Relationships between physical activity and depression in community-dwelling individuals with spinal cord injury: a study based on structural equation modeling and fuzzy-set qualitative comparative analysis.

Abstract

To explore the effects of physical activity (PA) on depression in community-dwelling individuals with spinal cord injury (SCI). It is a cross-sectional study. Participants completed measures of physical activity scale for individuals with physical disabilities, Beck depression inventory version 2, numeric rating scale, and chronic pain grade scale. Relationships among variables were explored by structural equation modeling (SEM). Fuzzy-set qualitative comparative analysis (fsQCA) was used to explore multiple causal pathways to depression. The direct effect of PA on depression was -0.213 (95% CI: -0.328, -0.099, <i>p</i> < 0.001). The mediating effect of pain intensity and pain interference was -0.034 (95% CI: -0.070, -0.007, <i>p</i> = 0.035). fsQCA found three configurations triggered high depression. In H1a and H1b, high depression was triggered by low PA, low pain intensity, high pain interference, complications, or unemployment. In H2, high depression was triggered by high PA, high pain intensity, high pain interference, complications, and unemployment. Making PA the foundation and incorporating pain management as a key supportive strategy may effectively improve depressive symptoms in the population with SCI. However, it is crucial to assess individuals' circumstances and provide personalized interventions rather than adopting a uniform way.