Using inferred mobility status to estimate the time to major depressive disorder diagnosis post-spinal cord injury

Arch Phys Med Rehabil, 2020 · DOI: 10.1016/j.apmr.2019.11.014 · Published: April 1, 2020

Spinal Cord Injury Mental Health Rehabilitation

Simple Explanation

This study examines the prevalence and timing of major depressive disorder (MDD) diagnoses after spinal cord injury (SCI). It uses insurance claims data to understand how mobility, inferred from durable medical equipment (DME) use, affects the risk and time to MDD diagnosis. The researchers used a commercial insurance claims database to identify individuals with SCI and tracked their MDD diagnoses over three years. They also created a measure of inferred mobility status (IMS) based on DME claims, such as wheelchairs and walkers, to understand how mobility impairment affects MDD. The study found that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI. This suggests that mobility impairment plays a role in the development of depression after SCI.

Study Duration

3 Years

Participants

1,409 individuals with cervical or thoracic SCI

Evidence Level

Not specified

Key Findings

1
Post-SCI, 20.87% of the sample was diagnosed with new-onset MDD.
2
Significant 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.
3
Median time to MDD was 86 days.

Research Summary

This retrospective study examined the prevalence, risk factors, and time to MDD diagnosis post-SCI using commercial insurance claims data. The study also examined the interaction of inferred mobility status (IMS) with time to MDD diagnosis. The study found a high prevalence of MDD post-SCI (20.87% for new-onset MDD). Risk factors included employment, length of hospitalization, discharge with healthcare services, rehabilitation services, and greater inferred reliance on DME. Individuals with greater inferred reliance on DME are at a greater risk for MDD and have a shorter time to MDD diagnosis post-SCI, suggesting that mobility impairment plays a role in the development of depression after SCI.

Practical Implications

Clinical Screening

Increased awareness for clinicians to screen for depression, especially in those with high DME needs.

Early Intervention

Interventions targeting depression should be implemented early post-SCI, potentially within the first three months.

Resource Allocation

Allocate resources for mental health support, particularly for individuals with greater mobility impairments.

Study Limitations

1
Possible misidentification of MDD due to diagnosis or antidepressant claims occurring outside the study time frame.
2
Use of only ICD-9 diagnosis codes for MDD.
3
The validity of using HCPCS codes for DME to infer mobility status needs to be explored.

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