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Spinal Cord Injury Improves Mental Health?

Perceived quality of life was better than normal among men with spinal cord injuries.

Spinal cord injury (SCI) can have devastating consequences for physical functioning, related to the level of injury. Most of us assume that the emotional and social consequences are similarly severe. Researchers recruited subjects at two Veterans Administration hospitals to examine whether men’s self-perceived quality of life was linked to injury severity.

The study population consisted of 20 men with "high SCI" with lesions at or above T6 (some were quadriplegics), 10 with "low SCI" with lesions below T7, and 11 nondisabled men (controls). Injuries occurred many years previously (mean: high-SCI group, 27.9 years; low-SCI group, 16.5 years). Some controls had mononeuropathies or mild polyneuropathies. Subjects rated their life satisfaction, quality of life, and depression.

As expected, the high-SCI group had the lowest mean rating for physical functioning. The three groups rated their overall satisfaction with life similarly, including physical role, general health, and social functioning. The high-SCI group had the highest perceived emotional role in society and vitality. In further analysis, the worse the physical disability, the better was the overall mental health, especially in the high-SCI group. Depression levels did not differ among the groups. Analyses in patients without histories of traumatic brain injury had similar results.

Comment: More "severe" SCI was associated with better perceived quality of life, even compared with control group ratings. Although the controls were not completely healthy (some had neuropathies, which are often treated with psychiatric medications), this finding appears paradoxical. The authors hold that the finding may have a neurophysiologic basis, related to changes in sympathetic pathways and somatic sensory input. This study challenges our notions about the consequences of physical disability and highlights the need for empirical data rather than reliance on "logical" assumptions.

— Jonathan Silver, MD

Published in Journal Watch Psychiatry September 17, 2007

Citation(s):

Abrantes-Pais F de N et al. Psychological or physiological: Why are tetraplegic patients content? Neurology 2007 Jul 17; 69:261.

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