See All Evidence Sections
Mental Health After SCI

Education for Depression

Author Year
Research Design
PEDro Score
Total Sample Size
Methods Outcome
Zemper et al., (2003)
NInitial=67 NFinal=43
Population: Participants recruited from
an outpatient clinic or Center for
Independent living. Intervention group
was more educated and had fewer
retirees despite random assignment.
SCI: Mean age=47 yr; Gender:
males=30, females=13; Level of injury:
paraplegia=42%, tetraplegia=39%,
ambulatory=3%; Mean time since
injury=14 yr; Marital status:
single=28%, married=23%,
Intervention: A series of six 4 hr
workshop sessions held over a 3 mo
period, promoting health and wellness.
Sessions included lifestyle
management, physical activity, nutrition,
preventing secondary conditions,
individual coaching sessions, follow-up
phone calls during the 4 mo following
the workshops. Controls participated in
pre/post assessment but received no
Outcome Measures: Health Promoting
Lifestyle Profile II (HPLP II), Secondary
Conditions Scale (SCS), Self-rated
Abilities for Health Practices Scale
(SAHP), Physical Activities with
Disabilities Scale (PADS)
1 . The intervention group showed
statistically significant improvement
after intervention in several areas as
compared to the control group:
SAHP: (p<0.05) HPLP-II: (p<0.001).
Nutrition HPLP-II subscale:
improvement in nutritional awareness
and behaviour (p <0.05) Stress
HPLP-II subscale: Increased use of
stress management techniques and
decreases in perceived stress
1. SCS: fewer and less serious
secondary conditions (p<0.001)
Depression was less though did not
reach significance.
Federici et al., (2019)
Population: Mean age:
males=50.4±7.3 yr,
females=41.5±11.26 yr; Gender:
males=5, females=6; Time since
injury=30.1±9.4 yr; Level of injury:
tetraplegia=3, paraplegia=4, no
paraplegia/tetraplegia=4; Severity of
injury: complete=5, incomplete=2,
Intervention: Participants were 4
couples (one with SCI and one without)
and 3 singles with SCI who took part in
a sexual health psychoeducational
intervention in which 4 couples and 3
singles met every two weeks for 12
meetings of a growth group and
reported the results of their love lives
and persona lives.
Outcome Measures: Sexual interest
and satisfaction scale (SIS), Beck
depression inventory – II (BDI-II) and
Beck anxiety inventory (BAI).
1. All participants improved significantly
on item 5 of the SIS scale “How are
your opportunity and your ability to
enjoy sexuality yourself?” (p<0.01),
SIS scale total score (p<0.05) and
BAI scores (p<0.05).
2. No difference was found for SIS
scale’s general satisfaction after
injury or for BDI (p>0.05).
3. Significant effect found on item 5 of
the SIS scale “How are your
opportunity and your ability to enjoy
sexuality yourself?” for both
individuals and partners (p<0.05 for
Dunn et al., (2000)
NInitial=371 NFinal=371
Population: Gender: mixed group-with
more males; Mean time since
injury=18.44 yr.
Intervention: Follow-up after initial
rehabilitation was completed addressing
the secondary conditions post-SCI as
well as the primary effects of their spinal
cord injury. The focus is wellness,
health promotion, and illness prevention
through a continuum of coordinated
Outcome Measures: Secondary
Conditions Scale (SCS); Check Your
Health Questionnaire (CYHQ).
1. An overall difference between the two
groups was found (p=0.0004).
2. Medical Follow-up group reported a
significantly higher subjective rating
than did the No-F/U group on 3
variables: Health (p=0.0068),
Independence (p=0.005), Absence of
depression (p<0.0001). (Fisher’s
protected least significant diff. test).
3. A MANOVA showed a main effect on
education on health, independence
and absence of depression
(p=0.0098). Further analysis showed
that as education increased subjects
reported greater health, and
independence and lower depression.


Three studies evaluated the effect of education program in reducing symptoms of depression post SCI (Dunn et al. 2000; Federici et al. 2019; Zemper et al. 2003). Two programs involved education regarding wellness and health promotion (Dunn et al. 2000; Zemper et al. 2003). Zemper (2003) found no significant improvement in depressive symptoms, while Dunn (2000) found that the intervention resulted in decreased depressive symptoms. Federici et al. (2019) provided sexual health psychoeducation over 12 sessions and found no significant improvement in depressive symptoms.


There is conflicting evidence for the effectiveness of education programs in reducing depressive symptoms post SCI (Dunn et al. 2000; Federici et al. 2019; Zemper et al. 2003).

Chapter Downloads
Patient Handouts
Outcome Measures
Active Clinical Trials