1
|
Singh S, Saini R, Mathur R, Sarkar S, Sagar R. The prevalence of depression in people following limb amputation: A systematic review and meta-analysis. J Psychosom Res 2024; 181:111677. [PMID: 38657566 DOI: 10.1016/j.jpsychores.2024.111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To estimate the prevalence of depression in people with limb amputation. Additionally, factors affecting the prevalence or pattern of depression following limb amputation were explored. METHODS Systematic literature search to identify all relevant studies assessing prevalence of depression following limb amputations was conducted through following databases: PubMed/ MEDLINE, Scopus, Embase, and Web of Science. Search period was since inception of database till December 2021. Meta-analyses using random-effects model were conducted to estimate pooled prevalence of depression. RESULTS A total of 61 studies comprising 9852 limb amputees were included. Pooled prevalence of depression following limb amputations was 33.85% (95% CI: 27.15% to 40.54%), with significant heterogeneity (I2 = 98.57%; p < 0.001). Sub-group meta-analysis showed that pooled prevalence of depression was significantly higher in studies conducted from middle-income (45.31%, 95% CI: 28.92% to 61.70%) as compared high income countries (28.31%, 95% CI: 23.97% to 32.64%). Greater activity restriction, amputation-related body image disturbances, social discomfort, perceived vulnerability regarding disability, and avoidant coping style were commonly reported factors associated with greater depression symptomatology. Whereas, good perceived social support, and use of more active coping strategies were commonly reported protective factors. CONCLUSION About one-third of all limb amputees suffered from clinically significant depression. This emphasizes need to sensitize health care professionals involved in providing care to people following limb amputation regarding the importance of periodically screening this vulnerable group of patients for depression and liaising with psychiatrists. Further, addressing risk factors identified in this review could help in reducing the rates of depression post-amputation.
Collapse
Affiliation(s)
- Swarndeep Singh
- Assistant Professor, Department of Psychiatry, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India.
| | - Romil Saini
- Department of Psychiatry, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Siddharth Sarkar
- National Drug Dependence Treatment Centre & Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| |
Collapse
|
2
|
Saini UC, Bu S, Bhayana H, Dhillon MS, Mehra A. Longitudinal Experience and Determinants for Common Mental Health Problems, Phantom Limb and Functional Outcome in Lower Limb Amputees. Indian J Orthop 2023; 57:2040-2049. [PMID: 38009175 PMCID: PMC10673785 DOI: 10.1007/s43465-023-01007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/21/2023] [Indexed: 11/28/2023]
Abstract
Background Amputation of a limb is equivalent to loss of a person's life. Psychological aspects are essential factors in dealing with the disability and functional outcome is a significant concern. Longitudinal studies have not examined the experience and determinants of common mental health problems and functional outcome in lower limb amputees. Materials and Methodology A total of 103 lower limb amputees were recruited and followed up for 6 months. Patients were assessed on Hospital Anxiety and Depression Scale (HADS) and Social Functioning (SF-36) Quality of life, semi-structured clinical interview for psychiatric disorders and phantom limb at baseline (in hospital), at 2 weeks, 3 months and 6 months, respectively after discharge. Holistic care was provided through psychological counselling, supportive sessions, medications if required, rehabilitation counselling, prosthesis implantation, and treatment as usual. Results Holistic care resulted in a statistically significant reduction in anxiety, depression and overall psychiatric morbidity as measured on HADS (p < 0.001). There was a significant improvement in all the domains of SF-36 (p -< 0.001) except the role of limitation due to physical activity. The intervention also resulted in a statistically significant reduction in the presence of phantom limbs. Conclusion Amputees should be provided holistic care under one roof, which was found to be very useful in treating psychiatric morbidity, social functioning and quality of life.
Collapse
Affiliation(s)
| | - Shubhankar Bu
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | | | | | - Aseem Mehra
- Department of Psychiatry, PGIMER, Chandigarh, India
| |
Collapse
|
3
|
Kumar A, Goyal E, Singh VP, Chaudhury S, Puria A. Psychiatric morbidity in individuals with permanent orthopedic disability. Ind Psychiatry J 2021; 30:S97-S102. [PMID: 34908673 PMCID: PMC8611563 DOI: 10.4103/0972-6748.328796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/02/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Individuals with permanent orthopedic disability present with a number of physical and mental health issues. Psychiatric illnesses have been seen more frequently among people with disabilities as compared to normal population. AIM To study psychiatric morbidity among people with permanent orthopedic disability. MATERIALS AND METHODS This cross-sectional, observational, hospital-based study was conducted at the department of psychiatry of a tertiary care hospital attached to a medical college during January 01, 2018, to December 31, 2018. The study included subjects over the age of 18 years comprising two groups: Group A (n = 50) including consecutive subjects with orthopedic disability and Group B (n = 50) including normal age- and sex-matched controls. Permission was obtained from the institutional ethics committee before the start of the study. Prior informed consent was obtained from all subjects. Sociodemographic variables were recorded, and psychiatric morbidity was screened on Mini International Neuropsychiatric Interview. RESULTS 62% (n = 31) of subjects in Group A had psychiatric morbidity as compared to Group B (22%, n = 11). Maximum psychiatric morbidity noted among subjects with disability was generalized anxiety disorder (22%, n = 11), followed by major depressive disorder (20%, n = 10) and alcohol dependence (18%, n = 9). Substance dependence was more in Group A (34%, n = 17) as compared to Group B (18%, n = 9). The most common substance dependence was for alcohol (18%, n = 9), followed by opioids (8%, n = 4) and tobacco (6%, n = 3). CONCLUSION Psychiatric morbidity including substance dependence is more common among people with orthopedic disability as compared to normal control subjects.
