Depression in patients with spinal cord injuries: A synthesis of cognitive and somatic processes

Depression in some patients with spinal cord injuries may be clinically significant and, when present, should be treated to decrease morbidity including decreased physical functioning. Depression associated with spinal cord injury (SCI) may be misevaluated, due to (1) nonspecific multifactorial production of depression symptoms and (2) SCI-specific decrease in somatic sensory central nervous system input. The Somatic Suppression Hypothesis suggests that SCI patients have difficulty experiencing any intense emotion because of suppression of physiological arousal. In addition, cognitive processes that may reduce depression in SCI patients include: (1) attribution of somatic symptoms of depression to medical (biological) causes, (2) realistic, positive expectations for physical improvement, and (3) the perception that the disability of the SCI is only minimally related to the patient’s self-care after complete evaluation. Health personnel should accept lack of depression in SCI, and should encourage positive realistic expectations of recovery.