spinal Cord, 42(9), 491–502. https://doi.org/10.1038/sj.sc.3101636

McColl, M. A., Arnold, R., Charlifue, S., Glass, C., Savic, G., & Frankel, H. (2003). Aging, spinal cord injury, and quality of life: structural relationships11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. Archives of Physical Medicine and Rehabilitation, 84(8), 1137–1144. https://doi.org/10.1016/S0003-9993(03)00138-2

Olkin, R. (2022). Conceptualizing disability: Three models of disability. American Psychological Association. https://www.apa.org/ed/precollege/psychology-teacher-network/introductory-psychology/disability-models

Evidence for “What can increase quality of life for people with SCI?” is based on:

Lakhani, A., Parekh, S., Watling, D. P., Grimbeek, P., Duncan, R., Charlifue, S., & Kendall, E. (2022). Access and engagement with places in the community, and the quality of life among people with spinal cord damage. The Journal of Spinal Cord Medicine, 45(4), 522–530. https://doi.org/10.1080/10790268.2020.1860867

Geyh, S., Ballert, C., Sinnott, A., Charlifue, S., Catz, A., D’Andrea Greve, J. M., & Post, M. W. M. (2013). Quality of life after spinal cord injury: a comparison across six countries. Spinal Cord, 51(4), 322–326. https://doi.org/10.1038/sc.2012.128

Chen, Y., Anderson, C. J., Vogel, L. C., Chlan, K. M., Betz, R. R., & McDonald, C. M. (2008). Change in Life Satisfaction of Adults With Pediatric-Onset Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 89(12), 2285–2292. https://doi.org/10.1016/j.apmr.2008.06.008

Nevala, N., Pehkonen, I., Koskela, I., Ruusuvuori, J., & Anttila, H. (2015). Workplace Accommodation Among Persons with Disabilities: A Systematic Review of Its Effectiveness and Barriers or Facilitators. Journal of Occupational Rehabilitation, 25(2), 432–448. https://doi.org/10.1007/s10926-014-9548-z

Ottomanelli, L., & Lind, L. (2009). Review of Critical Factors Related to Employment After Spinal Cord Injury: Implications for Research and Vocational Services. The Journal of Spinal Cord Medicine, 32(5), 503–531. https://doi.org/10.1080/10790268.2009.11754553

Trenaman, L., Miller, W. C., Querée, M., & Escorpizo, R. (2015). Modifiable and non-modifiable factors associated with employment outcomes following spinal cord injury: A systematic review. The Journal of Spinal Cord Medicine, 38(4), 422–431. https://doi.org/10.1179/2045772315Y.0000000031

Migliorini, C. E., New, P. W., & Tonge, B. J. (2011). Quality of life in adults with spinal cord injury living in the community. Spinal Cord, 49(3), 365–370. https://doi.org/10.1038/sc.2010.102

Helgeson, V. S. (2003). Social support and quality of life. Quality of Life Research, 12(1suppl), 25–31. https://doi.org/10.1023/A:1023509117524

Kashif, M., Jones, S., Darain, H., Iram, H., Raqib, A., & Butt, A. A. (2019). Factors influencing the community integration of patients following traumatic spinal cord injury: a systematic review. JPMA. The Journal of the Pakistan Medical Association, 69(9), 1337–1343.

Müller, R., Peter, C., Cieza, A., & Geyh, S. (2012). The role of social support and social skills in people with spinal cord injury—a systematic review of the literature. Spinal Cord, 50(2), 94–106. https://doi.org/10.1038/sc.2011.116

Chang, F.-H., Wang, Y.-H., Jang, Y., & Wang, C.-W. (2012). Factors Associated With Quality of Life Among People With Spinal Cord Injury: Application of the International Classification of Functioning, Disability and Health Model. Archives of Physical Medicine and Rehabilitation, 93(12), 2264–2270. https://doi.org/10.1016/j.apmr.2012.06.008

