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

Nobody was followed over time, so the study cannot show whether the home group was already more depressed during rehabilitation or became so after discharge. The two groups were screened at different points after injury (median 78 days at home vs 35 days in hospital), so time since injury rather than location could explain the differences. Only 42 people were screened at home, 155 people who were eligible declined screening, everyone spoke English, and most came from one hospital, so the sample may not represent people with new spinal cord injuries generally. The questionnaire was given in person, by telephone, or copied from the medical record, which may have produced different answers. The emotional/physical split, the item-by-item comparison and the regression analyses were decided after the data were collected and involved many comparisons; only loss of interest survived the stricter threshold. The PHQ-9 measures how severe depressive symptoms are, it does not diagnose depression, and its physical items overlap with the bodily effects of spinal cord injury. No information was collected on pain, medication, psychiatric history or social participation, all of which could affect scores.

The authors state that the investigators have no financial or nonfinancial disclosures to make in relation to this project. No funding source is named in the text.

Do not read this as proof that going home causes depression, or that the PHQ-9 total score will pick it up. The total score and the cutoff of 10 did not differ significantly between groups, and the differences that were found came from analyses of subscales and single items in 42 people screened at home a median of 78 days after injury compared with 35 days in the inpatient group. Time since injury, not location, may explain them.