Identifying Depression Severity Risk Factors in Persons With Traumatic Spinal Cord Injury
Identifying Depression Severity Risk Factors in Persons With Traumatic Spinal Cord Injury
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DOI：
10.1037/a0034904
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发表时间：
2014-02-01
影响因子：
2.7
通讯作者：
Bombardier, Charles H.
中科院分区：
文献类型：
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作者：
Williams, Ryan T.;Wilson, Catherine S.;Bombardier, Charles H.
目的/目标：检查人口统计学特征，健康和伤害相关特征之间的关系，以及在多个抑郁严重程度水平上的物质滥用。研究方法/设计：204例创伤性脊髓损伤（SCI）患者自愿参加文拉法辛缓释剂治疗重度抑郁症（MDD）的随机对照试验。工具包括患者健康问卷-9（PHQ-9）抑郁量表，酒精使用障碍识别测试（AUDIT），和物质滥用的职业再培训筛选（SAVR-S），其中包括3个分量表：药物滥用，酒精滥用，和一个微妙的项目规模。每个SAVR-S分量表都有助于总体物质使用障碍（SUD）结局。指定了三个比例优势模型，每个模型中包含不同的药物滥用措施。结果如下：44%的人没有抑郁症状，31%有轻度症状，16%有中度症状，6%有中度严重症状，3%有重度抑郁症状。AUDIT和SAVR-S药物滥用子量表评分显示，酒精滥用是抑郁症状严重程度的显著预测因子。SAVR-S物质使用障碍（SUD）筛查结果是最具预测性的变量。在使用AUDIT酒精滥用指标的模型中，教育水平仅能显著预测抑郁症的严重程度。结论/影响：SAVR-S测量的可能SUD最能预测创伤性SCI患者的抑郁症状严重程度。药物和酒精筛查对于识别有抑郁风险的个体很重要，但两者的筛查可能是最佳的。需要进一步研究抑郁症的风险和保护因素，包括心理社会特征。
Purpose/Objective: Examine the relationship between demographic characteristics, health-, and injury-related characteristics, and substance misuse across multiple levels of depression severity. Research Method/Design: 204 persons with traumatic spinal cord injury (SCI) volunteered as part of screening efforts for a randomized controlled trial of venlafaxine extended release for major depressive disorder (MDD). Instruments included the Patient Health Questionnaire-9 (PHQ-9) depression scale, the Alcohol Use Disorders Identification Test (AUDIT), and the Substance Abuse in Vocational Rehabilitation-Screener (SAVR-S), which contains 3 subscales: drug misuse, alcohol misuse, and a subtle items scale. Each of the SAVR-S subscales contributes to an overall substance use disorder (SUD) outcome. Three proportional odds models were specified, varying the substance misuse measure included in each model. Results: 44% individuals had no depression symptoms, 31% had mild symptoms, 16% had moderate symptoms, 6% had moderately severe symptoms, and 3% had severe depression symptoms. Alcohol misuse, as indicated by the AUDIT and the SAVR-S drug misuse subscale scores were significant predictors of depression symptom severity. The SAVR-S substance use disorder (SUD) screening outcome was the most predictive variable. Level of education was only significantly predictive of depression severity in the model using the AUDIT alcohol misuse indicator. Conclusions/Implications: Likely SUD as measured by the SAVR-S was most predictive of depression symptom severity in this sample of persons with traumatic SCI. Drug and alcohol screening are important for identifying individuals at risk for depression, but screening for both may be optimal. Further research is needed on risk and protective factors for depression, including psychosocial characteristics.