A longitudinal study of people with spinal cord injury found that depressive symptom scores were shaped mainly by physical complaints rather than negative views of the self. In the 165-person cohort, non-zero BDI-II scores at both the acute I and late assessments were concentrated in tiredness, sleep, appetite, loss of energy, sexual interest and loss of pleasure, while negative-self-attitude items were usually zero. Using a total-score cutoff of 14, 41 participants (24.8%) had clinically relevant overall depressive symptoms at acute I, 35 (21.2%) at the late stage and 16 (9.7%) at both stages.
What the questionnaire captured
The score was not a diagnosis by itself. The Beck Depression Inventory-II, or BDI-II, uses 21 items scored from 0 to 3, with the item scores added to a total ranging from 0 to 63. In this analysis, a total of 14 separated clinically irrelevant from clinically relevant overall symptoms, so the percentages describe a questionnaire-defined threshold rather than a formal diagnosis of major depressive disorder.
Researchers followed the same participants from an acute I baseline to a later assessment and compared the spinal cord injury pattern with reference cohorts. Those reference data included 614 healthy controls and 134 people with MDD in FOR2107, along with 181 healthy controls and 43 people with MDD in CIMH. The analysis used a synchronized BDI score for the comparison, but it was not a validated cross-cohort diagnostic measure.
The symptom mix differed from MDD
On the synchronized score, SCI participants were higher than healthy controls but lower than people with MDD. The MDD profiles exceeded SCI scores for most items, especially those involving self-dislike, failure and guilt. The result points to a different symptom mix after spinal cord injury, in which physical-somatic complaints were more prominent than negative self-attitudes.
Symptoms moved in both directions
The overall percentages did not tell the whole story. The study identified a worsened subgroup of 19 people whose total score changed from below 14 at acute I to at least 14 at the late stage. A recovered subgroup of 25 moved from at least 14 at acute I to below 14 later. Worsening involved persistent or increased somatic symptoms along with increases in several non-somatic symptoms. Recovery involved declines in the main somatic symptoms while other items remained low.
These symptom shifts did not appear to track neurological or functional recovery. Fisher exact tests indicated that developing or recovering from clinically relevant overall depressive symptoms appeared not to be associated with neurological or functional recovery. The authors say that finding needs caution because the study was observational, the subgroups were limited, and treatment and diagnostic information were absent.
Recovery models were stronger than symptom models
The prediction analysis drew a sharper line between the outcomes. A random-forest model for clinically relevant depressive symptoms at the late stage had a median AUROC of 0.60, described in the analysis as mediocre discrimination. Models aimed at recovery performed better within the available SCI data: median AUROC was 0.82 for AIS recovery, 0.93 for UEMS recovery and 0.86 for SCIM-III mobility recovery. AIS is a neurological recovery measure, UEMS captures upper-extremity motor recovery, and SCIM-III mobility reflects functional recovery. The models were assessed with repeated nested cross-validation, which repeatedly trains and checks a model on separate portions of the data.
A warning about interpretation
The authors interpret the predominance of somatic items as possibly reflecting direct consequences of the injury and suggest that cognitive-emotional symptoms may be especially important during later follow-up. That is a reading of symptom patterns, not evidence that one kind of screening improves outcomes. The late-symptom model also lacked independent-cohort validation, and the study's small exploratory subgroups limit how far the findings can be generalized.
Taken together, the study is a caution about reading BDI-II totals after spinal cord injury, not a new diagnostic rule. The authors acknowledged that the analyzed datasets were not publicly available because they contained sensitive personal data that could not be shared.
Paper data and sources
Original title: Characterization of depressive symptoms in individuals with spinal cord injury through the Beck Depression Inventory, and their role in recovery.
Authors: Roman Schefzik, Laura Heutehaus, Christian Schuld et al.
Journal/Repository: Scientific reports
Status: Peer-reviewed
First online: 2026-08-20
DOI: 10.1038/s41598-026-66971-7
Original paper · Full text