Instrumentos de evaluación y tasas de depresión en personas con lesión de la médula espinal: una revisión sistemática

Placeres, Aline Ferreira; Fiorati, Regina Célia

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Sumário

Review • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2017037303388 copiar

Instrumentos de evaluación y tasas de depresión en personas con lesión de la médula espinal: una revisión sistemática

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Identificar, describir, diferenciar y calificar los instrumentos utilizados para evaluar la depresión y también identificar el porcentaje y las tasas medias de depresión en personas con lesión de la médula espinal.

Método:

Esta es una revisión sistemática de la literatura aplicándose un abordaje cualitativo. Los bancos de datos SciELO, LILACS, PubMed y PsycINFO fueron consultados. Artículos originales fueron clasificados conforme a las variables (lesión de la médula espinal, depresión e instrumentos de evaluación). Los estudios se presentan de acuerdo con los instrumentos en publicaciones recientes de los últimos 11 años.

Resultados:

Cinco instrumentos de evaluación fueron encontrados. Se utilizó el PHQ-9, un instrumento de cribado para el diagnóstico de la depresión, en la mayoría de los estudios, todo siendo llevado a cabo en los Estados Unidos y con factor de impacto y número de participantes más altos. Estudios con el PHQ-9 presentaron un score total de personas que alcanzaron los criterios para depresión sin clasificarse por severidad con un promedio del 17,6% ± 7,3%, mientras que la BDI presentó el 51,6% ± 15,1% y la HADS mostró el 37,5% ± 31% de las personas con algún grado de depresión.

Conclusión:

Este estudio fue importante en la identificación de cuáles instrumentos pueden emplearse para evaluar la depresión-la descripción de cada uno, algunas de sus diferencias-, los cuales se utilizan en los mejores estudios, y las tasas de depresión en distintas partes del mundo. Fue importante asimismo demostrar cómo el PHQ-9 es un instrumento importante, pero su uso está limitado a los EE.UU.

DESCRIPTORES
Depresión; Paraplejía; Médula Espinal; Evaluación de la Discapacidad; Enfermería Psiquiátrica; Revisión

Variables

Theoretical framework

Spinal Cord Injury:
A condition with significant disabling and permanent clinical manifestations caused by partial or total failure of the spinal cord functioning, due to an injury that affects the anatomical integrity of this organ⁽¹²12. Fechio MB, Pacheco KMB, Kaihami HN, Alves VLRA. A repercussão da lesão medular na identidade do sujeito. Acta Fisiatr. 2009;16(1):38-42.⁾.

People with traumatic spinal cord injury: biopsychosocial changes and experienced expectations.

Depression:
Depression is a mood disorder characterized by depressed mood, decreased interest or pleasure in things, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness and guilt, decreased ability to think and concentrate, recurrent thoughts of death⁽¹³13. American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais-DSM-V. Porto Alegre: Artmed. 2014. p.155-88.⁾.

Depression is frequent in people who have suffered spinal cord injury and is related to the inherent characteristics of each individual. Experiencing spinal cord injury includes a series of daily challenges and biopsychosocial adversities that negatively interferes with the way of perceiving the new life condition. Investigating the mental health of people with spinal cord injury helps to identify emotional problems and possible psychic disorders for their prevention and treatment⁽⁹9. Berto CD, Barreto BDM. Pessoas com lesão medular traumática: as alterações biopsicossociais e as expectativas vividas. Unoesc Ciênc. 2011;2(2):174-83.⁾.

