Original article
Posttraumatic Stress Disorder and Spinal Cord Injury

https://doi.org/10.1016/j.apmr.2010.05.012Get rights and content

Abstract

Krause JS, Saunders LL, Newman S. Posttraumatic stress disorder and spinal cord injury.

Objectives

To identify the prevalence of posttraumatic stress disorder (PTSD) after spinal cord injury (SCI) in a sample averaging over 2 decades postinjury at assessment. Related objectives are to confirm the factor structure, compare subscales with those reported in a nonclinical sample, and identify the relationship of PTSD with depression.

Design

Survey.

Setting

A medical university in the Southeastern United States.

Participants

Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States. A cohort of adults (N=927) with traumatic SCI of at least 1 year duration at enrollment in 2002 to 2003 and a minimum of 7 years at the time of assessment completed the study materials.

Interventions

Not applicable.

Main Outcomes Measures

PTSD was measured by the Purdue Posttraumatic Stress Disorder Scale-Revised, and depression was measured by the Patient Health Questionnaire 9-item.

Results

PTSD was reported by less than 10% of the participants. Item endorsement decreased as a function of years postinjury, primarily because of low rates of endorsement among those 21 or more years postinjury. Confirmatory factor analysis did not result in an acceptable fit for subscales, item sets, or factors previously reported in the literature. Participants scored higher than a nonclinical sample (reported in the literature) on the arousal and avoidance subscales but lower on the re-experiencing subscale. Item endorsements were lower for the first set of items that relate directly to the SCI itself, with the highest item endorsement for “have difficulty remembering important aspects of event.” PTSD rarely occurred in the absence of a depressive disorder.

Conclusions

PTSD does not appear to be highly prevalent in long-term SCI survivors, and endorsement of items related to re-experiencing and even recalling the injury are rare. Because SCI often is accompanied by mild traumatic brain injury, difficulty recalling the event may have an organic rather than psychologic component.

Section snippets

Purpose

Our purpose was to identify the prevalence of PTSD and relative frequency of the 3 types of PTSD symptoms (re-experiencing, arousal, avoidance), confirm the factor structure of the PPTSD-R, and identify the relationship of PTSD symptoms with depression after SCI. We used a larger cohort of participants who were injured for a greater number of years than has been used in previous research. We used a relatively large sample of persons with SCI (N=927) and chose to use the PPTSD-R because it

Participants

All participants are from a 35-year longitudinal study and were first identified from 1 of 3 rehabilitation hospitals. The 3 inclusion criteria were traumatic SCI, minimum of 18 years of age, and minimum of 1 year postinjury (the first cohort required 2 years postinjury). At the time of the previous follow-up in 2002 to 2003, there were a total of 1543 active participants. Of these, 942 participated during the most recent follow-up in 2008 to 2009 (61.0% response rate). There were 237 deaths

Item Responses

Endorsement rates for the first set of items (those related to the event itself) were relatively low (table 1). For instance, less than 5% of the sample endorsed any item as “often,” with the exception of “have difficulty remembering important aspects of event.” Endorsement of the second set of items was much higher (these items related to problems since the event). Item endorsement was significantly related to years postinjury (table 2), with the lowest rates consistently reported among those

Discussion

The results of the current study suggest that PTSD after long-standing SCI, as defined by a minimum of 8 years postinjury, at first assessment, and an average of over 20 years, is similar to the prevalence in the general population.3 First, less than 10% of the sample met the diagnostic criteria. This figure is not substantially different than that observed in nonclinical samples from the general population3 or several studies using participants with SCI.4, 5 Second, the item with the highest

Conclusions

PTSD was relatively rare in the participant sample, which was substantially larger than that reported in previous studies. In particular, re-experiencing the event was rare, less than that reported in a nonclinical sample in the general literature. Because we used the PPTSD-R that explicitly referred back to the event of SCI, it is less likely that the PTSD diagnosis was confounded with disability resulting from the injury. PTSD appears to be comorbid in a substantial portion of cases of

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