Pyschological symptoms following amputation

NewsBot · Mar 15, 2006

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Check list of symptoms scl - 9o - R at persons with extremities amputations.
Bosn J Basic Med Sci. 2006 Feb;6(1):58-61

Multidimensional Inventory Check List of Symptoms (SCL-90-r) is based on self-evaluation and it has been used for determination of level of: somatisation, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobias, paranoia and psychosis at persons which are exposed to long term emotional and physical stress. Our goal was to determine relations of physical trauma and psychological changes at persons with lower extremities amputations and to determine factors which influence those changes. Thirty seven persons with lower extremities amputations were examined. The sample included 26 (70,2 %) veterans and 11 (29,7 %) civilians with diseases related amputations. They voluntarily filled Check List of Symptoms SCL-90-r. Symptoms Inventory includes 9 dimensions of primary symptoms: SCL1-somatisation, SCL2-obsessive-compulsive symptoms, SCL3-interpersonal sensitivity, SCL4-depression, SCL5-anxiety, SCL6-hostility, SCL7-phobias, SCL8-paranoia, SCL9-psychosis and SCL10-extra scale. Inventory includes 90 statements, each evaluated with five-level scale of disorder. Every answer is graded with 0-4 points. Thirty seven persons with lower extremities amputations and average chronological age 46,2 +/- 10,92 years were analyzed. Considering marital status 30 (81,1 %) of them were married, 4 (10,8 %) were not married and 3 (8,1 %) were widowers. Considering level of amputation 27 of them (73,0 %) had amputation below knee, 5 (13,5 %) of them amputation above knee and 5 of them (13,5 %) foot amputation. SCL-90-r in both groups determined high level of sensitivity, anxiety, hostility and paranoia. Veterans showed higher level of paranoia comparing to civilians (p<0,002), and younger veterans and married ones had higher level of paranoia comparing to other veterans (p<0,01). Persons with amputations below and above knee showed higher level of paranoia comparing those with foot amputation (p<0,001). Persons with lower extremities amputations have considerably more expressed sensitivity, anxiety, hostility and paranoia. These dimensions are related to age, marital status and level of amputation. These determinants are very helpful for planning and creation of psychological support and rehabilitation of persons with lower extremities amputations.
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NewsBot · Apr 12, 2017

A predictive model of anxiety and depression symptoms after a lower limb amputation.
Pedras S et al
Disabil Health J. 2017 Mar 27. pii: S1936-6574(17)30055-9

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.
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NewsBot · Aug 17, 2018

Psychosocial adjustment to a lower limb amputation ten months after surgery.
Pedras S et al
Rehabil Psychol. 2018 Aug;63(3):418-430. doi: 10.1037/rep0000189.

OBJECTIVE:
This longitudinal multisite study examined the influence of demographic characteristics, psychological reactions, functionality, coping strategies, and social support on psychosocial adjustment to lower limb amputation 10 months after surgery.

METHOD:
Of an initial referral of 206 Portuguese patients, a sample of 86 patients who underwent a lower limb amputation due to Diabetes Mellitus Type II were evaluated during the hospitalization that preceded surgery (t0) and at inpatient follow-up consultations, 1 (t1), 6 (t2), and 10 months (t3) after surgery.

RESULTS:
Higher levels of anxiety symptoms and functionality at presurgery were associated with lower social adjustment to amputation and with higher adjustment to the limitations (t3) respectively. Traumatic stress symptoms (t1) were negatively associated with general and social adjustment, and with the adjustment to the limitations (t3). Perceived social support (t2) mediated the relationship between traumatic stress symptoms (t1) and adjustment to the limitations (t3). Male gender was associated with a higher anxiety and depression symptoms (t0) and with a higher level of functionality (t1). Male gender was associated with functionality at presurgery and postsurgery, and with anxiety and depression symptoms of presurgery.

IMPLICATIONS:
Results support the need to improve psychological screening and early treatment of anxiety symptoms before the surgery, as well as depression and traumatic stress symptoms after a lower limb amputation, and the promotion of social support over time, in order to promote psychosocial adjustment to amputation. This set of psychosocial variables should be included when planning postamputation rehabilitation and psychosocial intervention programs for this target population.
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