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Psychological Morbidity and Chronic Disease Among Adults With Traumatic Spinal Cord Injuries

A Longitudinal Cohort Study of Privately Insured Beneficiaries
  • Mark D. Peterson
    Correspondence
    Correspondence: Address to Mark D. Peterson, PhD, MS, Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, 325 E Eisenhower Pkwy, Ste 300, Ann Arbor, MI 48108.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Neil Kamdar
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI

    Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Anthony Chiodo
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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  • Denise G. Tate
    Affiliations
    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
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      Abstract

      Objective

      To compare the longitudinal incidence of psychological morbidities and multimorbidity and estimates of chronic diseases among adults with spinal cord injuries (SCIs) as compared with adults without SCIs.

      Methods

      Privately insured beneficiaries who had medical coverage at any time between January 1, 2001, and December 31, 2017 were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for a traumatic SCI (n=6,847).

      Results

      Adults with SCIs (n=6847) had a higher incidence of adjustment reaction (7.2% [n=493] vs 5.0% [n=42,862]), anxiety disorders (19.3% [n=1,322] vs 14.1% [n=120,872]), depressive disorders (29.3% [n=2,006] vs 9.3% [n=79,724]), alcohol dependence (2.4% [n=164] vs 1.0% [n=8,573]), drug dependence (2.3% [n=158] vs 0.8% [n=6,858]), psychogenic pain (1.0% [n=69] vs 0.2% [n=1,715]), dementia (6.5% [n=445] vs 1.5% [n=12,859]), insomnia (10.9% [n=746] vs 7.2% [n=61,722]), and psychological multimorbidity (37.4% [n=2,561] vs 23.9% [n=204,882]) as compared with adults without SCIs (n=857,245). The adjusted hazard ratios (HRs) of each psychological outcome were significantly higher for individuals with SCI and ranged from 1.18 (95% CI, 1.08-1.29) for anxiety disorders to 3.32 (95% CI, 1.93-5.71) for psychogenic pain. Adults with SCIs also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity (51.1% vs 14.1%), except human immunodeficiency virus infection/AIDS. After propensity matching for age, education, race, sex, and chronic diseases (n=5884 matched pairs), there was still a significantly higher incidence of most psychological disorders and psychological multimorbidity among adults with SCIs.

      Conclusion

      Adults with traumatic SCIs experienced an increased incidence of psychological morbidities and multimorbidity as compared with adults without SCIs. Clinical efforts are needed to improve mental health screening and targeted interventions to reduce the risk for psychological disease onset in the traumatic SCI population.

      Abbreviations and Acronyms:

      HR (hazard ratio), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), SCI (spinal cord injury), SMD (standardized mean difference)
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