Mental health, pain, and sleep factors associated with subjective cognitive difficulties in individuals with spinal cord injury.

Objective: We examined the relationships between self-reported demographic, mental health, physical health, and health behavior factors and subjective cognitive difficulties in a unique cohort of individuals with spinal cord injury (SCI) who averaged more than 30 years postinjury at assessment. Method: The study involved cross-sectional analyses of self-report assessment data collected during the most recent data-collection period (2018-2019) of a 45-year multicohort longitudinal study. Participants (n = 553) were identified from a specialty hospital in the southeastern United States and two midwestern university hospitals and were initially enrolled in the study in 1973-1974, 1984-1985, 1993-1994, or 2003-2004. The Patient-Reported Outcomes Measurement Information System (PROMIS) Cognitive Function-Short Form 8a v2.0 was the main outcome measure used to assess subjective cognitive difficulties. Results: Bivariate analyses indicated that greater subjective cognitive difficulties were associated with being female, elevated anxiety and depressive symptoms, sleep disturbance, cardiovascular disease, worse pain, polypharmacy, worse self-rated diet, and tobacco use. A hierarchical linear regression analysis including sociodemographic and SCI-related variables (Step 1) and physical, mental health, and health variables (added in Step 2) explained 33% of the variance in subjective cognitive difficulties, F(16, 421) = 13.45, p ≤ .001. Depressive, anxiety, and pain symptoms; sleep disturbance; and injury level remained significant predictors of variance in subjective cognitive symptoms when considering all variables simultaneously. Conclusion: Improving mental health symptoms, pain experiences, and sleep difficulties may be promising to improve subjective cognitive symptoms in individuals with SCI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).