1121 Association of Pre-Injury Depression History With Spinal Cord Injury Outcomes

INTRODUCTION: Spinal cord injury (SCI) patients face mental health challenges, with an estimated 22% receiving a depression diagnosis after SCI. Depressed SCI patients tend to have increased complications such as pressure ulcers and may experience greater mortality. However, less is known about the effect of preexisting depression on SCI outcomes. METHODS: The multicenter, prospectively maintained SCI Model Systems database was used. Adult traumatic SCI patients enrolled within 30-days of injury from 2010-2016 were included. Functional Independence Measure (FIM) at 1-year after injury was the primary outcome. Secondary outcomes included FIM item scores, ASIA Motor Index Score, and whether the patient converted to an improved ASIA Impairment Scale (AIS) grade. Multivariable regression was used to control for covariates such as age, sex, education level, anxiety history, injury severity, and function at rehabilitation admission. RESULTS: 1642 patients (14.5% with depression history) were included. The depressed (D) and non-depressed (ND) groups differed by sex, age, race, and anxiety history but had similar injury characteristics. The depressed group had less improvement and worse functional independence at 1-year (D:74 [44,82], ND:76 [53,85], p=.01). On multivariable regression, depression was associated with lower FIM (-3.1, 95% CI:[-5.7, -0.6], p=.01). Depression was associated with lower scores for all FIM items, but only bathing, dressing, transfers, and stairs differed significantly. There were no differences in ASIA Motor Index Score or the rate of improved AIS grade. CONCLUSIONS: A history of depression prior to SCI was associated with worse functional independence at 1-year after injury, despite similar recovery in motor function and AIS grade. These results suggest that early interventions may be warranted based on a depression history alone due to its significant impact on outcomes.