Post by Denise on Dec 13, 2004 20:36:51 GMT
Resources for managing depression in patients with spinal cord injury.
Author Denise Jane Watling, Rgn, Dip. HE. Dated 10th December 2004.
Current strategies supporting the Saving lives: Our Healthier Nation, (DOH, 1999; DOH 2002), aim to reduce death rates from suicide by 20% by 2010. The guidelines for managing self harm in primary and secondary care state that they…….’are not a substitute for professional knowledge and clinical judgment’ (NICE, 2004, p10). They specifically fail to accommodate this group of patients as they are primarily concerned with ‘individuals aged 8 or over who have self harmed’ (NICE, 2004, page 13). Among the myriad of post SCI complications 25% of men and 47% of females suffer with depression (Fuhrer et al, 1993). The suicide rate for patients with a SCI is between 2-6 times higher than the rate of the able bodied population and is greater in those patients with lower lesions. It could be argued that those with lower lesions have more control over how they take their own life being able to manage their upper limbs. An Italian study revealed that certain characteristics were significantly associated with a higher risk of developing psychological distress: the presence of severe complications, the lack of autonomy, and low educational level. The lack of reduction in anxiety and depression over time could mean that the two pathologies are maintained by the obstacles SCI patients meet every day resulting from their neurological deficit (Scivoletto et al 1997). A view supported by Frank et al, (1987); Fordyce and Brockway, (1990); Fuhrer et al, (1993) and the Paralysed Veterans of America [PVA] (1998). Major depressive disorders in America affect 6-10% of the able bodied population compared with 23-30% of SCI individuals (Charlifue and Gerhart 1991). However after 10 years the rate of suicide approaches that of the general population (Saulino 2003) which would support Scivoletto’s theory that psychological distress is a significant characteristic associated with depression. What is clear is that the current guidelines in the UK for treating this client group are inadequate and need reviewing nationwide. There is a need for further research which could address the current inadequacies of identifying and treating depression for SCI individuals in the community and the skills required to manage the condition effectively. In the United States the PVA in partnership with the Consortium for Spinal Cord Medicine released the document Depression Following Spinal Cord Injury: Clinical Practice Guidelines for Primary Care Physicians, (1998) which defines the basis of diagnosis and treatment of depression in SCI individuals in the community and is based on the whole on empirical evidence. An excellent resource guide which can be downloaded free on-line from their website www.pva.org/site/
References
Charlifue, S., and Gerhart, K., (1991), Behavioural and demographic predictors of suicide after traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 72, p488-492
Department of Health (2002) National Suicide Prevention Strategy, London: DOH (Chairman: Professor Louis Appleby)
Department of Health (1999) Saving Lives: Our Healthier Nation,. London: The Stationery Office
Frank, R.G.,Chaney, J.M. and Clay. D., (1992), Dysphoria: A major symptom factor in persons with disability or chronic illness. American Journal of Psychiatry, 43 (3) pp. 231–241.
Fordyce, W.E., and Brockway, J.A., (1990), Psychological assessment and management, cited in Kottle, F.J. and Lehmann, J.F., Krusen’s handbook of physical medicine and rehabilitation, (4th Edition), Philadelphia; W.B. Saunders, pp.153 – 170.
Fuhrer, M.R., D.H. Rintala, K.A., Hart et al.; (1993), Depressive symptomology in persons with spinal cord injury who reside in the community. Archives of Physical Medicine and Rehabilitation 74 (3) pp.255-260.
National Institute for Clinical Excellence, (2004), Draft for second consultation: Self-Harm: short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care, Guidelines for practice, London: NICE
Paralysed Veterans of America: Consortium for Spinal Cord Medicine, (1998), Depression following spinal cord injury: A clinical practice guideline for primary care physicians, Washington; PVA. (Chairman: Jason Mask).
Saulino, M. F., (2003) Rehabilitation of persons with spinal cord injuries, available at www.emedicine.com/orthoped/topic425.htm, accessed on 19th July 2004.
Scivoletto, G., Petrelli, A., Di Lucente, L., Castellano, V. (1997) Psychological investigation of spinal cord injury patients. Spinal Cord. 35 (8), pp.516-20.
Sederer, L., and Rothschild, A. J., (1997) Acute care psychiatry: diagnosis and treatment, Philadelphia: Lippincott, Williams and Wilkins.
