Understanding the Impact of Screening Location on Depressive Symptom Scores Among People With Spinal Cord Injury

Objective To compare Patient Health Questionnaire-9 (PHQ-9) responses among individuals screened in inpatient rehabilitation versus at home during the first year after spinal cord injury (SCI). Design Cross-sectional secondary analysis. Setting Depressive symptomology was assessed either during SCI acute inpatient rehabilitation stay (Inpatient Group [IG]) or postdischarge in home setting (Home Group [HG]). Participants A total of 148 individuals (N=148) with traumatic or nontraumatic SCI with complete PHQ-9 responses (42 HG; 106 IG) were included. Participants were 71% men, with a mean age of 48±19.5 years and a duration of injury (DOI) 62±55 days (between April 2019 and January 2024). Interventions Not applicable. Main Outcome Measures PHQ-9 scores and prevalence of suicidal ideation (SI). Results Median DOI in the IG was 35 days versus 78 days in the HG (P<.001). PHQ-9 total scores and the rate of probable major depressive disorder did not differ between the 2 groups (P=.09 for both); however, the median subscale score for nonsomatic (affective) items of the PHQ-9 was significantly greater in the HG (3.0) versus IG (1.0; P=.004). SI was greater in the HG (21%) versus IG (9%; P=.049). Furthermore, among those endorsing SI (N=19), the HG reported a significantly greater severity of SI based on median PHQ-9 (item 9) scores compared with the IG (2.0 vs 1.0; P=.035). Post hoc analyses indicated screening location as a significant predictor of nonsomatic subscores (P=.008) as well as SI (P=.029), after adjusting for DOI. Conclusions Elevated nonsomatic depressive symptom scores, including greater SI in the HG, highlight the heightened vulnerability of individuals transitioning from inpatient rehabilitation to home during the first year after SCI. These findings emphasize the need for systematic mental health screening during the early phase of community reintegration.