Psychiatric morbidity and related factors in the rehabilitation process of paraplegics at the National Spinal Injury Hospital in Nairobi, Kenya

Abstract

Many studies in the Western world have reported a high association between paraplegia and psychiatric morbidity. Some complications of paraplegia and characteristics of patients have been associated with psychiatric morbidity. No study in this field has been done in Kenya. The study was conducted at the National Spinal Injury Hospital in Nairobi, Kenya. O To establish the magnitude of psychiatric morbidity among paraplegics and to assess association with socio-demographic characteristics, mode of injury, therapeutic adherence and physical complications. This was a descriptive cross sectional study. All paraplegics undergoing rehabilitation at the National Spinal Injury Hospital. One hundred and twenty patients seen between the months of December 2003 and May 2004 met the study criteria and were recruited for the study. Paraplegic complications and adherence to therapy were determined through examination and reference to clinical notes. A socio-demographic data and treatment questionnaire was administered followed by a standard psychiatric interview and diagnosis made using DSM IV-TR criteria. Physical complications of paraplegia, level of adherence to therapy, and psychiatric morbidity. Out of the 135 patients seen over a six-month period, 128 patients consented to participate in the study. A large proportion of patients (70%) were below the age of 39 years. Road Traffic Accidents was the leading event causing injuries with most victims being passengers. Seventy-two patients (56.25%) were diagnosed with psychiatric disorder. Posttraumatic stress disorder was diagnosed in 23.4% of the subjects and was the leading psychiatric complication. Others were depression (17.2%), alcohol dependence (1.6%), generalized anxiety disorder (5%), cannabis abuse (8%) and somatization disorder in 7.5% of the patients. Variables significantly associated with

psychiatric morbidity were female gender, relatively young age, non-adherence to therapy,single or divorced and presence of physical complications. Conclusions: In the paraplegic population studied, a majority of patients had psychiatric morbidity.However, this co-morbidity was neither documented nor included in the management plan. Trauma and rehabilitation specialists dealing with paraplegics should identify and treat co-existing psychopathology and evaluation for psychiatric complications should be included in their rehabilitation and treatment algorithm.