Original ArticleA predictive model of anxiety and depression symptoms after a lower limb amputation
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.
References (58)
Depression, self-esteem, diabetes care and self-care behaviors among middle-aged and older Mexicans
Diabetes Res Clin Pract
(2014)- et al.
Barriers to diabetes management: patient and provider factors
Diabetes Res Clin Pract
(2011) - et al.
Psychological status of diabetic people with or without lower limb disability
Diabetes Res Clin Pract
(1996) - et al.
Prevalence of anxiety in adults with diabetes: a systematic review
J Psychosom Res
(2002) - et al.
Psychiatric and emotional sequelae of surgical amputation
Psychosomatics
(2006) - et al.
Depressive symptoms and mental health service utilization among persons with limb loss: results of a national survey
Arch Phys Med Rehabil
(2005) - et al.
Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees
Arch Phys Med Rehabil
(2003) - et al.
Slowing of wound healing by psychological stress
Lancet
(1995) - et al.
Predictors of pre and postoperative anxiety in emergency surgery patients
J Psychosom Res
(2003) - et al.
Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty
J Pain
(2013)