Characterization of depressive symptoms in individuals with spinal cord injury through the Beck Depression Inventory, and their role in recovery

Depressive symptoms show an increased prevalence in individuals affected by spinal cord injury (SCI), yet their in-depth characterization and association with clinical outcomes remain underexplored. We investigated depressive symptoms, operationalized through the items in the Beck Depression Inventory (BDI), in a longitudinal, observational study of 165 individuals with SCI, and explored their trajectories and association with neurological and functional recovery. 134 and 43 individuals with major depressive disorder (MDD) diagnosis from two reference cohorts were investigated to evaluate similarities and differences of the clinical manifestation of depression. At baseline (one month after injury), 25% of individuals with SCI showed a clinically relevant degree of overall depressive symptoms, and 21% at follow-up (six or twelve months after injury). Predominant depressive symptoms involved physical-somatic phenomena such as sleep disturbances, fatigue, changes in eating habits, and reduced libido. In contrast, individuals with MDD diagnosis exhibited a broader range of symptoms, particularly those related to self-rejection and self-blame. A development of a clinically relevant degree of overall depressive symptoms from the baseline to the follow-up stage in individuals with SCI was primarily reflected in increases in BDI scores for items related to self-hatred, anhedonia, emotional overload, or cognitive stress. A random forest (RF) model using psychiatric, SCI-specific, and demographic baseline features to predict the presence of a clinically relevant degree of overall depressive symptoms at follow-up demonstrated only mediocre predictive performance. In contrast, similar RF models exhibited good performances in predicting neurological and functional recovery following SCI, relying primarily on SCI-specific (rather than psychiatric) baseline features. Depressive symptoms in individuals with SCI appeared to be largely unrelated to neurological and functional recovery and were primarily related to physical-somatic phenomena. This distinguishes them from the broader range of symptoms observed in individuals with MDD diagnosis, which more commonly encompass self-blame, self-hatred, and other cognitive-emotional dimensions. To help reduce the risk of undetected development of a clinically relevant degree of overall depressive symptoms during SCI treatment, it may be useful to focus particularly on cognitive-emotional symptoms, alongside physical-somatic symptoms, which may be affected by the direct consequences of the injury itself.