Boekamp J R, Overholser J C, Schubert D S
Harvard Medical School.
Int J Psychiatry Med. 1996;26(3):329-49. doi: 10.2190/CMU6-24AH-E4JG-8KBN.
Depression is a common problem following a spinal cord injury (SCI) and can greatly interfere with the rehabilitation process because of reduced energy, negative expectations, and social withdrawal. Understanding various factors which influence a vulnerability to depression may improve the diagnosis and treatment of depressive disorders and can improve rehabilitation outcome.
A thorough literature search was conducted using Medline, PsychLit, Pyschinfo, and Social Science Citation Index to identify relevant articles published between 1967 and 1995.
A diathesis-stress model is proposed to explain the increased risk of depressive symptoms after a SCI. Biological changes associated with SCI and pre-existing cognitive biases may influence the individual's vulnerability to stressful life events following the injury. The nature and frequency of stressful life events following the injury can tax the individual's coping resources. Furthermore, the perceived quality of social support and the severity of conflict within the family can influence the individual's adaptation.
Social support and recent stressors should be assessed to identify patients at high risk for depression. Patients are less likely to become depressed if their independence is fostered and they are encouraged to develop new sources of self-esteem. Relatives can be counseled to help maintain supportive relationships within the family.
抑郁症是脊髓损伤（SCI）后常见的问题，由于精力减退、消极预期和社交退缩，会极大地干扰康复进程。了解影响抑郁症易感性的各种因素可能会改善抑郁症的诊断和治疗，并能改善康复效果。
利用医学在线数据库（Medline）、心理学文献数据库（PsychLit）、心理学文摘数据库（Pyschinfo）和社会科学引文索引进行全面的文献检索，以确定1967年至1995年间发表的相关文章。
提出一个素质-应激模型来解释脊髓损伤后抑郁症状风险增加的原因。与脊髓损伤相关的生物学变化和先前存在的认知偏差可能会影响个体在受伤后对应激性生活事件的易感性。受伤后应激性生活事件的性质和频率会消耗个体的应对资源。此外，感知到的社会支持质量和家庭内部冲突的严重程度会影响个体的适应情况。
应评估社会支持和近期应激源，以识别抑郁症高危患者。如果能促进患者的独立性并鼓励他们建立新的自尊来源，患者患抑郁症的可能性就较小。可以为亲属提供咨询，以帮助维持家庭内部的支持性人际关系。
