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A Prospective Longitudinal Study of Trajectories of Depressive Symptoms After Dysvascular Amputation

Published:December 31, 2018DOI:https://doi.org/10.1016/j.apmr.2018.11.024

      Abstract

      Objectives

      Characterize the course of depressive symptoms during the first year after dysvascular amputation and identify factors that predict symptom trajectories.

      Design

      Prospective cohort study of individuals undergoing lower extremity amputation (LEA), surveyed at 4 time points (perioperative period, 6 weeks, 4 months, and 12 months postamputation). Multilevel modeling was used to describe and predict trajectories.

      Setting

      Four Veterans Affairs medical centers, a university hospital, and a level I trauma center.

      Participants

      Participants (N=141; 74% retention) were a consecutive sample, eligible if they were undergoing their first unilateral LEA secondary to dysvascular disease.

      Interventions

      Not applicable.

      Main Outcome Measure

      Patient Health Questionnaire-9.

      Results

      Approximately 40% of participants endorsed at least moderate depressive symptoms at perioperative baseline. 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 6 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 6 weeks. None of the covariates assessed significantly predicted trajectories of depressive symptom improvement.

      Conclusions

      Watchful waiting may be the most appropriate course of action for many patients in the first 6 weeks after amputation. After 6 weeks, however, symptom levels tend to stabilize, suggesting that active intervention is called for if patients remain depressed at this point. Some patients may benefit from more proactive intervention, such as those with prior mental health treatment histories.

      Keywords

      List of abbreviations:

      AIC (Akaike information criterion), BIC (Bayesian information criterion), DM (diabetes mellitus), LEA (lower extremity amputation), PAD (peripheral arterial disease), PHQ-9 (Patient Health Questionnaire-9), SPMSQ (Short Portable Mental Status Questionnaire), SRH (self-rated health)
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