Workshop on Disability in America A New Look: Summary and Background Papers (2006) / Chapter Skim
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Appendix N Depression as a Secondary Condition in People with Disabilities-Bryan Kemp
Appendix N Depression as a Secondary Condition in People with Disabilities-Bryan Kemp
Pages 234-250
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Depression is one of the most common, if not the most common, secondary conditions associated with disability. When it is left untreated, depression can cause inordinate personal suffering, increased disability, additional health problems, and stress in others.
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. Through this focused attention, the report sought to "promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities in the United States" (p.
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Secondary conditions can have either a direct or an indirect causal relationship to the primary impairment. A common direct relationship is one between a pressure sore and a spinal cord injury.
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Consequently, the rates of pressure sores tend to be higher among people who have a depressive disorder. Pressure sores represent one of the most expensive and devastating secondary health problems for people with spinal cord injuries.
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The first issue is defining depression, the second issue involves the measurement of depression as it applies to people with disabilities, and the third issue concerns the environmental barriers to obtaining proper clinical interventions for people who have a disability and who are depressed. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
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The major obstacle to the proper treatment of depression, especially major depression, is getting it identified. The high rate of depression among people with disabilities (and other "minority" groups)
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, the rates of conditions causing activity limitations across all ages in the United States were as follows: arthritis, 12 percent; heart disease, 11 percent; asthma, 4 percent; orthopedic impairments, 21 percent; and diabetes, 3 percent. In 1990, the Centers for Disease Control and Prevention initiated the first national colloquium dedicated to the prevention of secondary conditions after a spinal cord injury (Graitcer and Maynard, 1990)
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Several types of research needs were outlined, including more epidemiological research and research on prevention and care. In summary, the overall rate of depressive disorders, including both moderate and severe depression, among people with physical disabilities appears to be somewhere between 25 and 50 percent, with approximately half of these cases being major depression.
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studied 70 people with spinal cord injuries of various ages and with various durations of disability. They found no relationship between the level of spinal cord injury, scores on the Functional Independence Measure, age, or the duration of the injury and depression.
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. They found that coping methods that are more negative, such as escape-avoidance coping, typically correlates about 0.40 with negative outcomes such as depression in people with spinal cord injuries.
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For example, if the number of negative life events in a person with a disability is high and comprises such things as health problems, economic problems, and housing problems, then efforts should be directed toward improving those areas of the person's life. If the difficulty was with the use of inappropriate coping methods, then efforts could be used in counseling to explore other coping methods and try to reduce stress.
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reviewed an extensive range of studies in the spinal cord injury literature with the purpose of finding and evaluating the quality of intervention studies directly concerned with the treatment of depression. They found many correlates and concomitants of depressive symptoms among people with spinal cord injuries, but they could find only nine treatment studies that met the criteria for inclusion in their review.
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studied the effects of treating major depression in people with spinal cord injuries using a combination of psychotherapy and antidepressant medication. They used a quasiexperimental design in which the comparison group declined treatment but was monitored over a similar period of time as those who elected to receive treatment.
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testing of a stress and coping model in a sample of people with disabilities; (5) assessment of the effects of consumer education and various interventions to help prevent depression, such as the teaching of methods to help people cope with stress; (6)
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. Depression Following Spinal Cord Injury: A Clinical Practice Guideline for Primary Care Physicians.
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. Coping effectiveness training for people with spinal cord injury: preliminary results of a controlled trial.
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Applied Psychological Measures, 1, 385–401. Rehabilitation Research and Training Center on Aging with a Disability, Rancho Los Amigos National Rehabilitation Center.
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