Madhusudan T, Rathee S P
Command Hospital (CC), Lucknow, Uttar Pradesh, India.
Ind Psychiatry J. 2019 Jul-Dec;28(2):272-277. doi: 10.4103/ipj.ipj_53_16. Epub 2020 Aug 14.
Spinal cord injury (SCI) patients usually experience multiple and ongoing, neurological, and other medical problems with significant damage to the social and psychological well-being of themselves and their families.
Soldiers with SCI transferred to the regional centre after suitable stabilization of their fractures and general physical condition were included in the study. The baseline assessment included a diagnostic interview and review of case notes for a comprehensive, multi-axial diagnosis. The participants were assessed using the Barthel's Index, the Hospital Anxiety and Depression Scale, the General Health Questionnaire, Quality of life (QOL) Index, AFMC stressful life event Scale, and the Social Support Survey with the current defense or coping style also being recorded. Similar assessments were repeated at 1 month, 6 months, and at 1 year after intake.
It was noticed that the mean scores on the Hospital Anxiety and Depression Scale were below the cut-off point for diagnosable disorder, or in the mild end of the spectrum. However, the measures of psychological distress and QOL showed significantly high mean scores. Anxiety Scores showed little variation over time initially, and none of the mean differences (t values) reached statistical significance. However, when the scores of intake and those at 6 months are compared, there was a statistically significant improvement. Depression scores, on the other hand, showed a steady improvement with each assessment. General lack of well-being and psychological distress along with poor QOL remained high throughout the period of assessment with little variation over time .These morbidity measures could not be accounted for by variations in stressful life-event scores or by variations in degree of disability. Although the negative correlation between anxiety and depression scores and those on the QOL index approached conventional levels of significance, there was little correlation overall between morbidity measures and the putative modifying variables at any stage of assessment.
Although psychological symptoms of depressive and anxious spectrum was virtually universal, psychiatric illness at syndromal intensity warranting a formal psychiatric referral and management was rare in patients with SCI in the 1 year. The general well-being and QOL were expectedly dismal throughout. Expected correlations between the measures of social support and degree of disability with the measures of anxiety, depression, subjective distress, and QOL were not demonstrated .There is a need to look beyond these and explore factors such as lack of information, physical morbidity, quality of social support, and dependence for the activities of daily living to evolve a nuanced approach toward the challenge that these clientele represent.
脊髓损伤（SCI）患者通常会经历多种持续存在的神经及其他医学问题，这对他们自身及其家庭的社会和心理健康造成了严重损害。
本研究纳入了骨折及一般身体状况得到适当稳定后转至区域中心的脊髓损伤士兵。基线评估包括诊断性访谈和对病例记录的审查，以进行全面的多轴诊断。使用巴氏指数、医院焦虑抑郁量表、一般健康问卷、生活质量（QOL）指数、AFMC应激性生活事件量表和社会支持调查对参与者进行评估，并记录当前的防御或应对方式。在入组后1个月、6个月和1年重复进行类似评估。
注意到医院焦虑抑郁量表的平均得分低于可诊断障碍的临界点，或处于该范围的轻度一端。然而，心理困扰和生活质量的测量显示平均得分显著较高。焦虑得分最初随时间变化不大，且平均差异（t值）均未达到统计学显著性。然而，当比较入组时和6个月时的得分时，有统计学显著改善。另一方面，抑郁得分在每次评估时均显示出稳步改善。在整个评估期间，总体幸福感和心理困扰以及较差的生活质量一直居高不下，随时间变化不大。这些发病率指标无法通过应激性生活事件得分的变化或残疾程度的变化来解释。尽管焦虑和抑郁得分与生活质量指数之间的负相关接近传统的显著性水平，但在任何评估阶段，发病率指标与假定的调节变量之间总体相关性不大。
尽管抑郁和焦虑谱系的心理症状几乎普遍存在，但在1年时间里，脊髓损伤患者中需要正式精神科转诊和管理的综合征强度的精神疾病很少见。总体幸福感和生活质量在整个过程中都很糟糕。社会支持和残疾程度的测量与焦虑、抑郁、主观困扰和生活质量的测量之间预期的相关性未得到证实。有必要超越这些因素，探索诸如信息不足、身体发病率、社会支持质量以及日常生活活动依赖等因素，以形成一种针对这些患者所代表挑战的细致入微的方法。
