Risk of depression following cervical spinal cord injury: a nationwide cohort study, 2012-2023

Spinal cord injury (SCI) causes both physical and psychological sequelae. Depression is among the most common complications, but its long-term risk according to injury level remains unclear.

To evaluate the incidence and risk of depression in patients with SCI and to compare outcomes between cervical and thoracic/lumbar injuries using nationwide data.

We conducted a nationwide retrospective cohort study using Korean National Health Insurance and Health Screening data (2012-2023). Newly diagnosed spinal cord injury cases were identified after a 3-year washout and classified by injury level. Each was propensity-matched (1:20) with controls. Depression (single episodes and recurrent depression) risk was assessed using adjusted Cox models.

Among 1311 SCI patients with SCI (794 with cervical and 517 with thoracic/lumbar injuries) and 26,220 individuals without SCI, the mean follow-up was 4.1 years. Depression occurred in 11% of SCI patients and 6% of participants without SCI. The adjusted hazard ratio (aHR) for depression was 2.08 (95% confidence interval, CI 1.57-2.75) for cervical and 1.70 (95% CI 1.16-2.50) for thoracic/lumbar injuries. Higher risks were observed in men, individuals aged <60 years, current smokers, frequent drinkers, and low-income individuals. Kaplan-Meier analysis showed significantly lower depression-free survival among SCI patients (log-rank P < 0.001).

Cervical SCI is associated with a substantially higher risk of depression than lower-level injuries and matched controls. These findings highlight the need to integrate routine psychological screening and early mental-health intervention into SCI rehabilitation to improve emotional well-being and functional recovery.

Not applicable (observational study).