A recent meta-analysis reported rates of probably depression between 19 -26% with average prevelance of 22% (Williams & Murray 2015). Bombardier and colleagues (2004) surveyed 849 SCI outpatients at 1-year post injury and found 11.4% met criteria for major depressive disorder. Krause et al., (2000) suggest a 42% overall rate of depression with a 21% probable rate of major depression – indicative of a 4-fold increase of depressive disorders among individuals with SCI when compared with samples of non-disabled individuals. Of note, many studies do not include information regarding use of antidepressants, other medications, or psychotherapeutic interventions in their reports. Accordingly, observed rates of depressive symptoms may potentially be a reflection of multiple additional factors and the “net effect of all treatments” (Krause et al. 2008). As health problems can produce pain, fatigue, sleep disturbances, physical sensations and digestive troubles, the overlap of somatic symptoms can pose diagnostic challenges. In general, despite the potential for an increase in “false positives,” reports of somatic symptoms merit clinician review given their strong association with affective or more general symptoms of depression (Krause et al. 2008, Richardson & Richards 2008).