Jörgensen, S., Iwarsson, S., & Lexell, J. (2017). Secondary Health Conditions, Activity Limitations, and Life Satisfaction in Older Adults With Long‐Term Spinal Cord Injury. PM&R, 9(4), 356–366. https://doi.org/10.1016/j.pmrj.2016.09.004

van Leeuwen, C. M. C., Kraaijeveld, S., Lindeman, E., & Post, M. W. M. (2012). Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review. Spinal Cord, 50(3), 174–187. https://doi.org/10.1038/sc.2011.120

García-Rudolph, A., Cegarra, B., Opisso, E., Tormos, J. M., & Saurí, J. (2021). Relationships Between Functionality, Depression, and Anxiety With Community Integration and Quality of Life in Chronic Traumatic Spinal Cord Injury. American Journal of Physical Medicine & Rehabilitation, 100(9), 840–850. https://doi.org/10.1097/PHM.0000000000001773

Parker, M. A., Ichikawa, J. K., Bombardier, C. H., & Hammond, F. M. (2022). Association Between Anxiety Symptoms, Depression Symptoms, and Life Satisfaction Among Individuals 1 Year After Spinal Cord Injury: Findings From the SCIRehab Project. Archives of Rehabilitation Research and Clinical Translation, 4(3), 100211. https://doi.org/10.1016/j.arrct.2022.100211

Evidence for “What can decrease quality of life for people with SCI?” is based on:

Andresen, S. R., Biering-Sørensen, F., Hagen, E. M., Nielsen, J. F., Bach, F. W., & Finnerup, N. B. (2016). Pain, spasticity and quality of life in individuals with traumatic spinal cord injury in Denmark. Spinal Cord, 54(11), 973–979. https://doi.org/10.1038/sc.2016.46

Ataoğlu, E., Tiftik, T., Kara, M., Tunç, H., Ersöz, M., & Akkuş, S. (2013). Effects of chronic pain on quality of life and depression in patients with spinal cord injury. Spinal Cord, 51(1), 23–26. https://doi.org/10.1038/sc.2012.51

Kemp, B., Tsukerman, D., Kahan, J., & Adkins, R. (2014). Predicting Psychosocial Outcomes Using a Brief Measure of Quality of Life in a Sample of People with Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation, 20(3), 191–196. https://doi.org/10.1310/sci2003-191

Putzke, J. D., Richards, S. J., Hicken, B. L., & DeVivo, M. J. (2002). Interference due to pain following spinal cord injury: important predictors and impact on quality of life. Pain, 100(3), 231–242. https://doi.org/10.1016/S0304-3959(02)00069-6

Vogel, L. C., Krajci, K. A., & Anderson, C. J. (2002). Adults With Pediatric-Onset Spinal Cord Injury: Part 2: Musculoskeletal And Neurological Complications. The Journal of Spinal Cord Medicine, 25(2), 117–123. https://doi.org/10.1080/10790268.2002.11753611

Theisen, K. M., Mann, R., Roth, J. D., Pariser, J. J., Stoffel, J. T., Lenherr, S. M., Myers, J. B., Welk, B., & Elliott, S. P. (2020). Frequency of patient-reported UTIs is associated with poor quality of life after spinal cord injury: a prospective observational study. Spinal Cord, 58(12), 1274–1281. https://doi.org/10.1038/s41393-020-0481-z

Piatt, J. A., Nagata, S., Zahl, M., Li, J., & Rosenbluth, J. P. (2016). Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life. The Journal of Spinal Cord Medicine, 39(6), 693–698. https://doi.org/10.1080/10790268.2015.1123845

Wijesuriya, N., Tran, Y., Middleton, J., & Craig, A. (2012). Impact of Fatigue on the Health-Related Quality of Life in Persons With Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 93(2), 319–324. https://doi.org/10.1016/j.apmr.2011.09.008