Collapse
Affiliation(s)
- Ajay Kumar
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | - Ekram Goyal
- Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India
| | | | - Suprakash Chaudhury
- Department of Psychiatry Dr D Y Patil Medical College, Pune, Maharashtra, India
| | - Alka Puria
- Department of Biochemistry, DMCH, Darbhanga, Bihar, India
| |
Collapse
|
4
|
Shue S, Wu-Fienberg Y, Chepla KJ. Psychiatric Disease after Isolated Traumatic Upper Extremity Amputation. J Hand Microsurg 2020; 13:75-80. [PMID: 33867765 PMCID: PMC8041502 DOI: 10.1055/s-0040-1701156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction
Psychiatric disease after traumatic limb loss impacts rehabilitation, prosthesis use, and quality of life. The purpose of this study was to evaluate the prevalence of psychiatric disease in civilians after isolated, traumatic upper extremity amputation and determine if any risk factors are associated with developing psychiatric disease.
Materials and Methods
Demographics, time since injury, mechanism of injury, amputation level, hand affected (dominant vs. nondominant), Bureau of Workers’ Compensation (BWC) status, and prosthesis use were retrospectively reviewed for all patients treated from 2012 to 2017. For patients with an International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) diagnosed psychiatric disease, the diagnosis and length of treatment were recorded. Patients were grouped by presence or absence of psychiatric diagnosis and data analysis was performed using descriptive statistics, Fisher’s exact test, and relative risk.
Results
Forty-six patients met the inclusion criteria. Thirty-one patients (67.4%) had at least one diagnosed psychiatric condition. Major depressive disorder was the most common (
n
= 14), followed by posttraumatic stress disorder (
n
= 11), adjustment disorder (
n
= 11), anxiety (
n
= 6), and panic disorder (
n
= 2). No statistically significant correlation was seen between psychiatric illness and gender, age at the time of injury, time since injury, current employment status, BWC status, hand injured (dominant vs. nondominant), prosthetic use, or level of amputation.
Conclusion
The rates of depression and anxiety after traumatic upper limb loss in the civilian population are similar to reported rates after combat injury. While we were unable to identify a statistically significant association with any of the studied variables, upper extremity surgeons should be aware of the high prevalence of psychiatric disease after traumatic upper extremity amputation.
Collapse
Affiliation(s)
- Shirley Shue
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Yuewei Wu-Fienberg
- Division of Plastic Surgery, MetroHealth Medical Center, Cleveland, Ohio, United States
| | - Kyle J Chepla
- Division of Plastic Surgery, MetroHealth Medical Center, Cleveland, Ohio, United States
| |
Collapse
|
5
|
Tsoulou V, Karamolegou E, Kourakos M, Vasilopoulos G, Polikandrioti M. Association of State and Trait Anxiety Between Patients Who Had Undergone Traumatic Amputation and Their Family Caregivers. INT J LOW EXTR WOUND 2019; 18:176-185. [PMID: 31096796 DOI: 10.1177/1534734619848580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this research was to explore the association between state and trait anxiety experienced by patients who had undergone traumatic amputation and their family caregivers. The sample studied consisted of 50 hospitalized patients who had undergone traumatic amputation and 50 family caregivers. The collected data included patients' and caregivers' characteristics and the State Trait Anxiety Inventory scores. Fifty percent of patients and caregivers scored below 50 and 47, respectively (median), in trait anxiety. In terms of state anxiety, at least 50% of patients and caregivers scored below 56 and 50.5, respectively. These values indicate moderate to high levels of the impact of amputation on the trait and state anxiety of amputees and their caregivers. A positive linear correlation was found between the trait and state anxiety of the patients as well as between the trait and state anxiety of caregivers, as expected (ρ = 0.915, P < .001, and ρ = 0.920, P < .001, respectively). A statistically significant positive correlation was also observed between state patient anxiety and state anxiety of caregivers (ρ = 0.239 and P = .039) and between trait patient anxiety and trait anxiety of caregivers (ρ = 0.322 and P = .030). More specifically, as the patient's anxiety score (either trait temporary) increases, the score of the caregivers' anxiety increases and vice versa. Nurses should be aware of the association between anxiety of amputees and caregivers and, therefore, work in multidisciplinary teams to maximize clinical outcomes for patients after amputation and their families.
