Recently, UAB PM&R Assistant Professor Elizabeth Richardson, Ph.D., MSPH, along with UAB PM&R Director of Rehabilitation Psychology Casey Azuero, Ph.D., MPH, published an article in the Spinal Cord Injury Model System (SCIMS) Supplement issue of Topics in Spinal Cord Injury Rehabilitation on a collaborative SCIMS study that examined the Effects of Depression and Resilience During Acute Inpatient Rehabilitation on Pain Outcomes One Year After Spinal Cord Injury. In the following Q&A, Azuero shares insights from the research and how the findings can inform and improve patient care.
Q: What was the study about?
A: This study examined how depression and resilience during inpatient rehabilitation influence pain outcomes one year after a spinal cord injury (SCI). We were interested if higher resilience could reduce the effects of depression on both neuropathic and non-neuropathic pain and its interference with daily life.
Q: Who participated in the study?
A: The study included 2,327 individuals with traumatic SCI who were enrolled in the National SCIMS Database during their inpatient rehabilitation stay between October 2016 and August 2021 and completed a 1-year follow-up.
Q: How was the study conducted?
A: We used SCIMS measures of depression and resilience during inpatient rehabilitation and pain outcomes one year later, including both pain severity and how much pain interfered with daily life. Using statistical analyses, we evaluated whether early depression and resilience predicted later pain outcomes and whether resilience moderated the relationship between depression and pain. We used models that accounted for pain interference and pain intensity as well as demographic and injury-related factors. Additional analyses were conducted to better understand how the relationship between resilience and depression levels impact pain type (neuropathic and non-neuropathic) at year one.
Q: What did the study find?
A: The study found that depression during inpatient rehabilitation was a strong predictor of worse pain outcomes one year later, including higher pain intensity and greater interference with daily activities. In contrast, resilience had little independent effect on long-term pain, and it did not significantly lessen the impact of depression. These findings were generally consistent across different types of pain, although neuropathic pain tended to be more severe and more greatly interfere with sleep.
Q: How can we use the results?
A: These findings highlight the importance of early identification and treatment of depression during rehabilitation and validate our prioritization of mental health screening and interventions as part of our comprehensive care.