Original Article
A predictive model of anxiety and depression symptoms after a lower limb amputation

https://doi.org/10.1016/j.dhjo.2017.03.013Get rights and content

Abstract

Background

Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model.

Objective

This study focused on the characterization of anxiety and depression levels, before and after surgery, differences in levels of depression and anxiety before and after surgery and the predictors of anxiety and depression one month after surgery, in a sample of patients with DFU.

Methods

This was a longitudinal study with 179 patients with Diabetes Mellitus Type 2 and DFU indicated for amputation, screened for the presence of anxiety and depression symptoms during the hospitalization that preceded amputation and one month after surgery, during a follow-up consultation.

Results

The results showed a significant effect of anxiety and depression symptoms at pre-surgery in the prediction of anxiety and depression symptoms one month after LLA. Patients showed higher levels of anxiety than depression symptoms at pre-surgery, although anxiety significantly decreased on month after surgery. Both anxiety and depression symptoms contributed to depression after LLA, although anxiety at pre-surgery was the only predictor of anxiety at post-surgery.

Conclusions

Tailored multidisciplinary interventions need to be developed providing support before and after an amputation surgery, in order to reduce anxiety and depression symptoms and promote psychological adjustment to limb loss.

Section snippets

Participants and procedure

A sample of 179 patients with Diabetes Mellitus Type 2 (DMT2) and DFU indicated for amputation surgery was screened for the presence of anxiety and depression symptoms during the hospitalization that preceded LLA, and was assessed during a follow-up consultation at the hospital, approximately one month after surgery (mean 34.98 days). The mean duration of length of hospital stay was 25 days. Socio-demographic and clinical data were extracted from patient's medical charts by health professionals

Sample characterization

At baseline (T0), 179 patients with DFU participated in the study. Of these, seventy-six had already been amputated (23.7% and 76.3% major and minor LLAs, respectively), and 113 patients participated in the second moment of the assessment (T1) approximately one month after surgery (22.1% and 77.9% major and minor LLAs, respectively). Other sample socio demographic and clinical variables are presented in Table 1.

Incidence of anxiety and depression symptoms at T0 and T1

Based on the HADS, there was evidence of high levels of anxiety and depression

Discussion

The aims of this study were to assess and characterize the level of anxiety and depression symptoms in a sample of patients with DFU indicated for LLA at T0 and at T1, and which pre-surgery variables contribute to post-surgery anxiety and depression given that knowing the pre-surgery predictors of post-surgery emotional reactions would allow the development and implementation of preventive programs to support and promote positive clinical outcomes, in this population. According to results,

Conclusion

In this study, some dimensions of the ICF model were used to enhance the knowledge about the specific relationship between a health condition and personal factors before surgery, in order to prevent unfavorable outcomes after LLA. It is important to emphasize, that LLA is a medical condition, but it is not necessarily a disability. Disability arises from the interaction of a functional limitation with one's environment. Finally, we hope this study may shed some light regarding the emotional

Conflict of interest

The authors declare that they have no conflict of interest.

Compliance with ethical standards, human and animal rights and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Patients signed an informed consent.

Funding

This study was conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology.

Acknowledgments

The authors gratefully acknowledge the contributions of the Multidisciplinary Diabetic Foot Clinics of the following hospitals: CHP, CHSJ, CHVNG/E, CHTS, ULSAM and the Vascular Surgery Departments in Braga and CHSJ Hospitals. The authors also wish to thank all patients who agreed to participate in this study.

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