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Depressive mood in individuals with spinal cord injury (SCI) living in Greece

Spinal Cord (2018) | Download Citation


Study design

Cross-sectional study.


To provide data on depressive symptoms rates in the Greek SCI population and to investigate their association with demographic and clinical variables.


Greek territory.


One hundred and sixty-four individuals with SCI living in the community for at least 1 year after the completion of the primary inpatient rehabilitation program were included in the study. Our group of participants were enrolled from multiple rehabilitation centers throughout Greece and were evaluated for probable depression according to the Patient Health Questionnaire (PHQ-9). Univariable and multiple linear regression analyses were performed to assess the possible association of risk factors with the occurrence of depression. We had also examined the correlation between PHQ-9 and scales measuring social reintegration (Craig Handicap Assessment and Reporting Technique (CHART)), quality of life (World Health Organization Quality of Life BREF (WHOQOL-BREF)), and independence (Spinal Cord Independence Measure (SCIM)).


It was found that 18.2% of the sample had probable depression. The mean (SD) PHQ-9 score was 5.7  (4.9). The multiple linear regression analysis showed that high pain scores (P = 0.001) and suffering from both nociceptive and neuropathic pain (P = 0.005) were associated with depressive mood, while pressure ulcers had a significant effect (P = 0.049) only in the univariable analysis. Participant’s PHQ-9 scores had also a negative correlation with almost all CHART, WHOQOL-BREF, and SCIM subscales’ scores.


This study documents relatively low rates of probable depression among individuals with SCI in Greece. Severe pain and pressure ulcers were the main identified predictors of depressive mood.

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  1. 1.

    Scivoletto G, Petrelli A, Di Lucente L, Castellano V. Psychological investigation of spinal cord injury patients. Spinal Cord. 1997;35:516–20.

  2. 2.

    Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S. Causes of death after traumatic spinal cord injury-a 70-year British study. Spinal Cord. 2017;55:891–97.

  3. 3.

    Williams R, Murray A. Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil. 2015;96:133–40.

  4. 4.

    Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil. 2011;92:411–8.

  5. 5.

    Smith BM, Weaver FM, Ullrich PM. Prevalence of depression diagnoses and use of antidepressant medications by veterans with spinal cord injury. Am J Phys Med Rehabil. 2007;86:662–71.

  6. 6.

    Dorsett P, Geraghty T. Depression and adjustment after spinal cord injury: a three year longitudinal study. Top Spinal Cord Inj Rehabil. 2004;9:43–56.

  7. 7.

    Craig AR, Hancock KM, Dickson HG. Spinal cord injury: a search for determinants of depression two years after the event. Br J Clin Psychol. 1994;33:221–30.

  8. 8.

    Saunders LL, Krause JS, Focht KL. A longitudinal study of depression in survivors of spinal cord injury. Spinal Cord. 2012;50:72–7.

  9. 9.

    Krause JS, Kemp B, Coker J. Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators. Arch Phys Med Rehabil. 2000;81:1099–109.

  10. 10.

    Tate D, Forchheimer M, Maynard F, Dijkers M. Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap. Am J Phys Med Rehabil. 1994;73:175–83.

  11. 11.

    Tsai IH, Graves DE, Lai CH, Hwang LY, Pompeii LA. Association of internet use and depression among the spinal cord injury population. Arch Phys Med Rehabil. 2014;95:236–43.

  12. 12.

    Polyzos N, Karakolias S, Dikeos C, Theodorou M, Kastanioti C, Mama K, et al. The introduction of Greek Central Health Fund: has the reform met its goal in the sector of Primary Health Care or is there a new model needed? BMC Health Serv Res. 2014;14:583.

  13. 13.

    Niessen M, Peschar J. Comparative research on Education: overview, strategy and application in Eastern and Western Europe. Budapes: Elsevier; 2013.

  14. 14.

    Tzanos IA, Mitsiokapa E, Megaloikonomos P, Igoumenou V, Panagopoulos G, Papathanasiou J, et al. Social reintegration and quality of life after spinal cord injury: the Greek paradigm. J Biomed. 2016;1:36–43.

  15. 15.

    Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves D, Jha A et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med. 2011;34:535–46

  16. 16.

    Bryce TN, Budh CN, Cardenas DD, Dijkers M, Felix ER, Finnerup NB, et al. Pain after spinal cord injury: an evidence-based review for clinical practice and research. Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures Meeting. J Spinal Cord Med. 2007;30:421–40.

  17. 17.

    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.

  18. 18.

    Sakakibara BM, Miller WC, Orenczuk SG, PsyD, Wolfe DL. SCIRE Research Team. A systematic review of depression and anxiety measures with individuals with spinal cord injury. Spinal Cord. 2009;47:841–51.

  19. 19.

    Bombardier CH, Kalpakjian CZ, Graves DE, Dyer JR, Tate DG, Fann JR. Validity of the Patient Health Questionnaire-9 in assessing major depressive disorder during inpatient spinal cord injury rehabilitation. Arch Phys Med Rehabil. 2012;93:1838–45.

  20. 20.

    Kalpakjian CZ, Bombardier CH, Schomer K, Brown PA, Johnson KL. Measuring depression in persons with spinal cord injury: a systematic review. J Spinal Cord Med. 2009;32:6–24.

  21. 21.

    Whiteneck GG, Charlifue SW, Gerhart KA, Overholser JD, Richardson GN. Quantifying handicap: a new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil. 1992;73:519–26.

  22. 22.

    Development of the World Health Organization. WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28:551–8.

  23. 23.

    Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM-spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35:850–6.

  24. 24.

    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.

  25. 25.

    Krause JS, Saunders LL, Reed KS, Coker J, Zhai Y, Johnson E. Comparison of the Patient Health Questionnaire and the Older Adult Health and Mood Questionnaire for self-reported depressive symptoms after spinal cord injury. Rehabil Psychol. 2009;54:440–8.

  26. 26.

    Khazaeipour Z, Taheri-Otaghsara SM, Naghdi M. Depression following spinal cord injury: its’ relationship to demographic and socioeconomic indicators. Top Spinal Cord Inj Rehabil. 2015;21:149–55.

  27. 27.

    Modirian E, Pirouzi P, Soroush M, Karbalaei-Esmaeili S, Shojaei H, Zamani H. Chronic pain after spinal cord injury: results of a long-term study. Pain Med. 2010;11:1037–43.

  28. 28.

    Kalpakjian CZ, Albright KJ. An examination of depression through the lens of spinal cord injury. Women’s Health Issues. 2006;16:380–8.

  29. 29.

    Botticello AL, Chen Y, Cao Y, Tulsky DS. Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injury. Arch Phys Med Rehabil. 2011;92:464–71.

  30. 30.

    van Leeuwen CM, Post MW, Westers P, van der Woude LH, de Groot S, Sluis T, et al. Relationships between activities, participation, personal factors, mental health, and life satisfaction in persons with spinal cord injury. Arch Phys Med Rehabil. 2012;93:82–9.

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Author information


  1. Rehabilitation Department, University of Patras, Patras, Greece

    • Ioannis–Alexandros Tzanos
    •  & Elias Panagiotopoulos
  2. 1st Orthopedics Department, University of Athens, Athens, Greece

    • Andreas Mavrogenis
    •  & Panagiotis Papagelopoulos
  3. 1st PRM Department, National Rehabilitation Centre, Ilion, Greece

    • Konstantina Gioti


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Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Ioannis–Alexandros Tzanos.

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