Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

Study design: Prospective, cross-sectional study, based on cases of spinal cord injury (SCI). Setting: Three outpatient medical departments in Seoul, Korea. Objectives: To assess depressive symptoms in patients on clean intermittent catheterization after SCI. Methods: In total, 102 subjects ( 68 males and 34 females, mean age 39.5 with a range of 18 - 75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI). Results: For patients and controls, the average total BDI scores were 20.3 +/- 1.0 and 11.4 +/- 0.5, respectively (P < 0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42 - 10.31; P = 0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67 - 12.81, P = 0.003) of depression than those who were able to perform self-catheterization. Conclusions: The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patient's ability to perform self-catheterization.