A spinal cord injury (SCI) is lasting damage anywhere along the spinal cord as a result of accident or disease. A traumatic SCI results from a sudden trauma, such as a car accident, a fall, or a sports-related injury. After experiencing a traumatic event, some people develop a condition called post-traumatic stress disorder (PTSD). People with PTSD may have flashbacks of the trauma, avoid situations similar to the traumatic event, or experience frequent anxiety. People with a traumatic SCI may have symptoms of PTSD, and these symptoms may last for a long time after their injury. In a recent NIDILRR-funded study, researchers looked at PTSD experiences among people with traumatic SCI. They wanted to find out how commonly people with traumatic SCI develop PTSD. They also wanted to find out who is most likely to develop PTSD after a traumatic SCI, whether PTSD is more common in some racial/ethnic groups than others, and whether PTSD is related to other mental health conditions such as depression.
Researchers at the Rehabilitation Research and Training Center on Secondary Conditions in Individuals with SCI surveyed 1,063 adults 18 and older with traumatic SCI between January 2011 and December 2012. The participants came from three regions of the United States (Southeastern, Mountain, and Western) and all had experienced their SCI for at least a year. To identify PTSD, the participants completed a standardized questionnaire asking how often they experienced unwelcome and involuntary thoughts or feelings related to the event that caused their spinal cord injury over the past month, and what kinds of thoughts or feelings they experienced. The participants were considered to have PTSD if they reported experiencing multiple symptoms such as flashbacks, avoiding situations related to the trauma, and anxiety symptoms. The participants also answered basic questions about their background, including their race/ethnicity; about their mental health, including symptoms of depression and whether or not they were taking any medications for depression or stress; and questions about their health during the past year, including the number of times they received medical care due to a new injury (such as a fall) and the number of times they received medical care for any other reasons such as an illness or an issue related to their SCI.
The researchers found that about one-fourth of the participants had PTSD symptoms. When they looked at who was most likely to report PTSD symptoms, they found that:
- PTSD was more common for some racial and ethnic groups: The percentage of PTSD was lowest for the non-Hispanic white participants (19%). The non-Hispanic black participants had a higher percentage of PTSD (25%), as did the Hispanic participants (31%).
- PTSD was related to mental health: The participants who reported symptoms of depression, or who were taking medications for depression or stress, were more likely to have PTSD than those participants without symptoms of depression.
- PTSD was related to recent injury experiences: The participants who reported receiving medical care for a new injury not related to their SCI during the past year were more likely to have PTSD than those participants who were not treated for new injuries.
The authors noted that the findings of this study are consistent with previous studies, where racial/ethnic minorities reported higher rates of PTSD than non-Hispanic whites. Racial/ethnic minorities may experience inequality in healthcare and other areas which may add stress and worsen their experience of trauma. Rehabilitation professionals may want to pay special attention to their clients with SCI who come from racial/ethnic minority backgrounds. It is important to recognize what socioeconomic or environmental factors may lead to these inequalities that can contribute to additional stress after SCI.
The authors also noted that in this study, PTSD tended to be associated with depression and with recent injury experiences. Psychologists may wish to screen people with SCI for both depression and PTSD. Both conditions are treatable with counseling or medications. In addition, rehabilitation professionals may want to emphasize injury prevention as part of the wellness programs they offer to people living with SCI, as injury prevention can not only help people with SCI stay healthy, but also can help minimize experiences of PTSD.
To Learn More
The Longevity After Injury Project offers a collection of videos for professionals, researchers, and people with SCI and their caregivers, including videos on the importance of managing health, screening for depression, avoiding further injuries, and more:
The Model Systems Knowledge Translation Center (MSKTC) collection of consumer publications offers information and resources for a variety of SCI-related issues including pain management, depression, and injury prevention: http://www.msktc.org/sci
To Learn More About this Study
Cao, Y., Li, C., Newman, S., Lucas, J., Charlifue, S., & Krause, J.S. (2017) Posttraumatic stress disorder after spinal cord injury. Rehabilitation Psychology. This article is available from the NARIC collection upon request.