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J - Emotional Wellbeing

Roadmap: Where Do We Need to Go? Based on an E-Scan scoping review, there is a need to enhance clinical care and to ensure that standardized assessments are performed for emotional wellbeing, during inpatient rehabilitation, and then annually, in the community (or earlier, based on the clinical team’s discretion). Kalpakjian et al.13 conducted a systematic review of depression measures, and stated that more work assessing the psychometric properties (validity, reliability, responsiveness) in SCI, is needed before one measure can be recommended for use in clinical practice. In the review, the Patient Health Questionnaire-9 (PHQ-9) was identified as a good candidate, based on existing research, and its current use by the National SCI Statistical Centre Database (within the US Model SCI Systems). The authors suggest inclusion of a standardized assessment tool, especially when non-psychology personnel see individuals with SCI. However, Kalpakjian et al.13 caution that, before screening programs are implemented, resources (i.e., psychologists, psychiatrists, or other mental health personnel) are required for further evaluation and treatment, for those individuals who are identified as at risk, based on the results of their screening assessment. The Evidence: Specificity of the PHQ-3 ranges from 93% to 95% and sensitivity from 82% to 87%. The PHQ-9 has been shown to be a valid screening tool when compared with an interview by a mental health professional in the general population. This tool has also demonstrated excellent sensitivity, specificity, and reliability in the SCI population. © July. 2010 Next Nugget: Prevention of Skin Breakdown References: Depression following spinal cord injury: A clinical practice guideline for primary care physicians. 1998, Consortium for Spinal Cord Medicine. http://www.pva.org/site/News2?page=NewsArticle&id=7649 Sakakibara, B.M., et al., A systematic review of depression and anxiety measures used with individuals with spinal cord injury. Spinal Cord, 2009. 47(12): p. 841-51. Kroenke, K., R.L. Spitzer, and J.B. Williams, The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001. 16(9): p. 606-13. http://dx.doi.org/10.1046/j.1525-1497.2001.016009606.x The recommendation to conduct regular routine screening (Table 3.0) aligns with Actionable Nuggets (www.actionnuggets.ca), a best practice implementation project in which continuing medical education credits are available to primary care physicians, through the Canadian Medical Association planned for Spring 2013. Specifically, Actionable Nugget #14 states “Conduct annual screening for depression in patients with SCI, using the PHQ 3/9”. Best Practice: The PHQ-3/9 is an effective screening tool for the SCI population. patients with SCI using the PHQ3/9 annual screening for depression in Actionable Nugget #14: Conduct nuggets www.actionnuggets.ca Special Populations in Primary Care Actionable Screening for Depression in SCI Actionable Nugget #14: Conduct annual screening for depression in patients with SCI using the PHQ3/9 Actionable nuggets Special Populations in Primary Care The Problem: It is estimated that almost one-quarter of individuals with spinal cord injury (SCI) have a major depressive disorder. This represents a 4-fold increase in prevalence over non-disabled individuals. Rates of suicide are approximately 3 to 5 times that reported in the general population. Symptoms of depression can be overlooked or misidentified in people with disabilities due to the overlap in somatic symptoms such as fatigue and sleep disturbances. www.actionnuggets.ca SCI NUGGET #14 (of 20) Table 3.0 Best Practice Indicators for Emotional Welbeing Recommended, required and optional assessment tools are provided in Table 4.0 and, where possible, selected from the Spinal Cord Injury Rehabilitation Evidence Outcome Measures Toolkit (www.scireproject. com). Additional assessments were selected based on published articles11,14 and expert opinion. In cases where there is no clear consensus, options have been provided. Ideally, all sites should align their practice and use the same assessment tools. It is important to acknowledge that many of these assessments are designed for healthy individuals, with emotional distress. Often, they may include somatic symptoms that are difficult to distinguish from the consequences of SCI (e.g., numbness and tingling). The overlap between somatic signs and symptoms of emotional distress, and spinal cord-related impairments, may falsely inflate the individual’s overall score. More research is needed on the psychometric properties of these instruments, when applied to individuals with SCI. Table 4.0 Recomended Assesment Tools for Best Practice Indicators Best Practice Indicators FOR EMOTIONAL Welbeing YES NO 1. Conduct a screening assessment for emotional wellbeing on all individuals with SCI, during inpatient admission; and further assess, depending on results (e.g., diagnosis depression, if positive screen). 2.Re-assess emotional wellbeing, prior to discharge into the community. 3. Provide ongoing follow up annually, following discharge (or earlier, based on the clinical team’s discretion). Emotional Welbeing Construct ICF Component Assesment Tool CLINICAL UTILITY Recomended Required Assesments Depression Body Function Depression Anxiety Stress Scales (DASS)-21 or Patient Health Questionnaire-9 (PHQ-9) • Screening • Follow up Anxiety Disorders Body Function DASS-21 or General Anxiety Disorder-7 • Screening • Follow up Depression and Anxiety Body Function Structured Clinical Interview for DSM Disorders (SCID) or Mini-International Neuropsychiatric Interview (M.I.N.I.) • Diagnosis • Follow up Post-Traumatic Stress Disorder Personal Factors (Personal history and biography) Primary Care, Post-Traumatic Stress Disorder • Screening • Follow up Substance Use - Alcohol Personal Factors (Patterns of experience and behavior) CAGE Questionnaire • Screening Substance Use - Opioids Personal Factors (Patterns of experience and behavior) Opioid Risk Tool • Screening Recomended OPTIONAL Assesment Coping Personal Factors (Patterns of experience and behavior) Spinal Cord Lesion Coping Strategies Questionnaire or Ways of Coping • Screening • Follow up Self-Efficacy Personal Factors (Thoughts and beliefs) General Self-Efficacy Scale or Moorong Self-Efficacy Scale • Screening • Follow up Personality Personal Factors (Patterns of experience and behavior) Personality Assessment Inventory or Ten-Item Personality Inventory • Screening Social Support Environmental Factor Short Form Social Support Questionnaire • Screening • Follow up 104 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


J - Emotional Wellbeing
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