Peterson, M. D., Meade, M. A., Lin, P., Kamdar, N., Rodriguez, G., Krause, J. S., & Mahmoudi, E. (2022). Psychological morbidity following spinal cord injury and among those without spinal cord injury: the impact of chronic centralized and neuropathic pain. Spinal Cord, 60(2), 163–169. https://doi.org/10.1038/s41393-021-00731-4

Wollaars, M. M., Post, M. W. M., van Asbeck, F. W. A., & Brand, N. (2007). Spinal Cord Injury Pain: The Influence of Psychologic Factors and Impact on Quality of Life. The Clinical Journal of Pain, 23(5), 383–391. https://doi.org/10.1097/AJP.0b013e31804463e5

Rivers, C. S., Fallah, N., Noonan, V. K., Whitehurst, D. G., Schwartz, C. E., Finkelstein, J. A., Craven, B. C., Ethans, K., O’Connell, C., Truchon, B. C., Ho, C., Linassi, A. G., Short, C., Tsai, E., Drew, B., Ahn, H., Dvorak, M. F., Paquet, J., Fehlings, M. G., & Noreau, L. (2018). Health Conditions: Effect on Function, Health-Related Quality of Life, and Life Satisfaction After Traumatic Spinal Cord Injury. A Prospective Observational Registry Cohort Study. Archives of Physical Medicine and Rehabilitation, 99(3), 443–451. https://doi.org/10.1016/j.apmr.2017.06.012

Burke, D., Lennon, O., & Fullen, B. M. (2018). Quality of life after spinal cord injury: The impact of pain. European Journal of Pain, 22(9), 1662–1672. https://doi.org/10.1002/ejp.1248

Evidence for “How does accessibility impact quality of life?” is based on:

Gurung, S., Jenkins, H.-T., Chaudhury, H., & Ben Mortenson, W. (2023). Modifiable Sociostructural and Environmental Factors That Impact the Health and Quality of Life of People With Spinal Cord Injury: A Scoping Review. Topics in Spinal Cord Injury Rehabilitation, 29(1), 42–53. https://doi.org/10.46292/sci21-00056

 

Image credits

  1. Two people sitting outside ©SCIRE, CC BY-NC 4.0
  2. Sam Sullivan https://samsullivan.ca/photo-gallery/
  3. Mother in wheelchair with child ©SCIRE, CC BY-NC 4.0
  4. Elderly man in wheelchair cityscape ©SCIRE, CC BY-NC 4.0

 

Disclaimer: This document does not provide medical advice. This information is provided for educational purposes only. Consult a qualified health professional for further information or specific medical advice. The SCIRE Project, its partners and collaborators disclaim any liability to any party for any loss or damage by errors or omissions in this publication.
Nov 21
0

Depression Treatments (Overview)

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Oct 07
0

Depression After Spinal Cord Injury

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Author: SCIRE Community Team | Reviewer: Brad Hallam | Published: 7 October 2017 | Updated: 17 June 2020

Depression is one of the most common mental health concerns among people living with spinal cord injury (SCI). This page provides an overview about what depression is and common treatments for depression after SCI.

Key Points

  • Depression is a psychological disorder involving a sad or depressed mood, loss of interest in activities, and many other symptoms.
  • Depression is common but not universal after SCI.
  • Depression is treatable. There are many effective treatments for depression, including antidepressant medications, counselling and talk therapies, and exercise programs.
  • Research suggests that cognitive behavioural therapy, antidepressant medications, exercise programs, or a combination of these interventions may help to improve depression after SCI.

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What is depression?

Depression (major depressive disorder) is a psychological disorder which involves depressed mood, loss of interest in activities, and a number of other symptoms that affect emotions, thoughts, behaviours, and the body.

Depression is not simply ‘feeling blue’ or the sadness that can accompany life events like the death of a loved one. It is a serious medical condition involving persistent and widespread feelings of distress that affect all aspects of a person’s life.

What are the signs and symptoms of depression?

