Article

OBJECTIVE: To investigate the factor structure and predictive validity of somatic
and nonsomatic depressive symptoms over the first 2.5 years after spinal cord
injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9). DESIGN: Somatic
and nonsomatic symptoms were assessed at baseline during inpatient
hospitalization (average of 50 days after onset) and during 2 follow-ups (average
of 498 and 874 days after onset). SETTING: Data were collected at a specialty
hospital in the Southeastern United States and analyzed at a medical university.
We performed time-lag regression between inpatient baseline and follow-up somatic
and nonsomatic latent factors of the PHQ-9. PARTICIPANTS: Adults with traumatic
SCI (N=584) entered the study during inpatient rehabilitation. INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURE: PHQ-9, a 9-item measure of depressive symptoms.
RESULTS: The inpatient baseline nonsomatic latent factor was significantly
predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the
second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient
baseline did not significantly predict either factor. In contrast, when
regressing latent factors between the 2 follow-ups, the nonsomatic factor
predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor
predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor
structure was not stable over time. Item analysis verified the instability of
somatic items between inpatient baseline and follow-up and also indicated that
self-harm at inpatient baseline was highly predictive of future self-harm.
CONCLUSIONS: Nonsomatic symptoms are better predictors of future depressive
symptoms when first assessed during inpatient rehabilitation, whereas somatic
symptoms become stable predictors only after inpatient rehabilitation. Self-harm
(suicidal ideation) is the most stable symptom over time. Clinicians should
routinely assess for suicidal ideation and use nonsomatic symptoms when
performing assessments during inpatient rehabilitation.

Langue : ANGLAIS