Reference	Year/ Country	Design / number of patients	Percentages of depression	Instrument used	Time of injury and application
Ferreira et al.⁽¹⁵15. Ferreira M, Guerra MP. Adaptação a lesão vertebro-medular. Psic Saúde Doenças. 2014; 15(2):380-95.⁾	2014 Portugal	Epidemiological/ Cross-sectional n=33	3.1% mild, 12.5% moderate and 3.1% severe depression	Hospital Anxiety and Depression Scale (HADS)	People between nine months and 37 years of injury during a hospital rehabilitation service
Almeida et al.⁽⁸8. Almeida AS, Espirito Santo PF, Silveira MM, Openheimer DG, Dutra RAA, Bueno MDGB, et al. Depressão em indivíduos com lesão traumática de medula espinhal com úlcera por pressão. Rev Bras Cir Plást. 2013;28(2):282-8.⁾	2013 Brazil	Epidemiological/ Cross-sectional n=50	28% of the patients showed mild to moderate depression, 16% showed moderate to severe depression, and 6% presented severe depression	Beck Depression Inventory	People between one year and more than nine years of injury during outpatient follow-up
Conceição et al.⁽²2. Conceição MIG, Auad CJ, Vasconcelos M, Macêdo A, Bressaneli R. Avaliação da depressão em pacientes com lesão medular. Rev Bras Ter Comport Cogn. 2010;7(2):43-59.⁾	2010 Brazil	Epidemiological/ Cross-sectional n=125	35.2% had mild to moderate and 36.8% had moderate to severe depression	Beck Depression Inventory	People between one month and 21 years of injury during inpatient rehabilitation
Bombardier et al.⁽¹⁶16. Bombardier CH, Faan JR, Tate DG, Richards JS, Wilson CS, Warren AM, et al. An exploration of modifiable risk factors for depression after spinal cord injury: which factors should we target? Arch Phys Med Rehabil. 2012;93(7):775-81.⁾	2012 USA	Epidemiological/ Cross-sectional n=244	20% were between 20 and 29 years of age, with these presenting higher average scores compared with other age categories	Patient Health Questionnaire-9 PHQ-9	People between one month and more than 30 years of injury during outpatient follow-up
Cuff et al.⁽¹⁷17. Cuff L, Fann JR, Bombardier CH, Graves DE, Kalpakjian CZ. Depression, pain intensity, and interference in acute spinal cord injury. Top Spinal Cord Inj Rehabil. 2014;20(1):32-9.⁾	2014 USA	Epidemiological/ Cross-sectional n=203	28% patients presented moderate to severe depression	Patient Health Questionnaire-9 PHQ-9	People between three days and nine months of injury during inpatient rehabilitation
Tsai et al.⁽¹⁸18. Tsai H, Graves DE, Lai CH, Hwang LY, Pompeii LA. Association of internet use depression and among the spinal cord injury population. Arch Phys Med Rehabil. 2014;95(2):236-43.⁾	2014 USA	Epidemiological / Cross-sectional n=4,618	18.1% presented depression as determined by the diagnostic method	Patient Health Questionnaire-9 PHQ-9	Reanalysis of national data collected years earlier with people with an average of 5.3 ± 0.09 years of injury
Avluk et al.⁽¹⁹19. Avluk OC, Gurcay E, Gurcay AG, Karaameth OZ, Tamkan U, Cakcia A. Effects of chronic pain on function, depression, and sleep among patients with traumatic spinal cord injury. Ann Saudi Med. 2014;34(3):211-6.⁾	2014 Turkey	Epidemiological/ Cross-sectional n=44	38.6% showed mild depression, 43.2% had moderate depression, and 9.1% showed severe depression	Hamilton Rating Scale (HAM-D)	People with more than six months of injury during inpatient rehabilitation
Anderson et al.⁽²⁰20. Anderson CJ, Vogel LC, K Chlan KM, Betz RR, McDonald CM. Depression in adults who sustained spinal cord injuries as children or adolescents. J Spinal Cord Med. 2007;30 Suppl 1:S76-82.⁾	2007 USA	Epidemiological/ Longitudinal n=232	52.2% showed minimal depressive symptoms, 19.8% had mild depressive symptoms, 5.6% showed moderate depressive symptoms, 1.3% presented moderate to severe depression, and 0.4% had severe depression	Patient Health Questionnaire-9 PHQ-9	People between five and 34 years old accompanied by a registry of a health service
