Patient-reported outcome measures for depressive symptoms in adults with spinal cord injury: a COSMIN systematic review

OBJECTIVE: To evaluate the measurement properties of patient-reported measures of depressive symptoms in adults with spinal cord injury and inform their purpose-specific selection and interpretation in clinical and research settings. DESIGN: Systematic review. SUBJECTS/PATIENTS: Adults with traumatic or non-traumatic spinal cord injury. METHODS: 10 databases were searched from inception to 25 June 2026, with reference checking, citation tracking, instrument websites, and targeted searches. Two reviewers independently selected reports, extracted data, assessed risk of bias, rated measurement properties, and graded certainty using current international guidance for outcome measurement instruments. RESULTS: 28 reports evaluated 27 separately scored versions, forms, or depression subscales from 14 instrument families. The Spinal Cord Injury-Quality of Life Depression Item Bank had the strongest condition-specific development and internal-structure evidence, but evidence gaps and insufficient measurement invariance prevented recommendation. The English Patient Health Questionnaire-9 had sufficient case-finding evidence but insufficient structural validity for interpreting its conventional total score as a clearly unidimensional severity measure. The English depression subscale of the Hospital Anxiety and Depression Scale showed sufficient structural validity, internal consistency, and construct validity. Evidence for measurement error and responsiveness was scarce. CONCLUSION: No measure had sufficiently complete evidence for routine use across screening, severity assessment, and change measurement.