The main symptoms of depression are a depressed mood and/or a loss of interest or pleasure in activities. Other symptoms may include some or all of these physical, emotional and cognitive (thinking) symptoms:

Physical Symptoms: 

Cartoon of man sitting on their bed frustrated

    • Changes in weight or appetite
    • Changes in sleep – either sleeping too much or too little
    • Moving or speaking slowly, or being fidgety and restless
    • Feeling tired or low energy

Emotional Symptoms:

Sillhouette cartoon man looking down

    • Feeling ‘down’, sad, or empty
    • Feeling worthless, hopeless, or guilty
    • Feeling irritable or angry

Cognitive (Thinking) Symptoms:

Cartoon man sitting with many thoughts directed to their mind

    • Trouble concentrating or making decisions
    • Thinking about death or suicide

Symptoms have to last for at least two weeks and be severe enough to interfere with the person’s life to be diagnosed as depression.

How is depression different from other emotional responses to SCI?

It is common to feel strong emotions after experiencing a serious injury like an SCI. Feelings of sadness, anger, and grief are all common responses to SCI that do not necessarily mean that someone has depression.

Emotional responses like grief tend to go away over time while the symptoms of depression are persistent. People experiencing depression are also more likely to feel negatively about themselves, such as feeling worthless or guilty. They are also prone to dwelling on negative events from their past and present, and projecting negative outcomes in the future.

Depression affects everyone differently, so its exact symptoms will be different from person to person. Depression is not always easy to recognize. If you suspect that you or a loved one may have depression, it is important to speak to a healthcare provider for more information.

How does depression affect people with SCI?

Depression is one of the most common mental health concerns after SCI. As many as 40% of people experience depression during rehabilitation and around 1 in 5 people experience depression a year after the injury.

Depression can be a serious problem after SCI. It can interfere with recovery and rehabilitation and is related to longer hospital stays, higher levels of pain, and lower quality of life after injury.

However, it is also important to keep in mind that not every person will develop depression after SCI. The majority of people adapt well to living with an SCI and depression is not a necessary part of adjustment to injury, but shows that a person is experiencing distress.

Hear Louise describe her experience with being told “you can’t walk again”

Suicide

Suicide rates are also higher among people with SCI than in the general population. If you or someone you know is thinking about suicide, contact a health provider or a crisis center immediately:

What causes depression?

Scientists do not know for sure what causes depression. Depression can affect anyone and happens for different reasons for each person. There are many different factors that may be related to depression, such as:

Potential sources of depression include your DNA and various factors in the brain.6-7

  • Stressful life events, like experiencing a serious injury or losing a job
  • Personal characteristics, such as personality and life experiences
  • Environmental factors, such as social support and personal security
  • Genetics
  • Medical conditions
  • Certain medications

Depression may be related to lower levels of certain brain chemicals called neurotransmitters. Neurotransmitters are chemicals in the brain that allow nerve cells to send messages. Lower levels of certain neurotransmitters, including serotonin, norepinephrine, and dopamine, are linked with depression. However, this is a complex relationship that scientists are still working to understand.

Unique challenges to coping after spinal cord injury

Experiencing an SCI can cause additional challenges which may contribute to depression:

  • Sensory deprivation (e.g., limited exposure to natural light) during the acute period
  • Health problems like pain, fatigue, and sleep problems
  • Grieving the loss of physical abilities and independence
  • Stresses of being in the hospital, such as being away from home for a long time and lack of privacy
  • Changes in self-image
  • Symptoms of other medical conditions like brain injuries and concussions
  • Uncertainty about what will happen in the future

How is depression diagnosed?

Depression is diagnosed through interviews with a health provider such as a doctor or psychologist. The health provider will ask questions about mood and a number of other symptoms, and may have you complete questionnaires about your symptoms.

There is no lab test that can diagnose depression, but lab testing may be done to rule out other conditions that may have similar symptoms, such as thyroid problems.

How is depression after SCI treated?

