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 et al. 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.