Date Presented 4/19/2018
We examined people with physical disabilities who received rehabilitation to see whether they had a higher risk of depressive symptoms than those who did not receive rehabilitation using four covariate adjustment methods. Our results revealed that rehabilitation receivers had a higher risk of depressive symptoms than nonreceivers.
Primary Author and Speaker: Yejin Lee
Additional Authors and Speakers: Ickpyo Hong, Mi Jung Lee, Hae Yean Park
PURPOSE: According to the International Classification of Functioning, Disability, and Health (ICF), rehabilitation professionals require a comprehensive knowledge of human functioning, including not only physical functions but also psychological symptoms such as depression (World Health Organization, 2001). Because depressive symptoms can adversely affect rehabilitation outcomes (Katon et al., 2007; Penninx et al., 1999), attention to depressive symptoms is important in the field of rehabilitation. However, no research has been conducted to investigate the risk of depressive symptoms in people who receive rehabilitation services. Therefore, the aim of this study was to examine whether people with physical disabilities who received rehabilitation services had a higher risk of depressive symptoms than those who did not receive these services.
METHOD: In this cross-sectional study, data on 3,568 adults with physical disabilities were retrieved from the 2014 Korean National Survey on People With Disabilities (NSPD) database. To calculate the risk of depressive symptoms in people with physical disabilities, we used four covariate adjustment methods: (1) multivariable regression model, (2) inverse probability of treatment weighting (IPTW) adjustment with normalized weight, (3) IPTW with stabilized weight (SW), and (4) greedy algorithms with 1:1 propensity score matching and covariate adjustment. The dependent variable was depressive symptoms (longer than 2 wk), and the independent variable was receiving or not receiving rehabilitation services. Baseline covariates included 19 demographic variables (e.g., disability severity, depression treatment, disability grade, social support) and 10 comorbidities (i.e., hypertension, dyslipidemia, stroke, heart problems, osteoarthritis, rheumatoid arthritis, back pain, lung problem, diabetes, and cancer).
RESULTS: The majority of the sample had a musculoskeletal disorder (n = 1,075, 30.1%) or fracture (n = 733, 20.5%). Of the 775 participants identified as having depressive symptoms, 312 (27.3%) were classified as rehabilitation receivers and 463 (18.9%) as nonreceivers. The majority of participants received physical therapy (n = 1,124, 99.8%), and a few individuals received other therapies (occupational therapy, n = 7; behavioral therapy, n = 4; speech therapy, n = 2; other therapy, n = 10; music, art, play, or behavioral therapy, n = 1). Although 23 baseline covariates were significantly different between rehabilitation receivers and nonreceivers (p < .05) before matching, all covariates were balanced (p > .05) after applying the IPTW and SW matching methods. The four covariate adjustment methods indicated a significantly higher risk of depressive symptoms (odds ratios = 1.191–1.233) in people who received rehabilitation services than in those who did not receive these services.
CONCLUSION: This study revealed that rehabilitation receivers were at higher risk of depressive symptoms than nonreceivers. Because depressive symptoms can cause myriad challenges for both society and individuals, rehabilitation professionals, including occupational therapists, should establish effective therapeutic strategies to carefully monitor and effectively reduce depressive symptoms in rehabilitation receivers to provide successful rehabilitation services.
IMPACT STATEMENT: The findings suggest that people with physical disabilities who receive rehabilitation services have a higher risk of depressive symptoms. Rehabilitation professionals need to establish therapeutic strategies to monitor and reduce risk of depression for clients in rehabilitation settings.
References
Katon, W., Lin, E. H., & Kroenke, K. (2007). The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. General Hospital Psychiatry, 29, 147–155. https://doi.org/10.1016/j.genhosppsych.2006.11.005
Penninx, B. W., Leveille, S., Ferrucci, L., van Eijk, J. T., & Guralnik, J. M. (1999). Exploring the effect of depression on physical disability: Longitudinal evidence from the established populations for epidemiologic studies of the elderly. American Journal of Public Health, 89, 1346–1352. https://doi.org/10.2105/AJPH.89.9.1346
World Health Organization. (2001). International classification of functioning, disability and health. Geneva: Author.