There are many different ways of treating depression. The first treatments are usually counselling, talk therapies and antidepressant medications. Other treatments for depression may include exercise and other medical, alternative, and self-help therapies.

Counselling and Talk therapies

Cartoon of two people talking

Counselling and talk therapies involve talking with a mental health provider such as a psychologist, counsellor, or social worker. There are many different types of talk therapies. Research done on depression after SCI has focused primarily on one type of therapy called cognitive behavioural therapy or CBT.

Cognitive behavioural therapy is a type of therapy that addresses how thoughts, feelings, and behaviours can contribute to mental health problems. It focuses on developing practical skills to help manage these conditions and can be done in many different formats, including one-to-one counselling, group therapy, and computer programs.

There is moderate evidence that cognitive behavioural therapy can help to improve depression symptoms after SCI. However, we do not know whether these effects last long-term.

Antidepressant medications

Antidepressant medications (antidepressants) are another common treatment option for depression. There is a wide range of different antidepressants that may be used. Some antidepressant medications can treat sleep, nerve pain and mood simultaneously, and these are often used in people with SCI. Antidepressants are prescribed by medical doctors.

The use of antidepressants to treat depression after SCI is mostly based on research studies done in the general population because there are not many studies done among people with SCI. However, there is weak evidence that combined antidepressant medications and talk therapies may help to improve the symptoms of depression among people with SCI.

Exercise

Exercise is now becoming more widely known as a treatment option for depression. Exercise may help treat depression because it helps to reduce pain and stress, causes the release of “feel-good” chemicals like endorphins, and helps to maintain mobility and quality of life.

Several different exercise-based programs have been studied for their effects on depression, after SCI. There is strong evidence that exercise helps to reduce the symptoms of depression after SCI.

Other treatments and strategies for depression

There are many other treatments used for depression. These treatments have not been studied extensively among people with SCI, so we do not know how effective they are for depression after SCI.

  • Organized wellness and health promotion programs
  • Living a healthy lifestyle (getting enough rest, eating healthy, and staying active)
  • Participating in enjoyable activities
  • Meditation and mindfulness training
  • Massage therapy
  • Acupuncture
  • Light therapy
  • Herbal and dietary supplements
  • Brain stimulation therapies such as Transcranial Magnetic Stimulation (TMS)

Addressing other medical problems

There are many factors related to spinal cord injury that may contribute to depression, such as chronic pain, fatigue, sleep problems, medication side effects, and health problems like repeated infections. Treating these problems may be another strategy that can help manage depression.

The bottom line

Depression is a psychological disorder involving depressed mood, loss of interest in activities, and a
number of other symptoms. Depression is one of the most common mental health concerns after SCI.
The research evidence suggests that cognitive behavioural therapy, combined medication and talk
therapy, and exercise programs help to improve the symptoms of depression after SCI. Further
research specific to people with SCI is needed to better understand which treatments are most
effective.

If you are concerned that you or a loved one has depression, it is important to speak to a healthcare
provider for more information and to determine the best treatment options for you

For a review of how we assess evidence at SCIRE Community and advice on making decisions, please see SCIRE Community Evidence.

References

Parts of this page have been adapted from the SCIRE Professional “Depression Following Spinal Cord Injury” Module:

Orenczuk S, Mehta S, Slivinski J, Teasell RW (2014). Depression Following Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 5.0: p 1-35.
Available from: scireproject.com/evidence/mental-health/depression/

Evidence for “How is depression after SCI treated?” is based on the following studies:

Counseling and Talk Therapies

[1] Dorstyn D, Mathias J, Denson L, Robertson M. Effectiveness of telephone counseling in managing psychological outcomes after spinal cord injury: A preliminary study. Arch Phys Med Rebabil 2012;93:2100-8.

[2] Heutink M, Post MW, Bongers-Janssen HM, Dijkstra CA, Snoek GJ, Spijkerman DC, et al. The CONECSI trial: results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury. Pain 2012;153:120-8.

