Anxiety and depression following traumatic limb amputation: a systematic review.

BACKGROUND Traumatic amputation can result in multiple physical, psychological and socio-economic sequalae. While there has been a significant increase in investment and public profile of the rehabilitation of patients who have experienced traumatic limb amputation, little is known about the prevalence of anxiety and depression, especially in the long term. OBJECTIVE To determine the association between traumatic limb amputation and anxiety and depression. DATA SOURCES A literature search of available databases including Cochrane, Medline, Embase, and PsycINFO was performed for relevant studies since 2002. Secondary outcomes included the effect on employment, substance misuse, relationships and quality of life. SELECTION CRITERIA Randomised control trials, observational studies or reviews which met the inclusion, exclusion and quality criteria. RESULTS Levels of anxiety and depression are significantly higher than in the general population. Significant heterogeneity exists between studies making meta-analyses inappropriate. Improved rehabilitation is having a positive effect on employment rates. There appears to be no significant effect on substance abuse and relationships. CONCLUSIONS All studies demonstrated high prevalence of anxiety and depression in post-traumatic amputees. No good prospective data exists for levels of anxiety and depression beyond two years of follow up and this should be an area of future study.

[1]  C. Scoville,et al.  Amputation Is Not Isolated: An Overview of the US Army Amputee Patient Care Program and Associated Amputee Injuries , 2006, The Journal of the American Academy of Orthopaedic Surgeons.

[2]  Malcolm MacLachlan,et al.  Affective distress and amputation-related pain among older men with long-term, traumatic limb amputations. , 2006, Journal of pain and symptom management.

[3]  N. Tai,et al.  Factors affecting outcome after traumatic limb amputation , 2012, The British journal of surgery.

[4]  P. Burdett-Smith,et al.  Improvements in trauma survival in Leeds. , 1995, Injury.

[5]  P. Dougherty.  Transtibial Amputees from the Vietnam War: Twenty-eight-Year Follow-up , 2001, The Journal of bone and joint surgery. American volume.

[6]  E J MacKenzie,et al.  Rehabilitation and the long-term outcomes of persons with trauma-related amputations. , 2000, Archives of physical medicine and rehabilitation.

[7]  G. Reiber,et al.  Prosthetic history, prosthetic charges, and functional outcome of the isolated, traumatic below-knee amputee. , 1995, The Journal of trauma.

[8]  D. Desmond,et al.  Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations. , 2007, Journal of psychosomatic research.

[9]  A. Norton,et al.  Marriage, Divorce, and Remarriage in the 1990s. , 1992 .

[10]  L. Radloff.  The CES-D Scale , 1977 .

[11]  M. Galarneau,et al.  Short-Term Physical and Mental Health Outcomes for Combat Amputee and Nonamputee Extremity Injury Patients , 2013, Journal of orthopaedic trauma.

[12]  M. Galarneau,et al.  Midterm health and personnel outcomes of recent combat amputees. , 2010, Military medicine.

[13]  Charles Maynard,et al.  Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: survey methods, participants, and summary findings. , 2010, Journal of rehabilitation research and development.

[14]  Matthew D. Bramlett,et al.  Cohabitation, marriage, divorce, and remarriage in the United States. , 2002, Vital and health statistics. Series 23, Data from the National Survey of Family Growth.

[15]  S. Wessely,et al.  The mental health of the UK Armed Forces in the 21st century: resilience in the face of adversity , 2014, Journal of the Royal Army Medical Corps.

[16]  S. Rauch,et al.  Psychiatric and emotional sequelae of surgical amputation. , 2006, Psychosomatics.

[17]  PW01-124 - Prevalence Of Psychiatric Co Morbidities In Traumatic Amputees-A Cross Sectional Study From Kashmir (Indian Part) , 2010, European Psychiatry.

[18]  N. Breslau.  The epidemiology of posttraumatic stress disorder: what is the extent of the problem? , 2001, The Journal of clinical psychiatry.

[19]  P. Dougherty,et al.  Long-term follow-up of unilateral transfemoral amputees from the Vietnam war. , 2003, The Journal of trauma.

[20]  O. Horgan,et al.  Psychosocial adjustment to lower-limb amputation: A review , 2004, Disability and rehabilitation.

[21]  A. Ateşalp,et al.  Depression in men with traumatic lower part amputation: a comparison to men with surgical lower part amputation. , 2003, Military medicine.

[22]  B. Pentland,et al.  Depression and anxiety symptoms after lower limb amputation: the rise and fall , 2009, Clinical rehabilitation.

[23]  C. van der Werken,et al.  Grade III open tibial fractures: functional outcome and quality of life in amputees versus patients with successful reconstruction. , 2001, Injury.

[24]  Beth D Darnall,et al.  Depressive symptoms and mental health service utilization among persons with limb loss: results of a national survey. , 2005, Archives of physical medicine and rehabilitation.

[25]  Z. Hawamdeh,et al.  Assessment of anxiety and depression after lower limb amputation in Jordanian patients , 2008, Neuropsychiatric disease and treatment.

[26]  D. Trunkey.  Guidelines for Essential Trauma Care , 2005, World Journal of Surgery.

[27]  C. Crombie,et al.  Normative data for the HADS from a large non-clinical sample. , 2001, The British journal of clinical psychology.

[28]  R. Larson,et al.  Risk for increased utilization and adverse health outcomes among men served by the Veterans Health Administration. , 2007, Military medicine.