Author Denise Jane Watling, Rgn, Dip. HE. Dated 10th December 2004.
Current strategies supporting the Saving lives: Our Healthier Nation, (DOH, 1999; DOH 2002), aim to reduce death rates from suicide by 20% by 2010. The guidelines for managing self harm in primary and secondary care state that they…….’are not a substitute for professional knowledge and clinical judgment’ (NICE, 2004, p10). They specifically fail to accommodate this group of patients as they are primarily concerned with ‘individuals aged 8 or over who have self harmed’ (NICE, 2004, page 13). Among the myriad of post SCI complications 25% of men and 47% of females suffer with depression (Fuhrer et al, 1993). The suicide rate for patients with a SCI is between 2-6 times higher than the rate of the able bodied population and is greater in those patients with lower lesions. It could be argued that those with lower lesions have more control over how they take their own life being able to manage their upper limbs. An Italian study revealed that certain characteristics were significantly associated with a higher risk of developing psychological distress: the presence of severe complications, the lack of autonomy, and low educational level. The lack of reduction in anxiety and depression over time could mean that the two pathologies are maintained by the obstacles SCI patients meet every day resulting from their neurological deficit (Scivoletto et al 1997). A view supported by Frank et al, (1987); Fordyce and Brockway, (1990); Fuhrer et al, (1993) and the Paralysed Veterans of America [PVA] (1998). Major depressive disorders in America affect 6-10% of the able bodied population compared with 23-30% of SCI individuals (Charlifue and Gerhart 1991). However after 10 years the rate of suicide approaches that of the general population (Saulino 2003) which would support Scivoletto’s theory that psychological distress is a significant characteristic associated with depression. What is clear is that the current guidelines in the UK for treating this client group are inadequate and need reviewing nationwide. There is a need for further research which could address the current inadequacies of identifying and treating depression for SCI individuals in the community and the skills required to manage the condition effectively. In the United States the PVA in partnership with the Consortium for Spinal Cord Medicine released the document Depression Following Spinal Cord Injury: Clinical Practice Guidelines for Primary Care Physicians, (1998) which defines the basis of diagnosis and treatment of depression in SCI individuals in the community and is based on the whole on empirical evidence. An excellent resource guide which can be downloaded free on-line from their website www.pva.org/site/
References
Charlifue, S., and Gerhart, K., (1991), Behavioural and demographic predictors of suicide after traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation, 72, p488-492
Department of Health (2002) National Suicide Prevention Strategy, London: DOH (Chairman: Professor Louis Appleby)
Department of Health (1999) Saving Lives: Our Healthier Nation,. London: The Stationery Office
Frank, R.G.,Chaney, J.M. and Clay. D., (1992), Dysphoria: A major symptom factor in persons with disability or chronic illness. American Journal of Psychiatry, 43 (3) pp. 231–241.
Fordyce, W.E., and Brockway, J.A., (1990), Psychological assessment and management, cited in Kottle, F.J. and Lehmann, J.F., Krusen’s handbook of physical medicine and rehabilitation, (4th Edition), Philadelphia; W.B. Saunders, pp.153 – 170.
Fuhrer, M.R., D.H. Rintala, K.A., Hart et al.; (1993), Depressive symptomology in persons with spinal cord injury who reside in the community. Archives of Physical Medicine and Rehabilitation 74 (3) pp.255-260.
National Institute for Clinical Excellence, (2004), Draft for second consultation: Self-Harm: short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care, Guidelines for practice, London: NICE
Paralysed Veterans of America: Consortium for Spinal Cord Medicine, (1998), Depression following spinal cord injury: A clinical practice guideline for primary care physicians, Washington; PVA. (Chairman: Jason Mask).
Saulino, M. F., (2003) Rehabilitation of persons with spinal cord injuries, available at www.emedicine.com/orthoped/topic425.htm, accessed on 19th July 2004.
Scivoletto, G., Petrelli, A., Di Lucente, L., Castellano, V. (1997) Psychological investigation of spinal cord injury patients. Spinal Cord. 35 (8), pp.516-20.
Sederer, L., and Rothschild, A. J., (1997) Acute care psychiatry: diagnosis and treatment, Philadelphia: Lippincott, Williams and Wilkins.