[3] Schulz R, Czaja SJ, Lustig A, Zdaniuk B, Martire LM, Perdomo, D. Improving the quality of life of caregivers of persons with spinal cord injury: a randomized controlled trial. Rehabil Psychol 2009;54:1-15.

[4] Craig AR, Hancock K, Dickson H, Chang E. Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy. Arch Phys Med Rehabil 1997;78:33-8.

[5] Craig AR, Hancock K, Chang E, Dickson H. Immunizing against depression and anxiety after spinal cord injury. Arch Phys Med Rehabil 1998a;79:375-7.

[6] Craig A, Hancock K, Chang E, Dickson H. The effectiveness of group psychological intervention in enhancing perceptions of control following spinal cord injury. Aust N Z J Psychiatry 1998b;32:112-8.

[7] Perry KN, Nicholas MK, Middleton JW. Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain. Clin J Pain 2010;26:206-16.

[8] King C, Kennedy P. Coping effectiveness training for people with spinal cord injury: Preliminary results of a controlled trial. Br J Clin Psychol 1999;38:5-14.

[9] Norrbrink BC, Kowalski J, Lundeberg T. A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. J Rehabil Med 2006;38:172-80.

[10] Dorstyn D, Mathias J, Denson L. Efficacy of cognitive behaviour therapy for the management of psychological outcomes following spinal cord injury: A meta-analysis. J Health Psychol 2010;16:374-91.

[11] Kennedy P, Duff J, Evans M, Beedie A. Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. Br J Clin Psychol 2003;42:41-52.

[12] Craig A, Hancock K, Dickson H. Improving the long-term adjustment of spinal cord injured persons. Spinal Cord 1999;37:345-50.

[13] Duchnick JJ, Letsch EA, Curtiss G. Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial. Rehabil Psychol 2009;54:123-32.

[14] Migliorini C, Tonge B, Sinclair A. Developing and piloting ePACT: A flexible psychological treatment for depression in people with chronic spinal cord injury. Behaviour Change 2011;28:45-54.

Medications

[1] Kahan JS, Mitchell JM, Kemp BJ, Adkins RH. The results of a 6-month treatment for depression on symptoms, life, satisfaction, and community activities among individuals aging with a disability. Rehabil Psychol 2006;51:13-22.

[2] Kemp BJ, Kahan JS, Krause JS, Adkins RH, Nava G. Treatment of major depression in individuals with spinal cord injury. J Spinal Cord Med 2004;27:22-8.

[3] Judd FK, Stone J, Webber JE, Brown DJ, Burrows GD. Depression following spinal cord injury. A prospective in-patient study. Br J Psychiatry 1989;154:668-71.

[4] Judd FK, Burrows GD, Brown DJ. Depression following acute spinal cord injury. Paraplegia 1986;24:358-63.

Exercise

[1] Hicks AL, Martin KA, Ditor DS, Latimer AE, Craven C, Bugaresti J, McCartney N. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being. Spinal Cord 2003;41:34-43.

[2] Ginis KAM, Latimer AE, McKechnie K, Ditor DS, McCartney N, Hicks AL, et al. Using exercise to enhance subjective well-being among people with spinal cord injury: the mediating influences of stress and pain. Rehabil Psychol 2003;48:157-64.

[3] Latimer AE, Ginis KA, Hicks AL, McCartney N. An examination of the mechanisms of exercise-induced change in psychological well-being among people with spinal cord injury. J Rehabil Res Dev 2004;41:643-52.

[4] Guest RS, Klose KJ, Needham-Shropshire BM, Jacobs PL. Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: Part 4. Effect on physical self-concept and depression. Arch Phys Med Rehabil 1997;78:804-7.

Other references:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Bombardier CH, Richards JS, Krause JS, Tulsky D, Tate DG. Symptoms of major depression in people with spinal cord injury: implications for screening. Arch Phys Med Rehabil 2004;85:1749-56.

