Psychophysiological impact of spinal cord injury: Depression, coping and heart rate variability

Objectives: The aim was to examine the association of post-injury heart rate variability (HRV), coping with injury (fighting-acceptance), and depression symptoms in individuals with spinal cord injury (SCI).Study Design: Cross-sectional study.Setting: Tertiary care spinal cord injury hospital.Participants: Ninety-one individuals with SCI.Methods: All participants were assessed for HRV using polar heart rate monitor RS 800 CX and completed the Patient Health Questionnaire and Spinal Cord Lesion Coping Strategy questionnaire. Participants were grouped based on level of injury (tetraplegic, high paraplegia, and low paraplegia) and injury duration (early vs. late). Odds ratio calculated the risk of depression using HRV and coping as factors for early and late duration groups. Spearman rho estimated the correlation between three ratios: HRV (LF vs. HF), depression (somatic vs. cognitive), and coping (fighting spirit vs. acceptance) for each level of injury group for early and late duration.Results: Individuals with SCI with high HRV had lower odds of depression (OR = 0.14, CI = 0.03-0.78) than individuals with SCI with low HRV in the early duration group. Individuals with SCI with high acceptance had lower odds of depression (OR = 0.19, CI  = 0.44-0.79) than individuals with SCI with low acceptance in the later duration group. In the later duration, HRV ratio negatively correlated with coping ratio in individuals with low paraplegia and depression ratio in individuals with high paraplegia.Conclusion: The aftermath of spinal cord injury might reflect a close association between the physiological response of autonomic variability and psychological response of coping and depression with implications for the level of injury and post-injury duration.