Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships

Abstract

Objectives To evaluate socioeconomic inequalities in social relationships, and to assess whether socioeconomic conditions and social relationships are independently related to mental health problems in individuals with a physical disability due to spinal cord injury (SCI). Methods We analyzed cross-sectional data from 511 individuals with SCI aged over 16 years who participated in the community survey of the Swiss SCI Cohort Study (SwiSCI). Indicators for socioeconomic conditions included years of formal education, household income, and financial strain. Social relationships were operationalized by three structural (partner status; social contact frequency; number of supportive relationships) and four functional aspects (satisfaction with: overall social support; family relationships; contacts to friends; partner relationship). General mental health was assessed by the Mental Health Inventory (MHI-5) of SF-36 and depressive symptoms were measured by the Hospital Anxiety and Depression Scale (depression subscale, HADS-D). Established cut-offs for general mental health problems (MHI-5 ≤56) and depressive symptomatology (HADS-D ≥8) were used to dichotomize outcomes. Associations were assessed using logistic regressions. Results Lower household income was predominantly associated with poor structural social relationships, whereas financial strain was robustly linked to poor functional social relationships. Financial strain was associated with general mental health problems and depressive symptomatology, even after controlling for social relationships. Education and household income were not linked to mental health. Poor structural and functional social relationships were related to general mental health problems and depressive symptomatology. Notably, trends remained stable after accounting for socioeconomic conditions. Conclusion This study provides evidence for socioeconomic inequalities in social relationships as well as for independent associations of financial strain and poor social relationships with mental health problems in individuals with SCI. Further research may develop strategies to improve mental health in SCI by strengthening social relationships. Such interventions may be especially beneficial for individuals with low income and financial strain.

Comparative neuroanatomy of the lumbosacral spinal cord of the rat, cat, pig, monkey, and human

“…7) to document their changes along the longitudinal (rostrocaudal) axis for all species (Figs. 8,9,10,11,12). Measurements for each individual specimen are shown in Supplementary Figs.…”

“…The spinal cord is an important part of the central nervous system that plays an essential role in the function of the body's sensorimotor and autonomic systems. Spinal cord injuries and diseases (e.g., spinal cord injury 1 , spinal muscular atrophy 2 , and amyotrophic lateral sclerosis 3 ) affect the lives of millions of people around the world, impacting their physical and mental health as well as the socioeconomical aspects of their lives [4][5][6][7][8][9] . Detailed knowledge of the neuroanatomy of the spinal cord is critical for understanding its pathologies and finding possible cures.…”

Economic impact of traumatic spinal cord injuries in the United States

“…Prolonged unhappiness can exacerbate a variety of mental illnesses, with studies showing that 18%-37% of TSCI patients presented with signs of major depressive disorder (MDD) [ 56 ] . Financial stressors such as job loss, financial crisis, and inability to pay bills are found in 31.2% of those with MDD [ 68 , 69 ] . Patients following a TSCI may additionally have altered decision making capabilities due to the increased incidence of MDD [ 70 ] .…”

‘I forget to do pressure relief’: Personal factors influencing the prevention of secondary health conditions in people with spinal cord injury, South Africa

“…Those with low income could not even manage to get a healthy diet compromising their nutritional status, thus increasing the risk of the development of SHCs and delaying wound healing for those with an existing pressure sore (Bhagat et al 2018 ). There is also a link between lack of finances and mental problems (Zürcher, Tough & Fekete 2019 ).…”