Poritz, Julia Marie Paul (2016-08). Predicting Pressure Ulcer Occurrence and Severity in the First Three Years Following Spinal Cord Injury. Doctoral Dissertation.
The purpose of the present study was to examine the role of depression and anxiety in predicting time to pressure ulcer occurrence and time to severe pressure ulcer occurrence during inpatient spinal cord injury (SCI) rehabilitation and in the first 3 years post-discharge. Participants were veterans with SCI who were admitted for initial inpatient rehabilitation to the Michael E. DeBakey VA Medical Center (MEDVAMC). Survival analysis was employed to assess time to pressure ulcer occurrence and time to severe pressure ulcer occurrence as a function of depression and anxiety. The sample included 82 veterans with SCI who were admitted to the MEDVAMC for inpatient rehabilitation between 2008 and 2011. Pressure ulcer occurrence and severe pressure ulcer occurrence were measured during inpatient rehabilitation and at years 1, 2, and 3 post-discharge. Veterans with higher scores on somatic items of depression had shorter severe ulcer-free survival times. For veterans without a pressure ulcer during inpatient rehabilitation, there was a statistically significant trend for endorsement of symptoms of depression and trauma-related anxiety to predict ulcer-free survival post-discharge. Additionally, those with higher scores on the somatic depressive items at admission and on the non-somatic depressive items at discharge had shorter severe ulcer-free survival times. The results offered partial support for the hypotheses of the present study. It can be concluded that providing mental health services during and after initial inpatient rehabilitation has the potential to improve both mental and physical health for veterans with SCI, while also saving the VA health care system millions of dollars.