Impact of Spinal Cord Injury on Mental Health: A Narrative Review

TL;DR

Spinal cord injury significantly increases the risk of mental health issues like depression and anxiety, and this review identifies factors that worsen or improve outcomes to guide rehabilitation.

Contribution

This review synthesizes recent evidence on mental health outcomes after spinal cord injury and identifies key factors influencing psychological well-being.

Findings

Higher prevalence of depression (26%-35%), anxiety (10%-26%), PTSD (12%-36%), and suicidal ideation (11%-33%) in individuals with spinal cord injury compared to the general population.

Socioeconomic disadvantages, pain, and secondary health conditions are linked to poorer mental health outcomes.

Resilience, social support, and physical activity are associated with better psychological outcomes.

Abstract

Spinal cord injury is a condition that radically alters an individual’s life, significantly affecting their mental health. This narrative review synthesizes evidence on depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation after spinal cord injury and reports key factors associated with poorer or more favorable mental health outcomes, to inform rehabilitation strategies and improve quality of life.

A literature search was conducted in PubMed and Scopus, covering the last decade (2015-2025). Thirty studies met the predefined eligibility criteria. The main outcomes examined were depression, anxiety, PTSD, suicidality, and overall quality of life linked to mental health. Outcomes were assessed using validated instruments reported in the included studies (e.g., Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Hospital Anxiety and Depression Scale (HADS)).

Across the included studies, individuals with spinal cord injury generally reported higher prevalence rates compared with general population estimates for depression (26%-35%), anxiety (10%-26%), PTSD (12%-36%), and suicidal ideation (11%-33%). Factors correlated with poorer mental health outcomes included socioeconomic disadvantages, pain interference, and secondary health conditions. In contrast, psychosocial factors such as resilience, self-efficacy, and social support, as well as physical activity, were associated with better psychological outcomes.

This narrative review highlights the substantial impact on mental health that has been reported after spinal cord injury, with higher rates of depression and other psychiatric disorders compared to the general population. By summarizing factors associated with poorer and more favorable mental health outcomes, this review aims to inform rehabilitation programs with a holistic approach, support timely identification of mental health issues, and guide management approaches to promote quality of life among individuals with spinal cord injury.

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