Introduction

1. Factors Influencing Quality of Life Following a Multisite Trial for Major Depression Disorder in SCI Denise G. Tate PhD1, Charles Bombardier PhD2, Jesse Fann MD2, Allen Heinemann PhD3, Martin Forchheimer MPP1, Jason Barber MS2, 1University of Michigan, Ann Arbor, MI; 2University of Washington, Seattle, WA; 3Rehabilitation Institute of Chicago, Chicago, IL Introduction Results Depression and Participation (CHART) The correlations between HAM-D and CHART both at baseline and Week 12 were as follows: r=-.33 (p<.0005); r= -.23 (p=.005). Depression and Satisfaction with Life (SWLS) Satisfaction with life was also associated with depression at both time points. Baseline: r=-.18; p=.045; Week 12: r=-.49; p<.0005. Those with fewer depression symptoms reported greater satisfaction with life after traumatic spinal cord injury. Quality of life (QOL) is an important outcome following spinal cord injury (SCI). Rates of depression among those with SCI tend to be higher than in the general population, ranging from 11-38% (Bombardier, 2004). This study is based on a RCT trial to evaluate the effectiveness of Venlafaxine XR, a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant to treat major depressive disorder (MDD) after SCI. We examined the relationship of depression to QOL pre and post-treatment. Second, we examined other factors that may influence this relationship. QOL was assessed as health related; satisfaction with life; interference with activities; and participation. This study was led by the University of Washington and included the University of Michigan as one of the collaborating sites. Findings reflect pre-trial data and that collected at its conclusion, 12 weeks later, Depression and Functional Disability (Sheehan’s Disability Scale) Depression was directly correlated with functional disability in work, social and family life at both time points. The Baseline correlation was r=.28 (p=.001) and at Week 12 it was r = .27 (p=.003) Prior Major Depressive Episodes Methods Design:Multi-site, randomized, double-blind, placebo-controlled trial (Project to Improve Symptoms and Mood after SCI - PRISMS). Correlations, test of means, plots and regressions were conducted. Participants:N=133. Inclusion criteria: 18-64 years old, >1 month post-SCI, at least moderately severe MDD or dysthymia. Informed Consents and IRB approval were obtained at each of the 6 sites: University of Washington, University of Alabama, University of Michigan, Rehabilitation Institute of Chicago, Baylor Institute of Rehabilitation, Craig Hospital and University of Miami. Outcomes: Hamilton Depression Rating Scale (HAM-D); QOL measures: Health Related QOL - SF-12 and Global QOL - Satisfaction with Life Scale (SWLS). The Craig Handicap Assessment Reporting Technique (CHART) was used both as a proxy for QOL and an indicator of level of participation and limitation in activities. Similarly, Sheehan”sDisability Scale was used to measure interference with functioning. All measures were administered at baseline and 12 weeks or end of the trial. Correlations, test of means, plots and regressions were conducted. . Depression and Health Related Quality of Life (SF-12) The physical scale of the SF-12 was not correlated with depression (HAM-D) at either time points. Significant correlations were obtained when using the mental health scale of SF-12 (Baseline: r= -.24; p=.005; Week 12: r= -.72; p<.0005 There were no significant differences between groups across number of episodes. Conclusions Participants Depression was associated with all measures of QOL, both at baseline and 12 weeks afterwards, with the exception of the physical domain of health-related QOL. Those reporting less depression also reported greater mental health related QOL, satisfaction with life, participation and less interference with life activities. Correlations with depression were strongest with mental health QOL and life satisfaction at 12 weeks, immediately after the trial. Depression symptoms decreased in all PRISMS participants. These findings, presented elsewhere, suggest that depression symptoms may indeed influence QOL outcomes. Interventions which address depression symptoms through behavioral activation and encouraging participation are thus likely to improve QOL. On average participants were 39.9 years old (S.D. 11.2); 74% were male; classified 22.5% as ASIA D; 36.7% with tetraplegia ABC; and 40.8% with paraplegia ABC; 31% were married; and the average time since injury was 15 years. Substance dependency was an issue for 46.5% of the sample prior in this trial. PTSD symptoms ranged from 45 to 49% and anxiety 17 to 19%. In terms of injury etiology, 36% were due to motor vehicle accidents, 32% due to violence, and 15% due to falls. Support: SCI Model System Collaborative grant H133A060107, National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education and Rehabilitative Services (OSERS), US Department of Education.