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

Table 1 Assessment results of anxiety and depressive symptoms in 149 study participants

Variable	Score range	Median (interquartile range)/n (%)
HAMA (points)	0-56	12.00 (9.00, 14.00)
No anxiety	0-6	20 (13.42)
Possible anxiety	7-13	77 (51.68)
Mild anxiety	14-20	52 (34.90)
Significant anxiety	21-28	0 (0.00)
Severe anxiety	29-56	0 (0.00)
HAMD (points)	0-52	14.00 (10.00, 16.50)
Normal	0-6	4 (2.68)
Possible depression	7-16	108 (72.48)
Mild to moderate depression	17-24	34 (22.82)
Severe depression	25-52	3 (2.01)

HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale.

Table 2 Anxiety and depression prevalence in 149 spinal cord injury patients

Variable	Score range	n (%)
Anxiety	HAMA ≥ 14 points	52 (34.90)
Depression	HAMD ≥ 17 points	37 (24.83)
Anxiety or depression	HAMA ≥ 14 points or HAMD ≥ 17 points	77 (51.68)
Anxiety and depression	HAMA ≥ 14 points and HAMD ≥ 17 points	12 (8.05)

HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale.

Table 3 American Spinal Injury Association grading in 149 spinal cord injury patients, mean ± SD/median (interquartile range)

ASIA grading	n (%)	HAMA (points)	HAMD (points)
A	22 (14.77)	13.23 ± 4.05	15.50 (12.00, 18.00)
B	34 (22.82)	12.50 ± 3.96	14.00 (12.00, 16.00)
C	46 (30.87)	11.59 ± 3.98	14.00 (11.00, 16.25)
D	47 (31.54)	10.15 ± 4.03	10.00 (9.00, 16.00)
F/χ2	-	3.847	5.178
P	-	0.011	0.001

ASIA: American Spinal Injury Association; HAMA: Hamilton Anxiety Scale; HAMD: Hamilton Depression Scale.

Table 4 Sleep quality profile in 149 spinal cord injury patients, median (interquartile range)/n (%)

Indicators	Score	> 1 point
Sleep quality (points)	2.00 (1.00, 2.00)	83 (55.70)
Sleep latency (points)	2.00 (1.00, 3.00)	106 (71.14)
Sleep duration (points)	2.00 (2.00, 3.00)	122 (81.88)
Sleep efficiency (points)	2.00 (1.00, 3.00)	107 (71.81)
Sleep disturbances (points)	2.00 (1.00, 3.00)	94 (63.09)
Use of sleep medication (points)	1.00 (1.00, 2.00)	55 (36.91)
Daytime dysfunction (points)	2.00 (1.00, 2.00)	78 (52.35)
Global PSQI score (points)	12.00 (11.00, 14.00)	-

PSQI: Pittsburgh Sleep Quality Index.

Table 5 Univariate predictors of postoperative anxiety and depression in the spinal cord injury cohort, n (%)

Variable	Anxiety/depression (n = 77)	Non-anxiety/depression (n = 72)	χ2	P value
Age (years)			4.993	0.026
< 60	42 (54.55)	52 (72.22)
≥ 60	35 (45.45)	20 (27.78)
Sex			8.688	0.003
Male	62 (80.52)	42 (58.33)
Female	15 (19.48)	30 (41.67)
Illness duration (months)			7.150	0.008
< 12	25 (32.47)	39 (54.17)
≥ 12	52 (67.53)	33 (45.83)
Level of injury			0.635	0.728
Cervical spinal cord	20 (25.97)	22 (30.56)
Thoracic spinal cord	47 (61.04)	43 (59.72)
Lumbosacral spinal cord	10 (12.99)	7 (9.72)
Cause of injury			0.111	0.739
Traumatic SCI	57 (74.03)	55 (76.39)
Non-traumatic SCI	20 (25.97)	17 (23.61)
Academic background			9.312	0.002
Below senior high school	59 (76.62)	38 (52.78)
Senior high school or above	18 (23.38)	34 (47.22)
ASIA grading			5.711	0.017
A-B	36 (46.75)	20 (27.78)
C-D	41 (53.25)	52 (72.22)
PSQI (points)			5.027	0.025
< 13	34 (44.16)	45 (62.50)
≥ 13	43 (55.84)	27 (37.50)

SC: Spinal cord injury; ASIA: American Spinal Injury Association; PSQI: Pittsburgh Sleep Quality Index.

Table 6 Multivariate predictors of postoperative anxiety and depression in the spinal cord injury cohort

Variable	B	SD	Wald	P value	OR	95%CI
Age (years)	0.983	0.418	5.534	0.019	2.673	1.178-6.064
Sex	1.385	0.441	9.878	0.002	3.994	1.684-9.474
Illness duration (months)	1.182	0.405	8.516	0.004	3.261	1.474-7.214
Academic background	1.373	0.424	10.497	0.001	3.947	1.720-9.056
ASIA grading	-0.847	0.405	4.386	0.036	0.429	0.194-0.947
PSQI (points)	1.212	0.405	8.944	0.003	3.361	1.519-7.440

OR: Odds ratio; CI: Confidence interval; ASIA: American Spinal Injury Association; PSQI: Pittsburgh Sleep Quality Index.