University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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It seems only natural that dealing with a serious illness can be a cause of depression. Making the adjustments required by a spinal cord injury, which can include learning to do ordinary tasks in new and unaccustomed ways, is a stressful process that can result in short-term or even a more lasting feeling of depression. A study in 1999 1 found that almost a third of people living with spinal cord injuries reported symptoms of depression. Almost 60% of the participants in our study reported feeling depressed at one time or another since their injury occurred.

Very often, people who are depressed withdraw from social interactions and stop participating in daily activities, even if they still seem friendly and energetic to casual observers 2. Sometimes such withdrawal is a way of asserting self-control or rebellion, especially for someone who is having to learn to depend on the help of others. About a quarter of people with spinal cord injuries who took part in one study 2 neglected their self-care as part of an overall sense of depression; more recent research confirmed that people who are depressed sometimes give up taking good care of themselves 3 4. Since many pressure ulcers (which means the same thing as "pressure sores" or "bedsores") are noticed at the earliest, and most easily curable, stages by the people with the ulcers themselves, self-neglect can create a serious risk that an ulcer will be missed and will grow, possibly leading to the need for surgery. And if depression is also causing someone to isolate themselves from friends and family who might otherwise help them to look after their skin 4, as study participant Odel did, the risk of a pressure ulcer developing and getting out of control is even higher. Like Mitch, one of the participants in our study, people who are depressed might lack energy and therefore stay in the same position for long periods of time, which can cause pressure that can result in a pressure ulcer forming. Another study participant, Brenda, not only became inactive when she felt depressed, but also started unhealthy eating habits, which caused her to gain weight, and that, in turn, added to her health problems. Other people who participated in our study and shared their experiences with depressed feelings and feeling bad include Robert and Steve.

Since it is very common, and even expected, that people will feel depression at some point during the process of living with a spinal cord injury, a person experiencing depression does not need to feel embarrassed or ashamed of it. It is not a sign of weakness; it is natural to experience sad or depressed feelings when going through major life changes or dealing with difficulties. What is important is to reach out for support when you feel these emotions. Possibly the best source of support are the friends and family who already are on your side. A number of studies have shown time and again that people with spinal cord injuries who feel they have a great deal of social support report they are much more satisfied with their lives, and experience much less depression, than people who don't call on those around them for support 5. For example, our study participant Ken relied on friends with and without spinal cord injuries, youth pastors, a young doctor, fellow members of his congregation, "phone pals" and his mother to inspire him to keep a good attitude and take good care of himself.

Another excellent form of support comes from trained professionals who are used to helping people with spinal cord injury and other illnesses deal with their feelings of depression. There are a number of different styles of coping with depression, ranging from stress reduction methods to learning new problem-solving skills, and including many forms of therapy, including talking about feelings, sharing feelings with people who have similar conditions, or looking at a wider meaning of life 5. To find some of these forms of help, your health care provider can refer you to a counselor, therapist or support group who can assist you; there may also be someone at your church, temple or prayer group who is qualified to counsel people who are feeling depressed. Reaching out to someone for assistance is one of the most strong and assertive choices you can make when you're feeling low. Some people might feel more comfortable talking to a trusted friend or family member about this subject. But whatever choice a person makes about whom they want to talk to, what counts is that they invite someone in to help them deal with depressed feelings. It's one of the best choices they can make!

If you would like to use the Internet to explore the subject of depression more, there are a lot of helpful resources. If you type the word "depression" into a search engine such as Google, Yahoo, or AOL, you will find literally thousands of websites with information about depression, some with links to self-help books, readings, support groups or ways to find therapists and counselors in your area.

Websites that deal in particular with the ways that people with spinal cord injuries have experienced depression include this detailed article, Adjustment to Spinal Cord Injury, at the Spinal Cord Injury Information Network, which is maintained by the University of Alabama at Birmingham, that discusses many of the emotions people commonly go through while making the adjustment to living with a spinal cord injury. A useful part of this article is a section that gives examples of how to counteract negative thoughts with rational, constructive thoughts and self-messages.

If you would like a very clear, easy-to-use guide about depression that includes information about how many problems that are common for people with disabilities can create depression or make it worse, try this excellent booklet, Depression and Disability: A Practical Guide, written by Dr. Karla Thompson for all people with disabilities, on the website of the North Carolina Office on Disability and Health. Esta información También se puede obtener en Español. Se llama "Depresión y Discapacidad - Guía Práctica", en formato "PDF".

Depression: What You Should Know is a very helpful PDF provided by the Consortium for Spinal Cord Medicine. And What's in Your Head? Who Put It There? is an excellent article in the online magazine New Mobility. In this essay, counselors and psychologists who have disabilities themselves discuss the issue of depression, pointing out that it can be the prejudices of society that can lead to sad or angry feelings in a person who uses a wheelchair. Their suggestions for fighting depression include having close relationships with family and friends, and looking for inspiration by seeing or reading about other people with disabilities who empower themselves for success.

The real message of these articles is that a person who is feeling depressed is not alone, that help is available, and, most importantly, that there is hope.

1 Kemp, B. J., & Krause, J. S. (1999). Depression and life satisfaction among people ageing with post-polio and spinal cord injury. Disability and Rehabilitation, 21, (5/6), 241-249.

2 MacLeod, A. D. (1988). Self-neglect of spinal injured patients. Paraplegia, 26, 340-349.

3 Witkowski, J. A., & Parish, L. C. (2000). The decubitus ulcer: Skin failure and destructive behavior. International Journal of Dermatology, 39, (12), 894-896.

4 Consortium for Spinal Cord Medicine. (2000). Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health-care professionals. Washington, DC: Paralyzed Veterans of America.

5 Galvin, L. R., & Godfrey, H. P. D. (2001). The impact of coping on emotional adjustment to spinal cord injury (SCI): Review of the literature and application of a stress appraisal and coping formulation. Spinal Cord, 39, 615-627.