Postoperative anxiety-depression in patients with spinal cord injury: Correlations with injury severity and sleep quality

doi:10.5498/wjp.v16.i6.113881

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Jun 19, 2026; 16(6): 113881
Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.113881

Postoperative anxiety-depression in patients with spinal cord injury: Correlations with injury severity and sleep quality

Kun-Chi Zhao, Xian-Ji Song, Yi-Ke Zhang, Hang Wang, Meng-Jie Yan, Zhi-Sen Tian

Zhi-Sen Tian, Hang Wang, Yi-Ke Zhang, Xian-Ji Song, Kun-Chi Zhao, Department of Spinal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China

Meng-Jie Yan, Department of Cardiovascular Medicine, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China

Co-first authors: Zhi-Sen Tian and Meng-Jie Yan.

Co-corresponding authors: Xian-Ji Song and Kun-Chi Zhao.

Author contributions: Tian ZS and Yan MJ designed the research and wrote the first manuscript, conducted the analysis and provided guidance for the research, and they contributed equally to this manuscript as co-first authors; Tian ZS, Yan MJ, Wang H, Zhang YK, Song XJ, and Zhao KC contributed to conceiving the research and analyzing data; Song XJ and Zhao KC contributed equally to this manuscript as co-corresponding authors. All authors reviewed and approved the final manuscript.

AI contribution statement: No AI tools (including ChatGPT, Grammarly, DeepL, etc.) were used for manuscript writing, language polishing, data analysis, study design, result interpretation, or image generation. All content is human-created.

Supported by Department of Science and Technology of Jilin Province, No. YDZJ202201ZYTS094.

Institutional review board statement: This study was approved by the Ethic Committee of China-Japan Union Hospital of Jilin University (approval No. 2025092902).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No additional data are available.

Corresponding author: Kun-Chi Zhao, Department of Spinal Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130033, Jilin Province, China. zhaokunchi@jlu.edu.cn

Received: November 4, 2025
Revised: December 21, 2025
Accepted: February 13, 2026
Published online: June 19, 2026
Processing time: 205 Days and 0.5 Hours

Abstract

BACKGROUND

Patients with spinal cord injury (SCI) commonly experience varying degrees of anxiety, depression, and sleep disturbances, which may hinder postoperative recovery.

AIM

To examine the association between postoperative anxiety-depression symptoms, injury severity, and sleep quality in patients with SCI.

METHODS

A total of 149 patients who underwent surgical treatment for SCI from December 2021 to December 2024 were enrolled. At three months postoperatively, all participants were assessed using the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) for psychological status, the American Spinal Injury Association (ASIA) Impairment Scale for injury severity, and the Pittsburgh Sleep Quality Index (PSQI) for sleep quality. Correlation analyses were conducted to evaluate relationships among postoperative anxiety, depression, SCI severity, and sleep disturbances, and regression analyses were used to identify predictors of psychological symptoms.

RESULTS

Mean HAMA and HAMD scores were 12.00 (9.00, 14.00) and 14.00 (10.00, 16.50), respectively, indicating mild anxiety (34.90%) and probable depression (24.83%). Higher ASIA grades were associated with elevated HAMA and HAMD scores. The mean global PSQI score was 12.00 (11.00, 14.00), with sleep duration, sleep efficiency, and sleep latency being the most affected domains (scores > 1). HAMA and HAMD scores showed significant positive correlations with ASIA grades and PSQI scores. Multivariate analysis identified age ≥ 60 years, male sex, disease duration ≥ 12 months, educational level below high school, ASIA grades A-B, and PSQI score ≥ 13 as independent risk factors for postoperative anxiety and depression.

CONCLUSION

Postoperative anxiety and depression are positively associated with SCI severity and impaired sleep quality management in patients with SCI.

Keywords: Spinal cord injury; Anxiety; Depression; American Spinal Injury Association Impairment Scale; Sleep quality; Correlation analysis

Core Tip: In these cohort of 149 patients with spinal cord injury (SCI), anxiety, depression, injury severity, and sleep quality were evaluated three months after surgery. A substantial proportion of the patients exhibited postoperative anxiety and depression, which were significantly and positively correlated with SCI severity and sleep disorders. Advanced age (≥ 60 years), male sex, disease duration ≥ 12 months, educational level of under senior high school, American Spinal Injury Association grades A-B, and Pittsburgh Sleep Quality Index score ≥ 13 were associated with an increased risk of postoperative anxiety and depression in patients with SCI.