Kalpakjian et al.⁽²¹21. Kalpakjian CZ, Albright KJ. An examination of depression through the lens of spinal cord injury: comparative prevalence rates and severity in woman and men. Womens Health Issues. 2006;16(6):380-8.⁾	2006 USA	Epidemiological/ Cross-sectional n=585	Prevalence rates for women were 7.9% for major depressive disorder and 9.7% for other depressive disorders; for men the rates were 9.9% and 10.3%, respectively	Patient Health Questionnaire-9 PHQ-9	People between one and 25 years of injury accompanied by national database
Migliorini et al.⁽²²22. Migliorini C, Callaway L, New P. Preliminary investigation into subjective well-being, mental health, resilience, and spinal cord injury. J Spinal Cord Med. 2013;36(6):660-5.⁾	2013 Australia	Epidemiological/ Longitudinal n=21	No participants reported clinically significant mental health symptoms at T1 as per the participation qualifying criteria at T2, but some participants (19%) reported clinically significant mental health symptoms at T2	Depression, Anxiety & Stress Scale-short form (DASS-21)	People accompanied by community database that participated in T1 research five years earlier and agreed to participate in T2
Lasprilla et al.⁽²³23. Lasprillaa JCA, Ketchumb JM, Starkweatherc A, Nichollsa E, Wilk AR. Factors predicting depression among persons with spinal cord injury 1 to 5 years post injury. NeuroRehabilitation. 2011;29(1):9-21.⁾	2011 USA	Epidemiological/ Longitudinal n=2,256	Prevalence of major depressive disorder was 11.9% for the 1^st year and 9.7% for 5^th year after spinal cord injury	Patient Health Questionnaire-9 PHQ-9	People accompanied by national database between 1 year and 5 years of injury
Krause et al.⁽²⁴24. Krause JS, Saunders LL, Reed KS, Coker J, Zhai Y, Johnso E. Comparison of the patient health questionnaire and the older adult health and mood questionnaire for self-reported depressive symptoms after spinal cord injury. Rehabil Psychol. 2009;54(4):440-8.⁾	2009 USA	Epidemiological/ Longitudinal n=727	10.7% of the participants fulfilled the diagnostic criteria for major depressive disorder	Patient Health Questionnaire-9 PHQ-9	People with more than one year of injury accompanied by a registry of a specialized hospital
Hassanpour et al.⁽²⁵25. Hassanpour K, Hotz-Boendermaker S, Dokladal P. Low depressive symptoms in acute spinal cord injury compared to other neurological disorders. J Neurol. 2012;259(6):1142-50.⁾:	2012 Switzerland	Epidemiological/ Longitudinal n=130	65% did not show depression, 30% had mild depressive symptoms, and 5% presented moderate to severe depressive symptoms	Beck Depression Inventory	People between one month and one year of injury during rehabilitation and clinical follow-up
Shin et al.⁽²⁶26. Shin J, Chae J, Min J, Lee C, Hwang S, Lee BS, et al. Resilience as a possible predictor for psychological distress in chronic spinal cord injured patients living in the community. Ann Rehabil Med. 2012;36(6):815-20.⁾	2012 Korea	Epidemiological/ Cross-sectional n=37	40.5% presented low psychological distress and the other 59.5% presented high psychic suffering	Hospital Anxiety and Depression Scale (HADS)	People hospitalized for annual examinations with a mean of 8.35 ± 7.0 years of injury
