Depression Often Follows Dysvascular Amputation
January 11, 2019
Individuals undergoing lower-limb amputations secondary to dysvascular disease were found to have depressive symptoms during the first year after the procedure, according to a study published online December 31, 2018, in the Archives of Physical Medicine and Rehabilitation.
Patients were surveyed four times (perioperative period and six weeks, four months, and 12 months post-amputation) at four U.S. Department of Veterans Affairs (VA) medical centers, a university hospital, and a Level I trauma center. Multilevel modeling was used to describe and predict trajectories, and patients completed a health questionnaire.
A total of 141 participants (74 percent retention) were a consecutive sample, and eligible if they were undergoing their first unilateral amputation secondary to dysvascular disease. Roughly 40 percent of participants affirmed at least moderate depressive symptoms at perioperative baseline, the study found. Individuals with greater depressive symptoms in the perioperative period concurrently reported greater pain, poorer self-rated health, and prior mental health treatment. In the first six weeks after amputation there was a substantial improvement in depressive symptoms, especially among individuals with greater symptoms at baseline. Depressive symptoms were generally stable after six weeks, the study found. None of the covariates assessed significantly predicted trajectories of depressive symptom improvement.
As a result, researchers found that watchful waiting may be the most appropriate course of action for many patients in the first six weeks after amputation. After six weeks, however, symptom levels tend to stabilize, suggesting that active intervention is called for if patients continue to remain depressed. Some patients may benefit from more proactive intervention, such as those with prior mental health treatment histories, the study found.