Difficulties inherent in conducting intervention studies are numerous (King & Kennedy, 1999). The SCI population can be heterogeneous. Most sites do not have access to a large number of individuals and obtaining treatment and appropriate control groups requires the participation of multiple sites. Also, ethical concerns over providing the best possible care to all individuals with SCI are obvious, so that withholding aspects of treatment in order to establish control conditions is no longer acceptable (e.g. (Kahan, Mitchell, Kemp, & Adkins, 2006). To date, research strategies have frequently used self-report screening measures (e.g. Beck Depression Inventory, Zung Depression Inventory, Patient Health Questionnaire-9, Center for Epidemiological Studies – Depression Scale; Older Adult Health and Mood Questionnaire; Depression, Anxiety and Distress Scale), and while they offer many benefits (e.g. low cost, quick, easy to complete), they require further evaluation to support a diagnosis of depression.
Three studies examined the effects of interventions aimed towards psychological impairment post SCI. In a systematic review, Elliot and Kennedy (2004) evaluated the effectiveness of depression treatments post SCI through a systematic narrative review of the results. The study found psychological interventions, pharmacological therapy and functional electric stimulation had moderate to high level of evidence in improving depressive symptoms post SCI. Dorstyn et al., (2011) and Mehta et al., (2011) examined the effectiveness of Cognitive Behavioural Therapy (CBT) on a range of psychosocial issues faced by individuals with SCI. Both studies found small to large effects of CBT on depressive and anxiety symptoms. Dorstyn et al., (2011) also found moderate to large effect sizes in the improvement of quality of life post CBT treatment in individuals with SCI.