Bombardier et al.⁽²⁷27. Bombardier CH, Adams LM, Fann JR, Hoffman JM. Depression trajectories during the first year after spinal cord injury. Arch Phys Med Rehabil. 2016;97(2):196-203.⁾	2016 USA	Epidemiological/ Longitudinal n=168	Low/stable depression 63.8%, mild/moderate depression 29.1%, and persistent moderate/severe depression 7.1%	Patient Health Questionnaire-9 PHQ-9	Persons between three months and one year of injury accompanied by a medical center
Klyce et al.⁽²⁸28. Klyce DW, Bombardier CW, Davis TJ, Hartoonian N, Hoffman JM, Fann JR, et al. Distinguishing grief from depression during acute recovery from spinal cord injury. Arch Phys Med Rehabil. 2015;96(8):1419-25.⁾	2015 USA	Epidemiological / Cross-sectional n=206	8.4% showed depression	Patient Health Questionnaire-9 PHQ-9	People with an average of 53.5 ± 40.5 days of injury admitted to rehabilitation centers
Fann et al⁽²⁹29. Faan JR, Crane DA, Graves DE, Kalpakijian CZ, Tate DG, Bombardier CH. Depression treatment preferences after acute traumatic spinal cord injury. Arch Phys Med Rehabil. 2013; 94(12):2389-95.⁾	2013 USA	Epidemiological/ Cross-sectional n=183	28% had probable major depression	Patient Health Questionnaire-9 PHQ-9	People with an average of 51.6 ± 38.1 days of injury undergoing inpatient rehabilitation.
Hoffman et al.⁽³⁰30. Hoffman JM, Bombardier CH, Graves DE, Kalpakijian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil. 2011;92(3):411-8.⁾	2011 USA	Epidemiological/ Longitudinal n=1,035	21% participants showed probable major depression in 1^st and 18% in 5^th year	Patient Health Questionnaire-9 PHQ-9	People between one year and five years of injury accompanied by a national database
Fann et al.⁽³¹31. Fann JR, Bombardier CH, Richards JS, Tate DG, Wilson CS, Temkin N. Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil. 2011;92(3):352-9.⁾	2011 USA	Epidemiological/ Cross-sectional n=947	23% had probable major depression	Patient Health Questionnaire-9 PHQ-9	People with an average of 11.0 ± 9.7 years of injury were monitored in a national database and rehabilitation centers
Khazaeipour et al.⁽³²32. Khazaeipour Z, Seyedeh-Mohadeseh SM, Naghdi M. Depression following spinal cord injury: its relationship to demographic and socioeconomic indicators. Top Spinal Cord Inj Rehabil. 2015;21(2):149-55.⁾	2015 Iran	Epidemiological / Cross-sectional n=134	49.3% participants showed mild to severe depression	Beck Depression Inventory	People with a mean of 3.86 ± 3.9 years of injury in outpatient rehabilitation
Williams et al.⁽³³33. Willians RT, Wilson CS, Heinemann AW, Lazowski LE, Fann JR, Bombardier C. Identifying Depression Severity Risk Factors in Persons With Traumatic Spinal Cord Injury. Rehabil Psychol. 2014;59(1):50-6.⁾	2014 USA	Epidemiological/ Cross-sectional n=204	44% had no depression symptoms, 31% had mild symptoms, 16% had moderate symptoms, 6% had moderately severe symptoms, and 3% had severe depression symptoms	Patient Health Questionnaire-9 PHQ-9	People between one month and 50 years of injury recruited from outpatient clinics, follow-up systems, hospital referrals, and clinical research records
Richardson et al.⁽³⁴34. Richardson EJ, Richards JC. Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury. Rehabil Psychol. 2008;53(2):243-9.⁾	2008 USA	Epidemiological/ Longitudinal n=2,570	Depression:20.7% in the 1^st year, 17.6% in the 5^th year, 12.1% in the 15^th year and 12.2% in the 25^th year.	Patient Health Questionnaire-9 PHQ-9	People between one year and 25 years of injury accompanied by a national database

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Aline Ferreira Placeres, Laboratório Communitas, Prédio da Terapia Ocupacional Av. Bandeirantes, 3900 - Vila Monte Alegre CEP 14049-900 - Ribeirão Preto, SP, Brazil alineplaceres@yahoo.com.br