Collapse
|
6
|
Abstract
BACKGROUND The sudden jolt of becoming an amputee brings with it the realization of loss of independence and self-built psychological and physical security. Advances in the field of prosthesis give the individual hope for better future, but the presence of psychological morbidity is a hurdle to be crossed in the road to satisfactory rehabilitation. AIM This study aimed to assess the psychiatric morbidity in amputees and the response to treatment. MATERIALS AND METHODS One hundred newly amputated soldiers were assessed by means of clinical interview, General Health Questionnaire, Impact of Event Scale, Hospital Anxiety Depression Scale, McGill Pain Questionnaire, and Dallas Pain Questionnaire. Individuals were treated with appropriate medications and psychotherapy, and response to treatment was assessed. RESULTS Psychiatric disorders were diagnosed in 66% including adjustment disorders (40%), depressive episode (20%), and posttraumatic stress disorder (6%). Phantom sensation and phantom pain were noted in 72% and 64% of participants, respectively. More psychiatric disorders and phantom sensation were found in the early months after amputation. Psychiatric morbidity was associated with negative body image, distressing pain, and restriction of activities of daily life. Treatment produced complete remission of symptoms in 65.15% of individuals suffering from psychiatric disorders and statistically significant reduction in the scores of psychiatric rating scales. CONCLUSIONS There is a high prevalence of psychiatric morbidity among amputees. Psychiatric treatment produces significant improvement in the psychological well-being of amputees and underlines the need to focus on the psychological rehabilitations of the amputee apart from physical rehabilitation.
Collapse
Affiliation(s)
- Sojan Baby
- Department of Psychiatry, Command Hospital (Southern Command) and AFMC, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D.Y. Patil Medical College, Hospital and Research Center, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Tejvir Singh Walia
- Department of Psychiatry, Military Hospital, Jhansi, Uttar Pradesh, India
| |
Collapse
|
7
|
Abstract
This article presents findings of two studies that investigated coping with physical disability within the multivariate transactional model of stress. In the first study, 30 persons with locomotor disability were interviewed to explore the nature of stressors and coping strategies. In the second study, five scales were administered on a sample of 120 persons with locomotor disability to investigate the role of personal and situational variables in determining the extent of perceived distress and its relationship with coping. The manner in which anāsakti and positive life orientation moderated the relationship between perceived distress and coping was also investigated. The findings revealed that the major stressors which led to distress were ego-related stressors, inability to fulfil traditional gender roles, problems in interpersonal relationships with family and others, physical barriers and deformed body image. Education was found to be the strongest predictor of perceived distress and problem-focused coping was significantly related to lower levels of distress. Moderation analyses showed that with stronger belief in the philosophy of anāsakti and higher positive life orientation, lower levels of distress were strongly related to problem focused coping. The impli-cations of these findings for psycho-social rehabilitation of persons with physical disability are discussed.
Collapse
|
8
|
Abstract
Amputation is a major health burden on the families, society, and on medical services as well. Traumatic limb amputation is a catastrophic injury and an irreversible act which is sudden and emotionally devastating for the victims. In addition, it causes inability to support self and the family and driving many patients toward various psychiatric disorders. Extensive information regarding the effects of amputation has not been ascertained and therefore it was decided to do a systematic review. The goal of this review was to provide comprehensive information of peer-reviewed papers examining the psychological distress among amputees in India. A search of the literature resulted in a total of 12 articles with varied sample size from 16 to 190. The sample has been largely comprised males with lower limb amputation caused by primarily traumatic ones, i.e., motor vehicle accident, railway track accidents, machinery injury, blasts, etc., The prevalence of psychiatric disorders among amputees has been found to be in the range of 32% to 84% including depression rates 10.4%-63%, posttraumatic stress disorder 3.3%-56.3%, and phantom limb phenomenon 14%-92%. Although the studies reported that symptoms of anxiety and depression become better over the course of time, however surgical treatment providers need to liaise with psychiatrists and psychologists to support and deal with the psychological disturbances.
Collapse
Affiliation(s)
- Anamika Sahu
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Srivastava K, Chaudhury S. Rehabilitation after amputation: psychotherapeutic intervention module in Indian scenario. ScientificWorldJournal 2014; 2014:469385. [PMID: 24526895 DOI: 10.1155/2014/469385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/29/2013] [Indexed: 11/18/2022] Open
Abstract
Psychological aspects of adjustment to amputation are varied and not addressed in the present treatment regime. There is no research evidence available of psychological intervention and outcome in Indian scenario. One hundred and seventy-three consecutive patients with limb amputations were randomly assigned to psychotherapeutic intervention module (PIM, study group) (n = 90) and treatment as usual group (TAU, control group) (n = 83). Patients with psychotic disorder were excluded from the study. Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Amputees Body Image Scale (ABIS), and Impact of Event Scale (IES) along with specially designed information schedule were administered individually. Structured psychotherapeutic module was developed for the intervention. Patients in PIM group were given six therapy sessions, addressing the specific areas of concern. All patients were evaluated on the same tools after two months of therapy. Analysis showed that after treatment a significant reduction in scores was noted on CRSD, STAI, ABIS, and IES in the PIM group. On the TAU group a significant reduction was seen only in the ABIS. The psychological intervention module proposed by authors was efficacious in alleviating the psychological distress, depression, and anxiety and thus was vastly superior to the conventional method of management of amputees.
Collapse
|