DeVivo MJ, Black KJ, Richards JS, Stover SL. Suicide following spinal cord injury. Paraplegia1991;29:620-7.

Charlifue SW, Gerhart KA. Behavioral and demographic predictors of suicide after traumatic spinal cord injury. Arch Phys Med Rehabil 1991;72:488-92.

Hartkopp A, Bronnum-Hansen H, Seidenschnur AM, Biering-Sorensen F. Suicide in a spinal cord injured population: Its relation to functional status. Arch Phys Med Rehabil 1998;79:1356-61.

Dreer L, Elliott T, Shewchuk R, Berry J, Rivera P. Family caregivers of persons with spinal cord injury predicting caregivers at risk for probable depression. Rehabil Psychol 2007;52:351-7.

Consortium for Spinal Cord Medicine. Depression following spinal cord injury: A clinical practice guideline for primary care physicians. Washington, DC: Paralyzed Veterans of America. 1998.

Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias N, Svenson LW, et al. Depression following traumatic spinal cord injury. Neuroepidemiology 2005;25:55-61.

Kennedy P, Rogers B. Anxiety and depression after sinal cord injury: A longitudinal analysis. Arch Phys Med Rehabil 2000;81:932-7.

Krause JS, Bombardier C, Carter RE. Assessment of depressive symptoms during inpatient rehabilitation for spinal cord injury: Is there an underlying somatic factor when using the PHQ? Rehabil Psychol 2008;53:513-20.

Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. Natural history of major depression after spinal cord injury. J Spinal Cord Med 2008;31:236.

Mehta S, Aubut JL, Legassic M, Orenczuk S, Hansen KT, Hitzig SL,et al. An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabil Psychol 2011;56:15-25.

Elliott TR, Kennedy P. Treatment of depression following spinal cord injury: An evidence-based review. Rehabil Psychol 2004;49:134-9.

Zemper ED, Tate DG, Roller S, Forchheimer M, Chiodo A, Nelson VS, et al. Assessment of a holistic wellness program for persons with spinal cord injury. Am J Phys Med Rehabil 2003;82:957-68.

Dunn M, Love L, Ravesloot C. Subjective health in spinal cord injury after outpatient healthcare follow-up. Spinal Cord 2000;38:84-91.

Diego MA, Field T, Hernandez-Reif M, Hart S, Brucker B, Field T, et al. Spinal cord patients benefit from massage therapy. Int J Neurosci 2002;112:133-42.

Defrin R, Grunhaus L, Zamir D, Zeilig G. The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury. Arch Phys Med Rehabil 2007;88:1574-80.

Perkes SJ, Bowman J, Penkala S. Psychological therapies for the management of co-morbid depression following a spinal cord injury: a systematic review. J Health Psychol. 2014 Dec;19(12):1597-612.

Dezarnaulds A, Ilchef R. Psychological Adjustment after Spinal Cord Injury – Useful strategies for health professionals. Agency for Clinical Innovation. Feb 2014. Available from: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0010/155197/Psychosocial-Adjustment.pdf. Accessed Feb 22, 2016.

Image credits

  1. A woman suffering from Clinical Depression ©Berkah Icon, CC BY 3.0 US
  2. Insomnia ©Gan Khoon Lay, CC BY 3.0 US
  3. Sad ©Juan Pablo Bravo, CC BY 3.0 US
  4. depression ©Gan Khoon Lay, CC BY 3.0 US
  5. wheelchair lonely physical hospital land care ©ferobanjo, Pixabay License
  6. Nerve cell neuron brain neurons nervous system ©ColiN00B, Pixabay License
  7. DNA ©Servier Medical Art, CC BY 3.0
  8. Clinician and client © SCIRE Community
  9. therapy ©Adrien Coquet, CC BY 3.0 US
  10. White green and red medication capsules ©Pikrepo, CC0 1.0
  11. Exercising with trainer © SCIRE Community


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