**5. Mental health after SCI**

Mental good health is important for transitioning our life with equilibrium; however, a traumatic SCI can disrupt that equilibrium since it causes the loss of our ability to have motor independency. Although the life expectancy of SCI patients has improved in the last decade [141], unfortunately, this condition has no cure to date and therapeutic strategies are limited to physical rehabilitation and support groups.

Psychiatric professionals have studied the relation between depression and anxiety as a SCI sequel and found that one out of two patients share in common continuous anxiety outbreaks and depression with a profound suicidal desire [142]. In addition, there is a significant higher risk of suffering psychiatric disorder in patients with a SCI such as dementia, psychosis, bipolar disorder, sleep disorder and illicit drug use [143]. The previous statement reveals that retrieving a life with normal parameters of mental health represents a challenge for patients and the doctors involved in the recovery of such disease.

Among all the mental illness that patients with SCI can develop, depression prevails over all mental health disorders. A cross sectional survey revealed that over 30% of the patients had depressive disorder diagnosed [144].

Although the initial injury is only the first of many traumata in the life of these patients, there are other factors that are related to increase mental illness; intermittent catheterization, sphincterotomy, continuous bed shift among others insults that endure for the rest of their life [145]. Though these procedures are for the patients benefit, they often chose to protect themselves from being oppressed by these disruptions, some patients retrieve themselves into the conservationwithdrawal response until they become uncooperative, express of wanting to be left in loneliness and passively acquire depressive signs [146].

As previously mentioned, physical exercise has positive results at a systemic level in the rehabilitation therapies, this beneficial effects includes diminishing of depression in individuals with SCI. Mood data (POMS questionnaire) and analysis for inflammatory mediators resulted in a significant reduction in total mood

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disturbance pre to post-exercise, and pre to one-hour post-exercise and there was a significant decrease in TNF-α from pre to post-exercise. Thus, acute exercise can positively affect mood in SCI patients and exercise-induced changes in inflammation contribute to such improvements [147].

At last, is important to mention that pharmacological therapies may give the patients some relief but are not always sufficient to promote adaptability to such condition. Emotional assessment may play a role in long-term adjustment [148].

Neurobiological and psychiatric assessments for SCI have been evolving throughout the years and the results are promising, but social issues are important for the reinsertion of these patients to society. It has been documented that social necessities are as important as physical [149]. Lack of job opportunities, transportation, marriage, social relations are a few of a big list of the social outcomes followed by a SCI [150].

Several studies has demonstrated that a proper social assessment such a reintegration to the community, interaction with groups of SCI injured patients, sports and psychosocial treatment can improve the clinical health issues [151].

The family context is very important in order to achieve higher health scores within SCI patients. Family brings support and comprehension of the patient's situation. However, when family integration falls apart due to diver's socioeconomics, demographics and emotional variables the recuperation of the patients may be a challenge [152].

The economic weight of the health care systems and the family financial difficulties to deal with, are a great challenge. As it is, raising awareness for improve prevention to reduce occurrence of these types of injuries, and medical and technological advances management for medical care in the social resources allocation [153]. And socioeconomics impact that damage severely the life quality of the patients. However, since the life expectancy of these patients has improved in the last decade [141] these patients often present functional impairments in several areas of their life such as: psychological/psychiatric, organ dysfunction, sexuality, economics, family and social interactions [154].
